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Associations of vacation time with lifestyle, long-term mortality and health-related quality of life in old age: The Helsinki Businessmen Study
Abstract
Introduction
There are few longitudinal studies of relationships between vacation and later health outcomes. We studied these during a 26-year follow-up of the Helsinki Businessmen Study.
Methods
In 1974, at mean age of 47 years, 2741 members of a cohort of executives and businessmen born 1919–1934 were clinically examined and reported their annual vacation time (dichotomized >21 [n = 2001] vs. ≤21 days [n = 740]), self-rated health (SRH) and perceived physical fitness using a five-step scale. In old age in 2000 (mean age 73 years), the survivors filled in the RAND-36/SF-36 health-related quality of life (HRQoL) questionnaire. Mortality between 1974 and 2000 was retrieved from national registers.
Results
At baseline, shorter vacation was associated with longer work time, higher BMI, more coffee consumption and worse SRH. During the 26-year follow-up, 778 men out of 2741 (28.4%) had died. Shorter annual vacation was associated with higher mortality with curves starting to diverge after 18 years of follow-up, (fully adjusted hazard ratio 1.29, 95% confidence interval 1.08–1.55, P = 0.005). In old age, shorter vacation in midlife was tentatively associated with worse general health.
Conclusions
Shorter vacation time in midlife was associated with characteristics related to lifestyle and with worse perceived health status, and predicted mortality up to old age in men.
... The second branch consists of a handful of studies in the medical literature (Eaker et al. 1992;Gump and Matthews 2000;Chikani et al. 2005;Strandberg et al. 2017;Kim 2019). The four US-based studies focus on the extensive margin of whether taking any vacation in a certain year is related to health, whereas a Finnish study compares individuals who took more than 21 days to those who took less. ...
... Approximately 230,000-250,000 people or 5-6% of the Swedish working population were employed in the central government sector in the period 1997-2011(Statskontoret 2015). Note that employees in (wholly or partly) state-owned enterprises and foundations are not central government employees. ...
... Staff turnover has been fairly stable at least since 2006. About 10-13% of those employed in a certain year quit their job in the following year (including due to retirement)(Statskontoret 2015).Content courtesy of Springer Nature, terms of use apply. Rights reserved. ...
This study estimates the causal effect of paid vacation on health. Using register data on the universe of central government employees in Sweden, I exploit an age-based rule stipulated in the collective agreement covering these employees. I achieve identification by combining a regression discontinuity with a difference-in-differences design to control for time-invariant differences between consecutive birth cohorts and isolate the true effect at two separate discontinuities at ages 30 and 40. The main results indicate that an increase of three paid vacation days at age 30 and four days at age 40 do not cause significant changes in health, as proxied by visits to specialized outpatient care, inpatient admissions, and long-term sick leaves. These findings challenge the anecdotal view of additional paid vacation days as an adequate means to improve workers’ health.
... Vacations from work-broadly defined as periods of one or more scheduled weeks away from the workplace-provide employees with a potentially powerful recovery opportunity (Lounsbury & Hoopes, 1986). The importance of vacations has been supported by evidence indicating that taking fewer vacations during one's working life is associated over time with significantly elevated risk of serious illness and premature mortality (Gump & Matthews, 2000;Strandberg, von Bonsdorff, Strandberg, Pitkala, & Raikkonen, 2017). Given the considerable potential of vacations for revealing recovery from work processes, there are relatively few vacation studies in the occupational health psychology literature. ...
... recovery process. Taking brief and sufficiently regular vacations therefore shows good potential for ensuring that employees' shortterm fatigue and negative affective states do not accumulate over time into more chronic forms of impairment, such as burnout or depression (Strandberg et al., 2017;Westman et al., 2004). Recovery during midterm vacations may be particularly critical for maintaining the health and well-being of the teaching profession, which continues to report above average levels of psychological strain (Health & Safety Executive, 2019;Kühnel & Sonnentag, 2011). ...
This study examined week-level changes in affective well-being among school teachers as they transitioned into and out of a 1-week vacation. In addition, we investigated the interactive influence of personality characteristics (specifically perfectionism) and spillover work activities during the vacation on changes in teachers' well-being. A sample of 224 teachers completed study measures across 7 consecutive weeks, spanning the period before, during, and after a midterm vacation (providing a total of 1,525 responses across the study period). Results obtained from discontinuous multilevel growth models revealed evidence of a vacation effect, indicated by significant reductions in emotional exhaustion, anxiety, and depressed mood from before to during the vacation. Across 4 working weeks following the vacation, exhaustion and negative mood exhibited a nonlinear pattern of gradual convergence back to prevacation levels. Teachers with a higher level of perfectionistic concerns experienced elevated working week levels of exhaustion, anxious mood, and depressed mood, followed by pronounced reductions in anxious and depressed mood as they transitioned into the vacation. However, a strongly beneficial effect of the vacation was only obtained by perfectionistic teachers who refrained from spillover work tasks during the vacation. This pattern of findings is consistent with a diathesis-stress model, in that the perfectionists' vulnerability was relatively dormant (or deactivated) during a respite from job demands. Our results may provide an explanation for why engaging in work-related activities during vacations has previously exhibited weak relationships with employees' recovery and well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... For instance, one study showed that employed women who take fewer vacations have a higher 20-year incidence of myocardial infarction or coronary death, controlling for potentially confounding factors such as age, systolic blood pressure, body mass index, diabetes, smoking, education, and occupation (Eaker, Pinsky, & Castelli, 1992). Other studies have shown that people who take fewer vacations have increased mortality rates 9 years later (sample: middle aged-men; Gump & Matthews, 2000), 26 years later (sample: men in business jobs; Strandberg, von Bonsdorff, Strandberg, Pitkälä, & Räikkönen, 2017), and 40 years later (sample: men in business jobs; Strandberg et al., 2018). These effects hold even when controlling for potentially confounding factors such as income, health-related behaviors (e.g., smoking, alcohol use, and work hours), and baseline health indicators (e.g., cholesterol, blood pressure, body mass index). ...
... Finally, although research has shown that vacations are important for health and well-being (de Bloom et al., 2009;Gump & Matthews, 2000;Strandberg et al., 2017Strandberg et al., , 2018, little is currently known about how many vacation days are needed to derive benefits for health and well-being. This raises questions about whether not using all of one's vacation days is necessarily harmful for the health and well-being of people who have a large number of vacation days. ...
Despite the benefits of vacations for health and well-being, many employees do not use all of their paid vacation days. In this article, we seek to understand why this occurs. Using a social cognitive perspective, we propose that employees use fewer vacation days when they do not believe they can successfully detach from work while on vacation (i.e., have low detachment self-efficacy), do not expect positive outcomes (e.g., feeling relaxed, connecting with loved ones) from their vacations, and expect negative outcomes (e.g., feeling stressed, facing negative financial consequences) from their vacations. We test this explanation across four studies in which we develop and validate measures for our social cognitive constructs (Studies 1-3) and test whether these constructs predict employees' unused vacation days (Study 4). Results revealed that employees had more unused vacation days if they lacked detachment self-efficacy, did not expect to feel relaxed on vacation, and expected negative financial consequences of vacations. Overall, our results highlight the usefulness of social cognitive theory for understanding employees' unused vacation days. We discuss implications for theory, future research, and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Vacations also had a great help to maintain people's work ability, health and happiness levels (Jessica et al., 2012;Jessica and Geurts, 2014). Strandberg et al. (2017) showed that less vacation hours is a marker of higher mortality through analyzing of middle-aged men in long term. Kawakubo and Oguchi (2019) illustrated that recovery experiences during vacations promoted employee creativity and improved occupational well-being. ...
Background
Fatigue is an important factor for the safety of ships. In order to alleviate fatigue of the seafarers, the STCW Convention (International Convention on Standards of Training, Certification, and Watchkeeping for Seafarers) has made many regulations on the working time of seafarers. At present, if a crew member takes only one day off at home before returning to work on the ship, the working time on the ship must be re-calculated again. If the time spent at home is not sufficient to allow the crew to recover, the regulations of only stipulating the working time, not stipulating the home vacation time, cannot guarantee the crew’s fatigue been well controlled. The aim of present study is to explore the relationship between vacation schedule and fatigue of the seafarers.
Methods
In present study, a simplified stress scale developed by the Ministry of Labor of Japan has been used as a measurement tool. The method of stratified sampling was adopted. Data collection mainly came from domestic ocean-going seafarers (n = 165). Analysis was conducted using the Cross (chi-square) analysis and hierarchical multiple regression analysis methods.
Results
We found that there was no difference between crew members of different positions in terms of average vacation time and on-board service time (p > 0.05). The length of last vacation time and this service time for seafarers of different positions showed obvious differences (p < 0.01). The rank has a significant effect on the length of the last vacation (χ² = 101.560, p = 0.000 < 0.01) and the length of this service time (χ² = 75.624, p = 0.000 < 0.01). Also, the results showed that there was a significant negative correlation between the duration of vacation and overall fatigue (t = –7.160, p = 0.000 < 0.01), while there was a significant positive correlation between the length of service time on board and overall fatigue (t = 3.474, p = 0.001 < 0.01).
Conclusion
The results indicated that a reasonable vacation schedule was crucial for the relief of the seafarers’ fatigue, and also played a positive role in the state of working on the ship again.
... Moreover, feelings of a personal failure to modify lifestyle according to instructionssuch as in the current intervention trial -can be especially frustrating for individuals concerned of their health. Indeed, shorter vacation in our cohort was associated with worse self-rated health, and tended to be associated with some mental components of quality of life (45). Also modern stress research has emphasized the effect of perceivedsubjective, not objectiveamount of stress in the pathway to health disorders (46,47). ...
Objectives
In a 5-year multifactorial risk reduction intervention for healthy men with at least one cardiovascular disease (CVD) risk factor, mortality was unexpectedly higher in the intervention than the control group during the first 15-year follow-up. In order to find explanations for the adverse outcome, we have extended mortality follow-up and examined in greater detail baseline characteristics that contributed to total mortality.
Design
Long-term follow-up of a controlled intervention trial.
Setting
The Helsinki Businessmen Study Intervention Trial.
Participants and Intervention
The prevention trial between 1974–1980 included 1,222 initially healthy men (born 1919–1934) at high CVD risk, who were randomly allocated into intervention (n=612) and control groups (n=610). The 5-year multifactorial intervention consisted of personal health education and contemporary drug treatments for dyslipidemia and hypertension. In the present analysis we used previously unpublished data on baseline risk factors and lifestyle characteristics.
Main outcome measures
40-year total and cause-specific mortality through linkage to nation-wide death registers.
Results
The study groups were practically identical at baseline in 1974, and the 5-year intervention significantly improved risk factors (body mass index, blood pressure, serum lipids and glucose), and total CVD risk by 46% in the intervention group. Despite this, total mortality has been consistently higher up to 25 years post-trial in the intervention group than the control group, and converging thereafter. Increased mortality risk was driven by CVD and accidental deaths. Of the newly-analysed baseline factors, there was a significant interaction for mortality between intervention group and yearly vacation time (P=0.027): shorter vacation was associated with excess 30-year mortality in the intervention (hazard ratio 1.37, 95% CI 1.03–1.83, P=0.03), but not in the control group (P=0.5). This finding was robust to multivariable adjustments.
Conclusion
After a multifactorial intervention for healthy men with at least one CVD risk factor, there has been an unexpectedly increased mortality in the intervention group. This increase was especially observed in a subgroup characterised by shorter vacation time at baseline. Although this adverse response to personal preventive measures in vulnerable individuals may be characteristic to men of high social status with subclinical CVD, it clearly deserves further investigation.
This study contributes to the vacation literature by exploring predictors of change in school teachers’ negative affective states around a 2-week (Christmas) vacation. Drawing from a combination of self-regulatory and effort-recovery theoretical principles, we hypothesized that supplemental work activity during the vacation might have some positive consequences for mood state, while simultaneously impairing the ability to recover from work-related exhaustion. Ninety teachers completed measures across eight consecutive weeks, spanning the period before, during, and after vacation (710 observations in total). Teachers’ weekly levels of emotional exhaustion, anxious mood, and depressed mood decreased significantly from before to during the vacation. Following the vacation, anxious mood showed the most rapid rate of increase, returning to its prevacation level within 2 weeks of work resumption. Exhaustion and depressed mood reemerged more gradually across 4 consecutive weeks following the vacation. Supplemental work activity during the vacation was associated with weaker recovery from exhaustion, but did not exhibit a detrimental relationship with change in anxious or depressed mood. Of note, supplemental working during the vacation was associated with a less pronounced reemergence of anxious mood after the vacation. Workrelated perseverative cognition (worry and rumination) during the vacation impeded energy restoration and mood repair and was related to faster fade out of beneficial vacation effects. These findings demonstrate the utility of examining discrete energy and mood states in respite research, reveal the mixed functions of engaging in supplemental work activity during vacations, and highlight the harmful impact of perseverative cognition on the recovery from work process.
Vigorous legislative activity is taking place regarding paid sick leave in the United States. Most existing research measures paid sick days autonomously without also considering other benefits such as flexible work and paid vacation. This descriptive study of a nationally representative sample of 4428 adult male workers finds 77.1% of workers have a combination of paid sick leave, flexible work, and vacation, while only 16.8% have just one of the three benefits. Future research should examine the correlates of combined benefit packages in terms of workers’ physical, emotional and financial health and wellbeing. Nationally representative data collection efforts should refine the measurement of workplace benefit variable to allow for these comparisons.
Using a nationally representative sample from the 2012 National Longitudinal Survey of Youth, this study evaluates the retirement savings of 994 older male US workers (ages 47–55) by their access to flextime, paid sick leave and vacation time. After controlling for 12 demographic, education, household, and work-related variables, when measured dichotomously, multiple regression findings indicated workers with flexible work time enjoyed a 24.8% increase in retirement savings compared to those who did not have flexible work time, and workers with paid sick leave had retirement savings 29.6% higher than those workers who lacked paid sick leave benefits. Further, when paid sick leave and vacation time were measured ordinally, workers with six to 10 paid sick leave days and workers with more than 10 paid sick days annually had a statistically significantly higher (30.1% and 40.7%, respectively) amount in their retirement savings. Statistically significant decreases in retirement savings were observed for workers with 1–5 vacation days annually. These robust findings suggest the provision of flextime and paid sick leave benefits may affect retirement savings among older adult male workers. Implications for policy are set forth.
To cooperate or not is one of the most challenging issues of supply chain management era. If the supply chain is managed optimally, the entire profitability increases. Meanwhile, corporate Social Responsibility (hereafter CSR) is defined as the social and ethical behavior of supply chain members against stakeholders such as shareholders, final customers, employees and executives. Moreover, the observance of the social responsibility obligations is of great importance for consumers and shareholders of companies. The decisions of the supply chain’s members play a direct role in determining the profits of each. These decisions are in conflict with other members in a competitive environment.
In this paper, the contradictory variables encompasses the cost resulting from the performance of corporate social responsibility, inventory, shortage, advertising and pricing in a two-level supply chain, consisting a manufacturer and a retailer. After identifying the quantitative variables for measuring the social responsibility using Delphi-Fuzzy methods and Interpretive Structural Modeling, the most important and influential variable of measuring the social responsibility performance (forced labor ratio) has been selected. Subsequently, after modeling the profit function of each player, optimal results were emanated according to the bargaining power of each member and based on Nash and Stackelberg games. Afterwards, with numerical examples, the optimization and sensitivity analysis of social responsibility in each model has been discussed. The results indicate that the profit of manufacturer and retailer reduces by increasing the proportion of forced labor. Based upon Nash equilibrium, the manufacturer’s profit decreases with a slight slope; nonetheless, on retailer and manufacturer leadership models, the profit decreases with a slight increase of the forced labor.
Objective: To examine the extent to which vacationing behavior is associated with metabolic outcomes. Specifically, we consider how total vacation episodes and total vacation days from the past 12 months relate to metabolic syndrome and metabolic symptoms.
Design: Sixty-three workers eligible for paid vacation attended a lab visit during which their blood was drawn and they completed an interview assessing vacationing behavior in the past 12 months.
Main outcome measures: Metabolic syndrome and metabolic symptoms are the main outcome measures.
Results: Over the past 12 months, participants took approximately five vacations (M = 5.44, SD = 3.16) and used about 2 weeks of their paid vacation days (M = 13.80, SD = 7.25). Participants rated vacations positively, expressing low levels of travel-, childcare- and financial burden-related stress. As vacation episodes increased, metabolic syndrome incidence (OR = 0.76, p = 0.051) and number of metabolic symptoms met (IRR = 0.92, p = 0.035) decreased. Notably, risk for metabolic syndrome decreased by nearly a quarter with each additional vacation taken by participants.
Conclusions: Overall, vacations are experienced as positive events. This positive subjective experience may translate into physical health benefits given that vacation frequency may protect against metabolic syndrome and symptoms.
The emerging interest in sustainability for process systems engineering is motivated by
the need to create an environmentally, economically and socially stable society. This is
because companies have realized that profit is not the only goal to be achieved. Therefore,
they are seeking ways to satisfy these criteria. From the assessment perspective, social
sustainability was always neglected, and only recently gained a lot of attention, largely
because stakeholders, as being aware of possible negative impacts resulting from
industrial processes, are engaging into decision making process and thus demanding more
transparency about social sustainability. Consequently, the development of the
appropriate methods and quantitative indicators is seen as one of the most important
research priorities in social sustainability.
The purpose of this dissertation is to enable the quantitative assessment of social
sustainability in supply chains and wastewater treatment processes. Thus, it employs
several methods that will help in achieving its stated goal. Defining indicators enhances
their effectiveness, while their validation and applicability are ensured using empirical
and content analysis. Other methods employed for the analysis of proposed social
sustainability indicators and their relationship with stakeholders and supply chain
echelons are bipartite network projection and ANOVA analysis, respectively.
The findings of this study show that social sustainability lacks detailed and appropriate
assessment methods with a clear definition, relevance and quantitative equation of the
indicators. Consequently, developing social sustainability indicators enables the
assessment of both the specific process and the whole supply chain in general. Overall,
these findings contribute to the field of social sustainability and process system
engineering by suggesting a novel approach in assessing social sustainability.
Despite the increased interest in social sustainability there is still lack of information for the social assessment, as well as a lack of appropriate quantitative social sustainability indicators to perform such assessment. In this paper, there is proposed a set of 31 quantitative social sustainability indicators enabling the evaluation of the whole supply chain. In particular, the issues related to labor practices and decent work, as well as human rights are analyzed. The indicators are developed based on literature review and validated by a content analysis of 141 sustainability reports, which cover all echelons (upstream, midstream, downstream) of supply chains. By considering differences that exist within different echelons of the supply chain, one-way statistical analysis (ANOVA) is performed in order to decide whether echelons affect the relevance of the indicators. Finally, using data available in sustainability reports the applicability of indicators is tested. Results of the content analysis showed that issues covered by all 31 indicators are addressed implicitly by companies in their sustainability reports, while ANOVA analysis showed that the type of echelon does not impact the relevance of the indicators, being this set of indicators a generic approach to holistic assessment of the supply chain. Further, it was verified how these indicators can be used for the assessment of the whole supply chain. Thus, the proposed indicators can be used for both performance assessment, as well as for periodical monitoring of the supply chains; they can also be an important tool in policy making.
Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke.
We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.
We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001).
Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.
Medical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.
Copyright © 2015 Kivimäki et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.
Socioeconomic status (SES) is consistently associated with health outcomes, yet little is known about the psychosocial and behavioral mechanisms that might explain this association. Researchers usually control for SES rather than examine it. When it is studied, only effects of lower, poverty-level SES are generally examined. However, there is evidence of a graded association with health at all levels of SES, an observation that requires new thought about domains through which SES may exert its health effects. Variables are highlighted that show a graded relationship with both SES and health to provide examples of possible pathways between SES and health end points. Examples are also given of new analytic approaches that can better illuminate the complexities of the SES-health gradient.
The authors aggregated the results of observational studies examining the association between long working hours and coronary
heart disease (CHD). Data sources used were MEDLINE (through January 19, 2011) and Web of Science (through March 14, 2011).
Two investigators independently extracted results from eligible studies. Heterogeneity between the studies was assessed using
the I2 statistic, and the possibility of publication bias was assessed using the funnel plot and Egger's test for small-study effects.
Twelve studies were identified (7 case-control, 4 prospective, and 1 cross-sectional). For a total of 22,518 participants
(2,313 CHD cases), the minimally adjusted relative risk of CHD for long working hours was 1.80 (95% confidence interval (CI):
1.42, 2.29), and in the maximally (multivariate-) adjusted analysis the relative risk was 1.59 (95% CI: 1.23, 2.07). The 4
prospective studies produced a relative risk of 1.39 (95% CI: 1.12, 1.72), while the corresponding relative risk in the 7
case-control studies was 2.43 (95% CI: 1.81, 3.26). Little evidence of publication bias but relatively large heterogeneity
was observed. Studies varied in size, design, measurement of exposure and outcome, and adjustments. In conclusion, results
from prospective observational studies suggest an approximately 40% excess risk of CHD in employees working long hours.
Objectives:
The aim of this meta-analysis is to investigate to what extent vacation has positive effects on health and well-being, how long such effects endure after work resumption, and how specific vacation activities and experiences affect these relationships.
Methods:
Based on a systematic literature search (PsycInfo, Medline) and methodological exclusion criteria, in a stepwise approach, 7 studies were selected and reviewed. Effect sizes (Cohen's d) were calculated i) for every outcome variable within every study, ii) for every study by averaging the effect sizes per study, and iii) for homogeneous categories of outcome variables (exhaustion, health complaints, life satisfaction).
Results:
The results suggest that vacation has positive effects on health and well-being (small effect, d=+0.43), but that these effects soon fade out after work resumption (small effect, d=-0.38). Our research further demonstrated that vacation activities and experiences have hardly been studied. Therefore, their contribution to vacation effect and fade out remains unclear.
Discussion:
Progress in future vacation research will depend on strong research designs that incorporate repeated measurements pre-, inter- and post-vacation.
The objective of this study was to determine the risk for various causes of posttrial death associated with vacation frequency during the Multiple Risk Factor Intervention Trial (MRFIT).
Middle-aged men at high risk for coronary heart disease (CHD) were recruited for the MRFIT. As part of the questionnaires administered during the first five annual visits, men were asked whether they had had a vacation during the past year. For trial survivors (N = 12,338), the frequency of these annual vacations during the trial were used in a prospective analysis of posttrial all-cause and cause-specific mortality during the 9-year follow-up period.
The relative risk (RR) associated with more annual vacations during the trial was 0.83 (95% confidence interval [CI], 0.71-0.97) for all-cause mortality during the 9-year follow-up period. For cause of death, the RRs were 0.71 (95% CI, 0.58-0.89) and 0.98 (95% CI, 0.78-1.23) for cardiovascular and noncardiovascular causes, respectively. The RR was 0.68 (95% CI, 0.53-0.88) for CHD (including acute myocardial infarction). These associations remained when statistical adjustments were made for possible confounding variables, including baseline characteristics (eg, income), MRFIT group assignment, and occurrence of a nonfatal cardiovascular event during the trial.
The frequency of annual vacations by middle-aged men at high risk for CHD is associated with a reduced risk of all-cause mortality and, more specifically, mortality attributed to CHD. Vacationing may be good for your health.
Purpose: Vascular risk factors in midlife may play a role in the development of cognitive decline, dementia and Alzheimer' disease (AD). The role of serum total cholesterol has yielded inconsistent results in diverse cohorts.
Background:
The aim was to investigate the relationship between self-rated health (SRH) in healthy midlife, mortality, and frailty in old age.
Methods:
In 1974, male volunteers for a primary prevention trial in the Helsinki Businessmen Study (mean age 47 years, n = 1,753) reported SRH using a five-step scale (1 = "very good," n = 124; 2 = "fairly good," n = 862; 3 = "average," n = 706; 4 = "fairly poor," or 5 = "very poor"; in the analyses, 4 and 5 were combined as "poor", n = 61). In 2000 (mean age 73 years), the survivors were assessed using a questionnaire including the RAND-36/SF-36 health-related quality of life instrument. Simplified self-reported criteria were used to define phenotypic prefrailty and frailty. Mortality was retrieved from national registers.
Results:
During the 26-year follow-up, 410 men had died. Frailty status was assessed in 81.0% (n = 1,088) of survivors: 434 (39.9%), 552 (50.7%), and 102 (9.4%) were classified as not frail, prefrail, and frail, respectively. With fairly good SRH as reference, and adjusted for cardiovascular risk in midlife and comorbidity in old age, midlife SRH was related to mortality in a J-shaped fashion: significant increase with both very good and poor SRH. In similar analyses, average SRH in midlife (n = 425) was related to prefrailty (odds ratio: 1.52, 95% confidence interval: 1.14-2.04) and poor SRH (n = 31) both to prefrailty (odds ratio: 3.56, 95% confidence interval: 1.16-10.9) and frailty (odds ratio: 8.38, 95% confidence interval: 2.32-30.3) in old age.
Conclusions:
SRH in clinically healthy midlife among volunteers of a primary prevention trial was related to the development of both prefrailty and frailty in old age, independent of baseline cardiovascular risk and later comorbidity.
Purpose
Vascular risk factors in midlife may play a role in the development of cognitive decline, dementia and Alzheimer’ disease (AD). The role of serum total cholesterol has yielded inconsistent results in diverse cohorts.
Objective
To analyze the relationship between the midlife cholesterol level and AD in late life in a homogenous cohort of Caucasian men.
Methods
The Helsinki Businessmen Study is a cohort of male business executives who have been followed-up since 1964. Midlife cholesterol level was available in 3293 men, of whom 205 developed a register-verified AD. Cognitively intact men in 2007 (n = 844) served as controls, and logistic regression adjusted for age and cardiovascular risk factors was used to investigate the association between cholesterol and AD.
Results
At baseline, the men with subsequent AD diagnosis had 0.4 mmol/L higher total cholesterol level than controls (6.7 vs 6.3 mmol/L). In adjusted analyses 1 mmol/L rise in total cholesterol was associated with a 22% increased risk of AD (odds ratio [OR] 1.22, 95% confidence interval 1.06 to 1.40, P = 0.005). Risk of AD (OR with 95% CI) also increased in a stepwise manner from the lowest to highest quartile of midlife cholesterol from 1.0 (referent) to 1.6 (1.01–2.6), 1.9 (1.2–3.0), and 2.0 (1.2–3.3), respectively.
Conclusion
In this longitudinal study with up to 43 years of follow-up, higher serum total cholesterol in early midlife was clearly associated with a higher risk of AD in late life.
Many studies have investigated the association between long working hours and health. By focusing on differences in the definition of long working hours and the influence of shift work, we attempt to explain why the results of these studies remain inconclusive.
We defined long working hours as working time greater than around 40 hours per week or 8 hours per day. Since previous studies have indicated that shift work is detrimental to health, we minimized the influence of shift work in the studies. We also placed importance on the existence of reference groups since this made the results clearer. Based on these points, we analyzed previous studies to clarify the epidemiological evidence regarding the association between long working hours and health. We established inclusion criteria and carried out a systematic search for articles published in the Medline and PsycINFO databases between 1995-2012.
We identified a total of 17 articles and 19 studies (12 prospective cohort and 7 cross-sectional studies). The outcomes were all-cause mortality, circulatory disease, diabetes mellitus, metabolic syndrome, depressive state, anxiety, other psychological disorders, sleep condition, cognitive function, and health-related behavior. Long working hours had significant adverse effects on most health outcomes.
We concluded that working long hours is associated with depressive state, anxiety, sleep condition, and coronary heart disease. However, further studies that appropriately deal with the definition of long working hours and shift work are needed.
This article reports on interrelationships between the medical and emotional health of 95 men who were prospectively followed from age 18 to 53. Fifty of these originally healthy men developed illness patterns sometimes called psychosomatic (ulcer, colitis, allergy, hypertension, musculo-skeletal disorders). These men were compared with the other 45 similarly studied men who never developed such illnesses. Although men who developed "psychosomatic" illnesses were more likely to seek medical or psychiatric attention, they exhibited only slightly more psychopathology. Both as children and as adults they had more physical illness of all kinds. They were less likely to indulge in vacations and athletics and more likely to use tranquilizers and excessive alcohol. Men with "psychosomatic" illnesses experienced a greater variety of somatic symptoms under stress, but the loci of these somatic symptoms shifted over time and were not significantly associated with the sites of psychosomatic illness. Premorbidly, the 20 men who were eventually to develop serious irreversible physical illness of any kind reflected far more psychopathology than the 45 men who developed psychosomatic illness.
This study investigates the relation of psychosocial variables to the 20-year incidence of myocardial infarction or coronary death among women in the Framingham Study. In 1965-1967, a psychosocial interview was given along with the collection of other coronary risk factor data. This study includes 749 women aged 45-64 years who were free of coronary disease at this baseline examination. Demographic variables, psychosocial scales (such as tension and reactions of anger), and individual interview items (such as attitudes toward children, money, and religion) were measured. When age, systolic blood pressure, the ratio of serum total cholesterol to high-density lipoprotein cholesterol, diabetes, cigarette smoking, and body mass index were controlled for in multivariate proportional hazards models, the predictors of the 20-year incidence of myocardial infarction or coronary death were as follows: among employed women, perceived financial status only; among homemakers, symptoms of tension and anxiety, being lonely during the day, difficulty falling asleep, infrequent vacations, housework affecting health, and believing one is prone to heart disease (p less than 0.05 for all variables); and among both groups of women combined, low educational level, tension, and lack of vacations. These results are discussed in relation to previous findings from the Framingham Study.
The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
Characteristics of 11,132 men aged 40-59 years and free from coronary heart disease (CHD) at entry were related to follow-up experience, using multivariate analysis. In 5 years among 2,404 U. S. railroad men and 8,728 European men there were 615 cases of CHD, 214 of whom died from CHD or suffered definite nonfatal infarction.
With five entry characteristics (age, systolic blood pressure, serum cholesterol, smoking habit, and body mass index), multiple logistic solutions for Europeans and Americans, separately, gave estimates of the individual probability of CHD. Classified by deciled scores for these probabilities, the expected and observed CHD cases were highly correlated (r = 0.930-0.981). Predictions based on European data applied to Americans, and vice versa, gave similar high correlations but American incidence was excessive compared with European experience.
Application of the analysis coefficients obtained from data in Europe and in the U. S. railroad to 6,221 other U. S. men 40-59 years of age, CHD-free at entry, gave good prediction of relative risk (r = 0.94) for observed versus predicted cases in deciles of risk score; however, the actual numbers of cases were underpredicted.
From single measurements of a few characteristics the multiple logistic solution usefully estimates the relative risk of CHD for individuals. Age, systolic pressure, and serum cholesterol are universally powerful predictors of risk. Variables not measured in this study or not yet identified contribute to the risk of CHD among American men.
Vacation has recently become a topic of interest in health research as both beneficial and adverse health effects have been documented. The present study was aimed at identifying vacation characteristics predicting health-related vacation outcome.
One hundred ninety-one predominantly white-collar employees (109 female, 82 males; mean age 37.8 yr, range 16-62 yr) received a questionnaire in the week after vacation assessing subject characteristics, physical vacation characteristics, the individual structuring of the day, health and social behavior, and stress during vacation as well as the perceived change of recuperation and exhaustion from before to after a vacation. Regression analysis was used to identify variables predicting vacation outcome.
Twenty-seven percent of the variance of the change of recuperation and 15% of the change of exhaustion could be explained. Recuperation was facilitated by free time for one's self, warmer (and sunnier) vacation locations, exercise during vacation, good sleep, and making new acquaintances, especially among vacationers reporting higher levels of prevacation work strain. Exhaustion was increased by vacation-related health problems and a greater time-zone difference to home, and was reduced by warmer vacation locations.
Health-related vacation outcome is significantly affected by the way an individual organizes his or her vacation.
To study the influence of a 3-week hiking vacation at moderate (1700 m) and low altitude (LA) (200 m) on key-markers of the metabolic syndrome, 71 male volunteers (age 36-66 yr old) with the metabolic syndrome [according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) - or World Health Organization (WHO) - definition] participated in the study and were randomly assigned into a moderate altitude (MA) group (1700 m, no. 36) and a low altitude (LA) group (200 m, no. 35). The 3-week vacation program included 12 moderate- intensity guided hiking tours [4 times/week, 55-65% heart rate maximum (HRmax)] with a total exercise time of 29 h plus moderate recreational activities. Both study groups had a comparable and balanced nutrition with no specific dietary restrictions. Anthropometric, metabolic and cardiovascular parameters were measured 10-14 days before vacation, several times during the 3-week vacation, 7-10 days and 6-8 weeks after return. All participants tolerated the vacation without any adverse effects. Body weight, body fat, waist-circumference, fasting glucose, total cholesterol, LDL-cholesterol (LDL-C), plasma fibrinogen, resting systolic and diastolic blood pressure were significantly decreased over time in both study groups. In the LA group, fasting insulin and homeostasis model assessment (HOMA)-index were significantly decreased one week after return. Relative cycle ergometry performance was significantly increased after return compared to baseline. In both study groups, waist-to-hip ratio (WHR), 2-h oral glucose tolerance test (OGTT), HDL-cholesterol (HDL-C), and triglycerides remained unchanged. The 3-week vacation intervention at moderate and LA had a positive influence on all key-markers of the metabolic syndrome. No clinically relevant differences could be detected between the study groups. A hiking vacation at moderate and LA can be recommended for people with stable, controlled metabolic and cardiovascular risk factors.