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In the health sector, the theme of work-related stress is a major issue, representing a significant risk factor on health-care providers which can also affect the quality of health services provided. It is therefore important to adopt a multidimensional evaluation system of work-related stress in order to integrate the results of the analysis of objective and subjective stress indicators. The adoption of a multidimensional validated tool as the one proposed by Inail, allows an integrated analysis of sentinel indicators, objective factors of context and content jointly to direct analysis of the subjective perception of workers through the analysis of the Management Standards developed by Health and Safety Executive. The comparison between three Healthcare Districts, three Mental Health Centers and Administrative Offices of an Healthcare Organization (652 workers involved) revealed the most critical areas which need urgent improvement intervention.

Objectives: To examine the association between two job stress models-the job strain (JDC) and the effort-reward imbalance (ERI) model-and ambulatory blood pressure monitoring in call handler operators., Methods: Participants included 74 women (age, 34.9 ± 9.9 years) and 26 men (age 36.0 ± 10.8 years) who were monitored on 2 workdays for ambulatory blood pressure. Measures of both job stress models were related to blood pressure by the generalized estimating equations (GEE) method while adjusting for potential confounders (gender, age, cigarette smoking, alcohol consumption, educational level, marital status, time of day, and work schedule)., Results: Workshifts were associated with an increase of 3-4 and 14 mmHg in mean arterial pressure (MAP) compared with diurnal activities out of work and sleeping period, respectively (P < 0.001). Ambulatory blood pressure was also significantly related with work schedule preference: unpleasant work schedule was associated with an increase of 2 mmHg in MAP compared with pleasant work schedule (P = 0.013). In the ERI model, subjects scoring high in work stress have higher ambulatory blood pressure at work, at home, and during sleep. Work stress by time interaction was not longer significant when controlling for potential confounders: generalized estimating equations revealed that MAP was influenced by BMI (>25 vs. <25: 0.7 (0.2-1.1) mmHg), workshift preference (unpleasant vs. pleasant: 2 (0.4-3.6) mmHg), and time of day. Weak not significant relation was found between ABP and psychosocial factors evaluated by the JDC and ERI models., Conclusion: These results do not support work stress as a significant factor influencing ABP in a homogeneous group of call-handlers. Complementary information independently obtained from the two work stress models could provide more exhaustive explanations on the stress-related effects on blood pressure.

Background: Experimental and clinical evidence suggest that stress can lead to ill-health through the disregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Studies to date have produced equivocal results likely due to different methodologies and failure to account for confounding factors. This investigation aimed to assess the relation between self-reported work-related stressors and salivary cortisol and to clarify the role of the potential confounders., Methods: Thirty-six call-handlers completed a self-administered job content questionnaire and collected seven daily salivary samples on two workdays and a weekend. The diurnal salivary cortisol output was expressed as cortisol awakening response (CAR), and cortisol output in the rest of the day. Salivary cortisol data were normalized by means of square root transformation. The generalized estimating equations method was used to assess the relation between job strain and cortisol levels after adjusting for gender, weekdays and adherence to the sampling schedule., Results: Job strain significantly influenced the total amount of cortisol response to waking (high strain vs. low strain: 1.1 (0.3-2.0) nmol/L). The cortisol response to waking showed gender-specific differences [women excreting greater cortisol than men: 1.1 (0.3-1.9) nmol/L], and weekday differences [workdays vs. weekend: 1.0 (0.3-1.6) nmol/L]. Non-compliance with the sampling protocol was associated with lower salivary cortisol than in adherent subjects., Conclusions: Our results provide further evidence for the HPA axis involvement in the physiological response to work stress. The measure of the CAR showed to be the sensitive index to assess the physiological response to psychosocial factors. Gender, weekday, and protocol compliance were confounding factors.

Objective: To investigate the association between work stress measures and salivary cortisol excretion in working and weekend days., Methods: In a sample of 68 healthy young call-centre operators dimensions of job stress from the demand-control model were related to repeated measures of salivary cortisol on seven samples (at awakening, +30 min, +60 min, + 3 h, +6 h, +9 h, and +12 h after awakening) at two working days and a weekend day., Results: The cortisol excretion on work days was higher than during weekend day with gender-specific differences as women only showed higher significant values for area under the curve (AUC(G)) and Diurnal cycle (chi(2) (2) = 8.10, P < 0.05; chi(2) (2) = 15.75, P < 0.05, respectively). There were no associations between job demand, job control and cortisol excretion, while the sociodemographic characteristics of the call-centre operators showed linear relation with the diurnal pattern of cortisol secretory activity., Conclusions: The hypothalamic-pituitary adrenocortical axis activation was higher in working day than in weekend day. This activation measured by salivary cortisol was not related to self-reported mental stressors assessed with job strain model. The availability of more specific psychometric scales would be useful to explore the relationship between salivary cortisol levels and measures of mental stress at workplace.

The psychophysiological mechanism behind the development of stress-related diseases includes a long-term both increase and decrease in circulating cortisol levels, leading to an allostatic disregulation of the hypothalamic-pituitary-adrenal (HPA) axis. This research explores the relationship between perceived stress (assessed by means of the Job Strain Model) and neuroendocrine response quantified by means of repeated measures of salivary cortisol in 46 call-centre operators. Job strain influenced the total amount of cortisol response to waking, but not the cortisol excretion in the remainder of the day. The cortisol response to waking showed gender-specific differences, women excreting greater cortisol than men [AUC(t): coeff (IC 95%) = 16.2 (5.3-27.1); AUC(i): coeff (IC 95%) = 8.3 (2.4-14.2); MnInc: coeff (IC 95%) = 5.2 (1.6-8.9)]. In long run the gender-specific differences of the dis-regulation of the hypothalamic -pituitary-adrenal (HPA) axis can be related to differences on prevalence of autoimmune diseases.