Influence of work environment on emotional health in a health care setting

BACKGROUND: Radical changes are taking place in health care services and might be expected to cause job dissatisfaction, absenteeism, somatic complaints and mental health problems. Research in this area is limited and focused primarily on nurses. AIM: To understand the impact of the work environment on the emotional health of doctors and nurses in a general hospital setting. METHODS: Cross-sectional study using self-reported questionnaires including the General Health Questionnaire, the Posttraumatic Stress Disorder (PTSD) Checklist for Civilians, the Trauma Experiences and Work Environment Scale. RESULTS: The response rates for the study were 28% (60) for doctors and 54% (431) for nurses. Whilst the prevalences of psychiatric disorder, anxiety, depression and PTSD were higher for doctors compared with nurses, this was not statistically significant. Both groups reported witnessing someone badly injured or killed as their most distressing experience (doctors 46% versus nurses 41%). Using multiple logistic regression, significant predictors of emotional health was task orientation for doctors (OR = 1.96, 95% CI = 1.1-3.6), and PTSD (OR = 17.2, 95% CI = 6.0-49.6), work pressure (OR = 1.2, 95% CI = 1.01-1.4) and innovation (OR = 0.81, 95% CI = 0.70-0.94) for nurses. CONCLUSION: The prevalence of psychiatric disorder among the doctors and nurses was similar to that in Britain. Elements of the work environment did impact on the emotional health of health care workers. Organizational development initiatives should include employee mental health issues in order to create a more positive work environment.     

Ageing and fitness to work

Ageing workers can be found in almost all occupations. Assessment of fitness to work in these workers is important, as it aims to match their functional capacity (which is reduced compared to younger workers), to the demands of their work (which may remain the same as that for younger workers). This outcome of assessment is influenced by the interaction between functional capacity, state of health, the nature of work, and possibilities for work accommodation. The assessment of functional capacity should include physical, mental and social capacity, as well as assessment of any disability. In addition to clinical or laboratory measurements, several authors have suggested the use of a 'work ability index' for specific occupations as a practical means of selecting the appropriate worker for the job. This index can also be used for monitoring functional capacity. In addition, as for any fitness to work assessment, a good understanding of the nature of the work and the work environment is required, and possibilities for work accommodations considered. While changes in the work environment and working conditions can be made to suit the functional capacity of the ageing worker, the maintenance of functional capacity is another important issue. There is a place for a greater role for disease screening and health promotion for such workers.     

A follow-up study on the association of working conditions and lifestyles with the development of (perceived) mental symptoms in workers of a telecommunication enterprise

AIM: This study investigated the association of working conditions and lifestyle with mental health in Japanese workers. METHODS: A follow-up study was carried out in the Kanto district of Japan of workers in a telecommunications enterprise who received their first annual health check-up between 1992 and 1996 and were between 20 and 54 years old. Workers who reported mental symptoms, had a past history of disease, or current illness at their first check-up were excluded from the analysis. In total, the study included 23 837 workers. The association between working conditions and lifestyle and the development of mental symptoms was investigated by pooled logistic regression analyses. RESULTS: Working long hours and part-time work, as opposed to normal daytime hours of work, were factors associated with the development of mental symptoms in males, as were smoking, short sleeping hours, little physical exercise, rarely taking three meals a day, frequently eating within 1 h before sleep, much preference for salty meals and little preference for vegetables. Consumption of alcohol was negatively associated with the development of mental symptoms in males. Overall, the results suggested that the lower the Healthy Work and Lifestyle Score, the higher the risk of developing mental symptoms. CONCLUSIONS: Working conditions and lifestyle, especially food preferences, have an apparent influence on the mental health of Japanese workers. Moreover, the Healthy Work and Lifestyle Score indicates that working conditions and lifestyle appear to have a cumulative influence upon the mental health of Japanese workers.     

Perceived job demands relate to self-reported health complaints

BACKGROUND: Illness and illness behaviour are important problems in the Dutch workforce. Illness has been associated with job demands, with high demands relating to poorer health. It has not been reported whether subjective health complaints relate to job demands. AIMS: To investigate whether perceived (physical and mental) workload and specific job demands are associated with self-reported health complaints. METHODS: Cross-sectional study of a random sample of 983 male employees working in manufacturing industry. Job demands and health complaints were investigated using the self-completed Basic Occupational Health Questionnaire. The relationship between demands and health complaints were studied using logistic regression analysis with health complaints as the outcome variable. RESULTS: The questionnaires of 867 workers (88%) were suitable for analysis. The prevalence of health complaints was high. Physical workload was related to musculoskeletal symptoms. Standing work predicted pain in the legs and thoracic as well as low back pain, while sedentary work predicted low back pain. Heavy lifting predicted low back pain and pain in the extremities. Regular bending predicted low back pain and pain in the legs. Repetitive movements predicted pain in the arms and thoracic as well as low back pain. Mental workload was associated with fatigue and chest pain. Working under time pressure and working behind schedule were not related to self-reported health complaints. CONCLUSIONS: Perceived physical job demands matched with self-reported musculoskeletal complaints, whereas perceived mental job demands were unrelated to specific complaints.     

社区卫生服务员工中职业紧张与倦怠的调查分析

目的弄清社区卫生服务员工职业紧张与职业倦怠的现状,探讨两者之间的关联。方法采用依据工作要求-自主模式与付出-回报失衡模式理论开发的简明职业紧张问卷和Maslach的职业倦怠问卷的修订版,对上海市的1397名社区卫生服务员工进行调查。运用多元Logistic回归分析不同职业紧张因子与职业倦怠的关联。结果有77.1%人被评定为职业紧张,有19.3%人呈现付出回报失衡,职业倦怠阳性率高达77.3%。职业倦怠均分为2.17±0.91,其3个维度情感耗竭均分为2.23±1.46,人格解体为1.04±1.15,个体成就感得分为3.78±1.36。高要求低自主是个体成就感降低的保护因子,以低D/C组为对照,中等与高组的OR值分别为0.54(95%CI=0.37~0.78)和0.42(95%CI=0.25~0.72)。社会支持是职业倦怠的保护因子,以低社会支持组为对照组,中、高社会支持组OR值分别为0.69(95%CI=0.47~1.00)和0.52(95%CI=0.35~0.77);付出回报失衡是职业倦怠的危险因子,以低付出回报失衡为对照,中等组的OR值为2.48(95%CI=1.33~4.62);高失衡组OR值为4.91(95%CI=1.78~13.6)。内在投入是情感耗竭和人格解体的危险因子。结论预防职业倦怠需要降低职业紧张程度,缓解付出回报失衡,同时增加社会支持。     

Risk factors for first-ever low back pain among workers in their first employment

BACKGROUND: Low back pain has been estimated to be the most costly ailment of people of working age. Both work characteristics and individual factors have been identified as risk factors. The first interaction between work characteristics and individual factors occurs when workers start in their first job. AIMS: To investigate work-related risk factors for first-ever low back pain in young workers in their first employment. METHODS: A cross-sectional analysis was performed on 278 young workers in their first employment and without a history of low back pain prior to working. Work-related physical factors, psychosocial work characteristics, individual variables and first-ever low back pain were queried by means of a questionnaire. RESULTS: About half of the workers who developed low back pain after job start did so in the first year of employment. An increased risk was observed for (i) long periods of seated work [relative risk (RR) = 3.2, 95% confidence interval (CI) = 1.6-6.4]; (ii) more than 12 flexion or rotation movements of the trunk per hour (RR = 3.0, 95%CI = 1.4-6.4); and (iii) more than 3 years seniority in a job involving lifting more than 25 kg at least once an hour (RR = 3.7, 95%CI = 1.4-9.4). As to psychosocial work characteristics, first-ever low back pain was associated with a combination of low psychological job demands and low supervisor support. CONCLUSION: Work-related physical factors and psychosocial work characteristics should be considered as risk factors for first-ever low back pain. First-ever episodes of low back pain are common in the first year of employment. This may reflect a lack of work experience or training.     

The scale of perceived occupational stress

This article reviews previous research on the scale of occupational stress and describes in detail the Bristol Stress and Health at Work study. This study had three main aims: firstly, to determine the scale and severity of occupational stress in a random population sample; secondly, to distinguish the effects of stress at work from those of stress in general life; and finally, to determine whether objective indicators of health status and performance efficiency were related to perceived occupational stress. These aims were investigated by conducting an epidemiological survey of 17,000 randomly selected people from the Bristol electoral register, a follow-up survey 12 months later, and detailed investigation of a cohort from the original sample. The results revealed that approximately 20% of the sample reported that they had very high or extremely high levels of stress at work. This effect was reliable over time, related to potentially stressful working conditions and associated with impaired physical and mental health. The effects of occupational stress could not be attributed to life stress or negative affectivity. The cohort study also suggested that high levels of occupational stress may influence physiology and mental performance. The prevalence rate obtained in this study suggests that 5 million workers in the UK have very high levels of occupational stress.     

职业倦怠在工作压力与健康功能间的中介效应

目的研究城市男性职业人群工作压力对其身心健康功能的影响,并探讨职业倦怠在其间的中介效应。方法从某城市中心城区随机抽取30～65岁的1133名男性职工进行横断面调查,用哥本哈根社会心理问卷（COPSOQ）、哥本哈根倦怠问卷（CBI）、以及SF－8分别测试工作压力、职业倦怠、和健康功能,运用中介分析研究工作压力和职业倦怠对职工身心健康的影响。结果工作压力的增加与男性职业人群生理健康和心理健康的下降有显著性关联（P〈0．01）,并可见明显的剂量一反应关系;职业倦怠作为中介变量,对生理健康和心理健康的下降分别起到了15．08％和23．84％的间接效应。结论工作压力对男性职业人群的身心健康均造成了不利影响,职业倦怠部分中介了上述作用。     

Physicians as clinical directors: working conditions, psychosocial resources and self-rated health

BACKGROUND: Physicians in clinical directors' positions fulfil their commitments in demanding work environments characterized by organizational changes and economic cutbacks. Little is known about the self-rated health of this group. AIM: To investigate whether self-rated health was associated with psychosocial working conditions, professional networks, job support, social networks and social support, sick leave and salary in Swedish physicians working as clinical directors. METHODS: A self-reported questionnaire was sent to 373 clinical directors. Odds ratios (ORs) were used for estimating the bivariate association between self-rated health and psychosocial resources. RESULTS: A total of 274 clinical directors agreed to participate in the study. The response rate was 73%. The clinical directors exposed to high job demands had a significantly higher probability of low self-rated health [OR = 3.4 and 95% confidence interval (CI) = 1.6-7.0] than those who were not in this situation. Furthermore, participants who were exposed to high job demands had an increased risk of low self-rated health (OR = 3.8 and 95% CI = 1.8-8.1) irrespective of available social support inside or outside work. High average working hours more than doubled the risk of low self-rated health (OR = 2.2 and 95% CI = 1.1-4.4). CONCLUSION: The job demands on physicians in clinical directors' positions may exceed ordinary means of support with consequent adverse effects on self-rated health. More research is needed to investigate the interaction between job demands and support systems in this group of health care workers.     

Job satisfaction of health care staff employed at health centres in Turkey

The objective of the study was to identify job satisfaction levels and their causes among health care workers employed at public health centres. A survey was therefore carried out of health care workers in 21 health centres in Konya, Turkey. The Minnesota Satisfaction Questionnaire was used to investigate job satisfaction. The satisfaction score and proportion of those satisfied were determined according to demographic features. The percentage of satisfied health care workers was 60% and the satisfaction score was 3.8 +/- 0.5. Midwives had the lowest satisfaction scores. Working environment and income were the most important factors for dissatisfaction. There was no correlation between global satisfaction and other demographic variables. These results showed that the health care workers at public health centres in the province have low satisfaction scores. Improving working conditions and income may improve the overall quality of health care provision.     

Protecting the health of employees caring for family members with special health care needs

Over half of American workers are holding a paid job while also providing unpaid assistance and support to a family member. Research shows that family members who provide care to children or adults with special health care needs are themselves at risk of physical and mental health problems. Yet, little research has explored how the work environment mediates the effects of caregiving on caregivers' mental and physical health. With a sample of 2455 currently employed U.S. adults from the Work, Family, Community Nexus (WFCN) survey, a random-digit dial, nationally representative survey of Americans aged 18-69, we examine whether paid leave and flexibility policies mediate the relationship between caregiving and health. In Ordinary Least Squares regression models, we find that paid leave to address family members' health was associated with better mental health status as measured by the 5-item Mental Health Inventory and paid sick leave with better physical health status as measured by self-rated overall health status. A supportive supervisor was also associated with improvements in mental and physical health. For both men and women, paid leave and a supervisor's support offset some or all of the negative effects of caregiving, but for women, the buffering effects of working conditions are slightly larger. Enhancing the unpaid leave guaranteed in the U.S. Family and Medical Leave Act so that it is paid and passing national paid sick days legislation will help ensure that employed caregivers can retain their jobs, receive needed income, and meet their own mental and physical health needs.     

Sickness absence due to influenza

In addition to its recognized health effects, influenza has socio-economic consequences, most notably sickness absence and associated work disruption. It may account for 10-12% of all sickness absence from work. Data on the impact of influenza on work are limited. Most research has assessed the impact of an intervention, usually influenza immunization. Within the available literature, there are five randomized controlled trials in the workplace that have assessed the effectiveness of influenza immunization as an intervention: two in the general working population and three in the health sector. If the benefit desired is a reduction in sickness absence as a cost-effective measure, the likely outcome is a modest gain in years when incidence of influenza is increased in the community. There are some distinctive factors in the health care industry: health care workers may exhibit different absence behaviour, they may be more exposed to infection at work and they may pose a risk as a source of nosocomial infection. From the occupational health perspective, how do we best inform employers currently? The cost-effectiveness case has not been absolutely proven. More research appears necessary, including assessment of those factors that influence uptake of influenza immunization. In the interim, a targeted approach to certain job categories may be the way forward.     

Determinants of accident proneness: a case-control study in railway workers

BACKGROUND: Accident proneness or workers who have more frequent occupational injuries is common but the role of occupational and individual factors has rarely been studied. AIM: To assess the relationships of certain occupational and individual characteristics with frequency of occupational injuries. METHOD: This case-control study included 1305 male workers with occupational injuries during 1999-2000 and 1305 controls from a railway company. A standardized questionnaire was completed by the occupational physician in the presence of the subject. The data were analysed using logistic regression. RESULTS: Having more than one injury was associated with short service in the present job, younger age, sleep disorders, smoking, requesting a job change, physical disability and lack of physical activity. Safety training was negatively related to injury frequency. Short service in the present job was the only significant factor for single injuries. CONCLUSION: This study identified a number of work and individual factors that predicted occupational injury frequency and may be useful in designing preventative measures. Occupational physicians could assist workers to be more aware of the risks and to find remedial measures.     

Ergonomics, musculoskeletal disorders and computer work

This review summarizes the knowledge regarding ergonomics and musculoskeletal disorders and the association with computer work. A model of musculoskeletal disorders and computer work is proposed and the evidence and implications of the model together with issues for future research is discussed. The model emphasizes the associations between work organization, psychosocial factors and mental stress on the one hand and physical demands and physical load on the other. It is hypothesized that perceived muscular tension is an early sign of musculoskeletal disorder, which arises as a result of work organizational and psychosocial factors as well as from physical load and individual factors. It is further hypothesized that perceptions of exertion and comfort are other possible early signs of musculoskeletal disorders in computer work. Interventions aimed at reducing musculoskeletal disorders due to computer work should be directed at both physical/ergonomic factors and work organizational and psychosocial factors. Interventions should be carried out with management support and active involvement of the individual workers.     

Overtime work and stress response in a group of Japanese workers

Background Working long overtime hours is considered a causeof mental health problems among workers but such a relationshiphas yet to be empirically confirmed. Aim To clarify the influence of overtime work on response tostress and to assess the role of other stress-related factorson this relationship. Methods The study was conducted among 24 685 employees of acompany in Japan. Stress response, job stressors and socialsupports were assessed by the Brief Job Stress Questionnaire.Participants were divided into five categories of overtime (0–19,20–39, 40–59, 60 h of overtime per month and exemptedemployees). Results The nonadjusted odds ratios for stress response for40–59 and 60 overtime hours per month in reference to0–19 overtime hours were 1.11 [95% confidence interval(CI) 1.03–1.19] and 1.62 (95% CI 1.50–1.76), respectively.After adjustment for self-assessed amount of work, mental workloadand sleeping time, the association between overtime work andstress response disappeared. Conclusions This large cross-sectional study shows that overtimework appears to influence stress response indirectly throughother stress factors such as self-assessed amount of work, mentalworkload and sleeping time.     

Bullying in Turkish white-collar workers

OBJECTIVES: To determine the prevalence of reported workplace bullying among a group of white-collar workers, to evaluate the association between reported bullying and its effect on health and to assess the effects of support at work for bullied workers. METHODS: A cross-sectional questionnaire survey among full-time government employees in the health, education and security sectors. Bullying was assessed using a 20-item inventory. The potential effects of reported bullying were assessed using the Job Induced Stress Scale, the Hospital Anxiety and Depression Scale, Job Satisfaction Scale and the Propensity to Leave Scale. RESULTS: The response rate was 79% (944/1,200) and 877 questionnaires were analysed after exclusion of non-complete data. Of respondents, 55% (483) reported experiencing one or more types of bullying in the previous year and 47% (416) had witnessed the bullying of others. The bully was most likely to be a superior. Sixty per cent of victims had tried to take action against bullying, but most were dissatisfied with the outcome. There were significant differences in anxiety, depression, job-induced stress and support at work scores between those reporting bullying and those not reporting bullying at work. Those who reported bullying with low support at work had the poorest scores on the mental health scales. CONCLUSIONS: Bullying is a serious problem in this group of workers and may lead to health consequences. Feeling that the work environment is supportive appears to have a protective effect in terms of the health outcomes.     

Piecework, musculoskeletal pain and the impact of workplace psychosocial factors

Aim To investigate the impact of piecework on musculoskeletalpain and general health, and the influence of perceived workplacepsychosocial factors on any such associations, in a generalUK population. Methods A questionnaire was mailed to an age-stratified randomsample of 10 000 adults aged 18–75 in North Staffordshire,UK. Respondents reporting a current main job were asked if thisjob was paid by a piecework system. Health measures were (i)number of pain areas according to a body manikin and (ii) generalhealth (SF-12v2). Other measures included questions on occupationalhistory and psychosocial aspects of the work environment. Results The adjusted response was 54%. A total of 1193 respondentsreported a current main job, of whom 201 (17%) reported piecework.Pieceworkers were more likely to be older (P < 0.05), male(P < 0.001) and in lower socioeconomic groups (P < 0.001)than non-pieceworkers. Piecework was associated with perceptionsof a poor psychosocial working environment, more pain areas(P < 0.05), more elbow (P < 0.01), forearm (P < 0.001)and hand pain (P < 0.05), and a lower physical health score(SF-12v2; P < 0.01), but no difference in mental health score(P = 0.60), compared with non-pieceworkers. After controllingfor psychosocial factors, and socioeconomic group, the associationsbetween piecework and pain areas, or physical health, were nolonger statistically significant. Conclusions These results show that piecework was associatedwith poorer self-reported general physical health and more areasof pain, which may be attributed to low socioeconomic group,and workplace perceptions of little job control, high physicaldemand and little supervisor support.     

Job stress and mental health among nonregular workers in Korea: What dimensions of job stress are associated with mental health?

Although nonregular workers experience higher job stress, poorer mental health, and different job stress dimensions relative to regular workers, little is known about which job stress dimensions are associated with poor mental health among nonregular workers. This study investigated the association between job stress dimensions and mental health among Korean nonregular workers. Data were collected from 333 nonregular workers in Seoul and Gyeonggi Province, and logistic regression analysis was conducted. Results of the study indicated that high job insecurity and lack of rewards had stronger associations with poor mental health than other dimensions of job stress when controlling for sociodemographic and psychosocial variables. It is important for the government and organizations to improve job security and reward systems to reduce job stress among nonregular workers and ultimately alleviate their mental health issues.     

A South-East Asian perspective

In order to discuss the subject of occupational medicine in the next century, changes in the present demographic profile and work activity must be considered first. Only then can the challenges be identified, and appropriate strategies be formulated to respond to them. In the diverse countries of South-East Asia, improved health and work conditions, the advent of new technology, a redistribution of work activity, and an ageing workforce can be expected. Two other factors that have specific impact in the region are the recent financial crisis and the occurrence of an international environmental haze from forest fires. The various countries in South-East Asia, which are in different stages of development, and have different problems and priorities, will respond differently to the demands for occupational health. It is likely that there will be a shift in the focus of current health care activities towards specific work sectors, the recognition of new hazards at work, the identification of newly emerging work related diseases, and an increase in health promotion in the workplace. Hopefully, there will be improved training of health professionals to ensure that there are adequate numbers and that they are well prepared to face these changes. Responsive, appropriate and well enforced labour legislation to protect the health of all workers, and international cooperation in occupational and environmental health are also required. As global and regional economic conditions continue to remain unstable and the impact of the crisis further takes its course, the final effect on occupational health in South-East Asia remains to be seen.