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      Investigating the Associations of Self-Rated Health: Heart Rate Variability Is More Strongly Associated than Inflammatory and Other Frequently Used Biomarkers in a Cross Sectional Occupational Sample

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          The present study aimed to investigate the possible mechanisms linking a single–item measure of global self-rated health (SRH) with morbidity by comparing the association strengths between SRH with markers of autonomic nervous system (ANS) function, inflammation, blood glucose and blood lipids. Cross–sectional comprehensive health–check data of 3947 working adults (age 42±11) was used to calculate logistic regressions, partial correlations and compare correlation strength using Olkins Z. Adjusted logistic regression models showed a negative association between SRH (higher values indicating worse health) and measures of heart rate variability (HRV). Glycemic markers were positively associated with poor SRH. No adjusted association was found with inflammatory markers, BP or lipids. In both unadjusted and adjusted linear models Pearson’s correlation strength was significantly higher between SRH with HRV measures compared to SRH with other biomarkers. This is the first study investigating the association of ANS function and SRH. We showed that a global measure of SRH is associated with HRV, and that all measures of ANS function were significantly more strongly associated with SRH than any other biomarker. The current study supports the hypothesis that the extent of brain–body communication, as indexed by HRV, is associated with self-rated health.

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          Most cited references 64

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          Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.

          A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.
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            Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.

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              Self-rated health and mortality: a review of twenty-seven community studies.

              We examine the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples. Twenty-seven studies in U.S. and international journals show impressively consistent findings. Global self-rated health is an independent predictor of mortality in nearly all of the studies, despite the inclusion of numerous specific health status indicators and other relevant covariates known to predict mortality. We summarize and review these studies, consider various interpretations which could account for the association, and suggest several approaches to the next stage of research in this field.

                Author and article information

                [1 ]Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
                [2 ]The Ohio State University, Department of Psychology, Columbus, Ohio, United States of America
                [3 ]Institute of Occupational and Social Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
                [4 ]Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
                [5 ]Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
                University of Utah, UNITED STATES
                Author notes

                Competing Interests: JEF was the major shareholder of HealthVision Ltd. until Dec. 2012, which organized the data collection. Since January 1st 2013 he now serves as a scientific consultant to Health Vision Ltd. All other authors declare no conflict of interest. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: MNJ MEK AL RMH KH JEF. Performed the experiments: MNJ MEK AL RMH KH. Analyzed the data: MNJ JK YB JFT. Contributed reagents/materials/analysis tools: MNJ JEF JFT. Wrote the paper: MNJ MEK AL RMH KH JEF JK YB JFT.

                Role: Academic Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                18 February 2015
                : 10
                : 2
                25693164 4333766 10.1371/journal.pone.0117196 PONE-D-14-39136

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                Figures: 3, Tables: 5, Pages: 19
                The work was supported by internal funds of the Mannheim Institute of Public Health (Heidelberg University). The Director of this Institute JEF is co-author of the manuscript and as such played a role in preparation and approval of this manuscript. He had no role in study design, analysis and decision to publish the manuscript. Julian F. Thayer was supported by a Humboldt Senior Research Award. This funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Research Article
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                For legal reasons, data may not be publicly deposited. Access to data is guaranteed by the Mannheim Institute of Public Health, Mannheim, Germany. Requests for data may be sent to the corresponding author or Joachim E. Fischer, Mannheim Institute for Public Health, Ludolf-Krehl-Str. 7–11, 68167 Mannheim, Phone: +049 621 383 9910, Fax: +049 621 383 9920, E-Mail: joachim.fischer@ .



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