Klaus Scheuch

The trigonometric regressive spectral analysis—a method for mapping of beat-to-beat recorded cardiovascular parameters on to frequency domain in comparison with Fourier transformation

Heart rate and peripheral blood pressure as physiological recorded vegetative parameters are very often rhythmically investigated with the Fourier Transformation (FT). In contrast to the original use of FT these parameters are still stochastic with overlaying rhythmical structures. The R-R intervals as independent variables of time are not equidistant. The mathematical structure for the spectral decomposition is critically analysed. The purpose of this article is the presentation of a mathematical method, considering both the statistical and rhythmical features of such time series. On the basis of trigonometric regressions, this method is presented to eliminate the equidistance problems, arising with the usage of FT, by a new mathematical approach. This method computes more precisely the spectral power especially in the VLF range (0.003-0.04 Hz) than FT, because this method of trigonometric regression does not perform a frequency quantization. This method has been used and successfully tested for the analysis of peripheral blood pressure and R-R intervals including an effective reduction of input data.

Effects of different stress settings on cardiovascular parameters and their relationship to daily life blood pressure in normotensives, borderline hypertensives and hypertensives

The aim of this study was to compare a traditional stress setting, consisting of two mental arithmetic tasks and two Stroop test modifications, and a stress setting of varying task demand and decision latitude according to Karaseks job strain model, with respect to their feasibility to elicit differences in cardiovascular reactivity and recovery in 20 normotensives, 20 borderline hypertensives, and 20 non-medicated hypertensives, carefully selected by means of World Health Organization criteria. In addition, the relationship between laboratory and everyday blood pressure was investigated. All subjects were tested under both stress settings in counterbalanced order. Blood pressure was recorded both intermittently from the brachial artery (Riva-Rocci) and continuously from the finger (Finapres). Heart rate and electrodermal activity were continuously measured as well. Furthermore, daily life blood pressure recorded by means of 24 h ambulatory monitoring during a normal working day served as criterion for the re-classification of the blood pressure groups by means of discriminant analysis using physiological recordings from baseline, test phases and rest phases. The groups did not show significant differences in their reactivity to the various mental stressors including the Karasek-model oriented ones but marked differences in their behaviour occurred during the 10 min of recovery following each stress setting. Both systolic and diastolic blood pressure in hypertensives failed to recover during this period. The results also showed the superiority of the Finapres method with respect to reflecting the dynamics of physiological recovery processes. None of the stress settings showed an advantage in predicting blood pressure in daily life. In general, the results question the validity of mental laboratory stressors for the prediction of cardiovascular changes in daily life but point to a possible role of recovery processes after stress in the development of essential hypertension.

Effort-Reward Imbalance and Mental Health Problems in 1074 German Teachers, Compared with Those in the General Population.

High degrees of premature retirement among teachers warrant investigating the occupational burden and the mental health status of this profession. A sample of 1074 German teachers participated in this study. Two samples of the general population (N = 824 and N = 792) were used as comparison groups. Work distress was assessed with the Effort-Reward-Imbalance questionnaire, and mental health problems were measured with the General Health Questionnaire (GHQ-12). Teachers reported more effort-reward imbalance (M = 0.64) compared with the general population (M = 0.57), and they perceived more mental health problems (GHQ: M = 12.1) than the comparison group (M = 9.5). School type was not associated with work stress and mental health. Teachers with leading functions perceived high degrees of effort and reward, resulting in a moderate effort-reward ratio and no heightened mental health problems. Teachers working full time reported more effort than teachers working part time, but the reward mean values of both groups were similar. This results in a somewhat unfavourable effort-reward ratio of teachers working full time. Moreover, teachers working full time reported more mental health problems. The results support the appropriateness of the effort-reward conception, applied to the profession of teachers. The higher degree of effort-reward imbalance and the level of mental health problems warrant preventive measures. Copyright

Predictors of mental health in female teachers

ObjectiveTeaching profession is characterised by an above-average rate of psychosomatic and mental health impairment due to work-related stress. The aim of the study was to identify predictors of mental health in female teachers.Material and MethodsA sample of 630 female teachers (average age 47±7 years) participated in a screening diagnostic inventory. Mental health was surveyed with the General Health Questionnaire GHQ-12. The following parameters were measured: specific work conditions (teacher-specific occupational history), scales of the Effort-Reward-Imbalance (ERI) Questionnaire as well as cardiovascular risk factors, physical complaints (BFB) and personal factors such as inability to recover (FABA), sense of coherence (SOC) and health behaviour.ResultsFirst, mentally fit (MH+) and mentally impaired teachers (MH−) were differentiated based on the GHQ-12 sum score (MH+: < 5; MH−: ≥ 5); 18% of the teachers showed evidence of mental impairment. There were no differences concerning work-related and cardiovascular risk factors as well as health behaviour between MH+ and MH−. Binary logistic regressions identified 4 predictors that showed a significant effect on mental health. The effort-reward-ratio proved to be the most relevant predictor, while physical complaints as well as inability to recover and sense of coherence were identified as advanced predictors (explanation of variance: 23%).ConclusionContrary to the expectations, classic work-related factors can hardly contribute to the explanation of mental health. Additionally, cardiovascular risk factors and health behaviour have no relevant influence. However, effort-reward-ratio, physical complaints and personal factors are of considerable influence on mental health in teachers. These relevant predictors should become a part of preventive arrangements for the conservation of teachers’ health in the future.

Cardiovascular reactivity of different mental stress models in normotensives, borderline hypertensives and hypertensives

The present study compared simulated job-strain-conditions according to Karasek, in which psychological demand and decision latitude are independently varied (model I), with traditional concentration and short-term memory tasks (model II), with respect to their feasibility to differentiate cardiovascular reactivity in various blood pressure groups. Twenty normotensives, 20 borderline hypertensives and 20 untreated hypertensives (20–45 years) were investigated under both models in counterbalanced order. Each model consisted of a baseline, four mental tests separated by rest phases and a final recovery period. Blood pressure (BP) was recorded both intermittently from the brachial artery (Riva-Rocci) and continuously from the finger (Penaz principle). Heart rate was also continuously recorded. The results show that model I evokes lower cardiovascular strain compared to model II, and that the expected cardiovascular effects can only be demonstrated for the peripheral BP in borderline hypertensives and hypertensives. Peripheral BP increases during the test phases of model I but decreases in model II. Cardiovascular reactivity does not significantly differ between the blood pressure groups. However, hypertensives show a significantly slower recovery in peripheral BP. With a reclassification rate of 70 percent over all conditions, the Karasek model does not give a more reliable discrimination of the blood pressure groups than model II. The usability of mental stress tests for identifying hypertension prone subjects is critically discussed.

Covariation and Temporal Stability of Peripheral and Brachial Blood Pressure Responses to Mental and Static Stress

Abstract Peripheral blood pressure measurement (Finapres technique) is a promising development in activation research. This paper tests and compares the temporal stability and covariation of peripheral and brachial blood pressure responses. Forty healthy subjects were tested four times at intervals of 1 day, 1 week, and 1 month. The tasks employed were two mental tasks (mental arithmetic and a Color Word Test) and a static (fingergrip) task. Recorded physiological parameters were peripheral and brachial systolic (SBP) and diastolic blood pressure (DBP). Mean peripheral SBP was about 20 mmHg higher than brachial SBP, but the difference between the DBP measures was negligible. Correlations between peripheral and corresponding brachial BP resting levels were low, with coefficients below 0.30. The correlations between peripheral and brachial SBP and DBP were higher for reactivity (change) scores (0.46-0.82) than for resting scores. Several types of inter- and intraindividual covariation were calculated to pro...

Oral health-related quality of life and oral status in a German working population.

The study aim was to identify predictors of impaired oral health-related quality of life (OHRQoL). Employees of five companies were offered a clinical full-mouth examination. Oral health-related quality of life was measured with the German version of the Oral Health Impact Profile (OHIP) and summarized as additive scores (OHIP-ADD) and as prevalence of negative impacts (OHIP-SC). Two logistic regression models were developed for the odds of increased scores of the target variables OHIP-ADD and OHIP-SC. The target variables were dichotomized, and for the OHIP-ADD, the cut-off point for having impaired OHRQoL was heuristically defined as OHIP-ADD > 34. For the OHIP-SC, the corresponding threshold was OHIP-SC > 0. In the model for the OHIP-ADD, female gender, impaired aesthetics, few posterior occluding pairs, and painful masticatory muscles proved to be significant independent variables. For the OHIP-SC, female gender, impaired aesthetics, painful masticatory muscles, joint sounds, missing mandibular teeth, and carious teeth were significant. This cross-sectional study showed that within the models for both OHIP-ADD and OHIP-SC the high-risk person for impaired OHRQoL is a woman with impaired aesthetics and painful masticatory muscles.

Peripheral and brachial blood pressure during standardized occupation-related tests in normotensive and mild hypertensive men and women

Abstract We investigated the usefulness of peripheral blood pressure (BP) measurement in the assessment of strain in occupational physiology. Our hypothesis was that the brachial and peripheral BP reflect physiologically different events under various occupation-related demands in normotensive (NT) and hypertensive (HT) people. A group of 20 female and 20 male subjects with unmedicated mild hypertension that had been diagnosed by ambulatory blood pressure monitoring [awake time systolic/diastolic BP (BPs/BPd) 142.9 (SD 11.3)/86.4 (SD 6.2) mmHg] and 40 NT matched by age and sex [BPs/BPd 120.0 (SD 9.8)/75.6 (SD 5.9) mmHg] attended a laboratory session to undertake mental arithmetic tasks, a fingergrip test and submaximal cycle ergometry. Brachial and peripheral BP as well as heart rate were measured using a sphygmomanometer and an continuously automatic blood pressure measuring device on the finger, respectively. The peripheral BPs was higher than brachial BPs, BPd was similar for peripheral and brachial BP except during cycle ergometry. Associations between the levels of brachial and peripheral BP depended on demands and did not explain more than 42% of the common variance. The highest correlations between the two BP methods were observed during habituation, recovery and mental demands, and weak correlations during cycle ergometry. For peripheral BPs and BPd we found significant correlations in all phases of the test (r=0.58 to 0.86, P < 0.001), also in ergometry (NT r=0.62, P < 0.001, HT r=0.53, P < 0.001), in contrast to the brachial BP. Peripheral BP differentiated the two BP groups (57.5%–72.5% correctly classified) which had been grouped by daily measurement of brachial BP, but brachial BP was superior in this respect with 65.0%–87.5% being correctly classified. These results supported the suggestion that the combined measurement of peripheral and brachial BP provides complementary information regarding physiological changes in NT and HT in different situations.

[Prevention in occupational health care--a societal challenge].

The metabolic syndrome, increasingly appearing amongst the elderly and recently in younger people with a most sudden increase in the age group < 30 years, is one of the main threats to European health in this century. Early diagnosis is the most efficient way to manage and to prevent metabolic syndrome from developing. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, reduced the risk of developing diabetes and metabolic syndrome. The challenges today are to develop and implement efficient strategies to identify those on risk and to implement prevention management programs for clinical practice. Company medical officers could play an important role while identifying persons with increased risk for the metabolic syndrome, because they are addressing patients and healthy working persons but also reaching persons who normally are not reached by the health-care system. The occupational medical health promotion has the structural requirement to implement preventive intervention also by using its influence to establish healthy workplaces. Implementing managed prevention programs in the occupational medical care setting will enable prevention of the metabolic syndrome without consuming large resources. This process will be challenging and must be sustainable requiring many partners but resulting in a profitable chance for occupational health care.ZusammenfassungDie Zunahme von Patienten mit einem metabolischen Syndrom, vorwiegend in einer Altersklientel > 40 Jahre mit einer Verschiebung zu einem immer jüngeren Manifestationsalter, entwickelt sich zu einem schwerwiegenden medizinischen, sozialen und ökonomischen Problem. Die frühzeitige Diagnose weist einen wirksamen Weg zur primären Prävention. Die Ergebnisse großer internationaler Studien belegen, dass die Prävention des Typ-2-Diabetes und metabolischen Syndroms bei Risikopersonen mit einer Lebensstilintervention möglich und effektiv durchführbar ist. Voraussetzungen dafür sind die frühzeitige Erkennung von Risikoträgern und das Vorhandensein strukturierter qualitätskontrollierter Programme zur Primärprävention.Bei der frühzeitigen Erkennung chronischer Erkrankungen nehmen Betriebsärzte eine Schlüsselposition ein, da sie nicht nur für Patienten, sondern überwiegend für Gesunde tätig sind und auch Zugang zu Personen haben, die sich einer medizinischen Versorgung eher entziehen. Die Betriebsmedizin verfügt auch über die dafür notwendigen strukturellen Voraussetzungen und kann für die gesundheitsfördernde Gestaltung der Arbeitsplätze sorgen sowie eine komplexe und adäquate Intervention ermöglichen.Die Implementierung von strukturierten Präventionsmanagementprogrammen im betriebsärztlichen Setting ist eine gute Möglichkeit zur Realisierung der Prävention von Typ-2-Diabetes und kardiovaskulären Erkrankungen durch Früherkennung eines metabolischen Syndroms, ohne das Gesundheitsbudget stark zu belasten. Die Herausforderung bedarf der aktiven Zusammenarbeit vieler Partner und ist nur langfristig erfolgreich umzusetzen, bedeutet aber ein lohnendes Investment für Risikopersonen, die klinische und wissenschaftliche Diabetologie und das betriebliche Gesundheitswesen in Deutschland.AbstractThe metabolic syndrome, increasingly appearing amongst the elderly and recently in younger people with a most sudden increase in the age group < 30 years, is one of the main threats to European health in this century. Early diagnosis is the most efficient way to manage and to prevent metabolic syndrome from developing. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, reduced the risk of developing diabetes and metabolic syndrome. The challenges today are to develop and implement efficient strategies to identify those on risk and to implement prevention management programs for clinical practice.Company medical officers could play an important role while identifying persons with increased risk for the metabolic syndrome, because they are addressing patients and healthy working persons but also reaching persons who normally are not reached by the health-care system. The occupational medical health promotion has the structural requirement to implement preventive intervention also by using its influence to establish healthy workplaces.Implementing managed prevention programs in the occupational medical care setting will enable prevention of the metabolic syndrome without consuming large resources. This process will be challenging and must be sustainable requiring many partners but resulting in a profitable chance for occupational health care.

Prävention im betrieblichen Setting – eine gesellschaftliche Aufgabe

The metabolic syndrome, increasingly appearing amongst the elderly and recently in younger people with a most sudden increase in the age group < 30 years, is one of the main threats to European health in this century. Early diagnosis is the most efficient way to manage and to prevent metabolic syndrome from developing. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, reduced the risk of developing diabetes and metabolic syndrome. The challenges today are to develop and implement efficient strategies to identify those on risk and to implement prevention management programs for clinical practice. Company medical officers could play an important role while identifying persons with increased risk for the metabolic syndrome, because they are addressing patients and healthy working persons but also reaching persons who normally are not reached by the health-care system. The occupational medical health promotion has the structural requirement to implement preventive intervention also by using its influence to establish healthy workplaces. Implementing managed prevention programs in the occupational medical care setting will enable prevention of the metabolic syndrome without consuming large resources. This process will be challenging and must be sustainable requiring many partners but resulting in a profitable chance for occupational health care.ZusammenfassungDie Zunahme von Patienten mit einem metabolischen Syndrom, vorwiegend in einer Altersklientel > 40 Jahre mit einer Verschiebung zu einem immer jüngeren Manifestationsalter, entwickelt sich zu einem schwerwiegenden medizinischen, sozialen und ökonomischen Problem. Die frühzeitige Diagnose weist einen wirksamen Weg zur primären Prävention. Die Ergebnisse großer internationaler Studien belegen, dass die Prävention des Typ-2-Diabetes und metabolischen Syndroms bei Risikopersonen mit einer Lebensstilintervention möglich und effektiv durchführbar ist. Voraussetzungen dafür sind die frühzeitige Erkennung von Risikoträgern und das Vorhandensein strukturierter qualitätskontrollierter Programme zur Primärprävention.Bei der frühzeitigen Erkennung chronischer Erkrankungen nehmen Betriebsärzte eine Schlüsselposition ein, da sie nicht nur für Patienten, sondern überwiegend für Gesunde tätig sind und auch Zugang zu Personen haben, die sich einer medizinischen Versorgung eher entziehen. Die Betriebsmedizin verfügt auch über die dafür notwendigen strukturellen Voraussetzungen und kann für die gesundheitsfördernde Gestaltung der Arbeitsplätze sorgen sowie eine komplexe und adäquate Intervention ermöglichen.Die Implementierung von strukturierten Präventionsmanagementprogrammen im betriebsärztlichen Setting ist eine gute Möglichkeit zur Realisierung der Prävention von Typ-2-Diabetes und kardiovaskulären Erkrankungen durch Früherkennung eines metabolischen Syndroms, ohne das Gesundheitsbudget stark zu belasten. Die Herausforderung bedarf der aktiven Zusammenarbeit vieler Partner und ist nur langfristig erfolgreich umzusetzen, bedeutet aber ein lohnendes Investment für Risikopersonen, die klinische und wissenschaftliche Diabetologie und das betriebliche Gesundheitswesen in Deutschland.AbstractThe metabolic syndrome, increasingly appearing amongst the elderly and recently in younger people with a most sudden increase in the age group < 30 years, is one of the main threats to European health in this century. Early diagnosis is the most efficient way to manage and to prevent metabolic syndrome from developing. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, reduced the risk of developing diabetes and metabolic syndrome. The challenges today are to develop and implement efficient strategies to identify those on risk and to implement prevention management programs for clinical practice.Company medical officers could play an important role while identifying persons with increased risk for the metabolic syndrome, because they are addressing patients and healthy working persons but also reaching persons who normally are not reached by the health-care system. The occupational medical health promotion has the structural requirement to implement preventive intervention also by using its influence to establish healthy workplaces.Implementing managed prevention programs in the occupational medical care setting will enable prevention of the metabolic syndrome without consuming large resources. This process will be challenging and must be sustainable requiring many partners but resulting in a profitable chance for occupational health care.