Health among hospital employees in Europe: a cross-national study of the impact of work stress and work control

This article analyses the effect of working conditions on the health of hospital employees across Europe. Hospital employees often have demanding jobs that increase their stress levels and, consequently, their risk of health problems. Work control - typified by employee autonomy and working time flexibility - helps them cope with high levels of work stress. Researchers have traditionally studied the relationship between working conditions, coping strategies and occupational health from an individual perspective. We argue that the individual work-health relationship is closely connected with the social and institutional context. This study explores how work stress and work control influence the health of hospital employees and aims to understand cross-country differences in this respect. Using data on over 1500 hospital employees who participated in the study 'Quality of work and life in a changing Europe' (2007) in eight European countries, we used ordinal regression analyses to test a range of hypotheses. The results show that work stress has a negative effect on the health of hospital employees, while work control is not found to have any effect on their health. Comparative analyses reveal that the effects of working conditions on health vary across European countries. While working overtime is more closely related to poorer health in Eastern European countries, we found evidence of a positive relationship between job autonomy and health in Western Europe only, indicating that circumstances in the working environment have differing effects on employee health in Eastern and Western Europe.     

Employer Role in Integrative Workplace Health Management

The health of the international workforce has been an increasing area of concern for the last two decades. Globalization of the world economy and rapid technological changes continue to change the nature of work and employment practices, exposing employees to new and serious health risks. These challenges are inescapable in any workplace, therefore it is important that employers examine how they can best fulfill their legal and leadership roles to protect and promote the health and well-being of their employees.This paper explores employer roles in employee health in the context of global and local challenges. A strategy is suggested for employers to deal with the multifaceted workplace pressures and health impacts on employees i.e. implementing an integrative holistic model of workplace health management (workplace health management is an approach to workplace health that includes health promotion, disease prevention, safety management and organizational development). Workplace health management has emerged from the latest developments in the settings approach to workplace health promotion.The changing world of work and the implications on employee health in the current climate of globalization and technological changes is also examined. In particular, it highlights mental health issues associated with the emerging epidemic of work stress from increased workplace pressures.The paper reviews the changing conceptions of the role of employers and contemporary approaches to management practices in a range of disciplines, drawing out the common principles and strategies to respond to changes. One essential message which has emerged from the review is that employers need to become change agents and visionary leaders who adopt a proactive, interdisciplinary and integrative system approach to formulate and develop company policies and workplace culture that facilitates employee participation, professional growth and team work.These contemporary management principles and strategies form the basis of the integrative model for workplace health management presented in this paper. In essence, the integrative model of workplace health management uses a participatory problem solving cycle to identify and address the numerous issues associated with health promotion and disease prevention, occupational safety and hazard reduction, and organizational improvement and human resource management. Specifically this involves the employees and employer participating in a needs-based program development and implementation cycle: identifying health priorities and addressing environmental, organizational, occupational and lifestyle determinants of employee health. The paper concludes with an overview of international development of workplace health management and reports on successful examples from European, Western Pacific and Pan American regions.     

Health and work ability among office workers

OBJECTIVE: To identify dimensions of health associated with work ability and to verify whether such relationships are influenced by demographic or occupational characteristics. METHODS: A cross-sectional study was carried out, including 224 employees of an employee health insurance and retirement savings company in the city of S?o Paulo, Brazil, in 2001. Subjects responded to self-administered questionnaires evaluating demographic and occupational characteristics, job satisfaction, health, and work ability. Associations between variables were measured using Chi-square tests, analysis of variance, and analysis of covariance. RESULTS: Occupational and demographic variables significantly associated with work ability were time in job (p=0.0423) and job satisfaction (p=0.0072). All dimensions of health evaluated were significantly associated with work ability (p<0.0001), and were independent of demographic and occupational characteristics. CONCLUSIONS: Results showed that, independently of other characteristics, better physical and mental health are associated with greater work ability. This provides evidence of the importance of considering health in all its dimensions.     

某油田工人工作心理控制源与职业应激的关系

目的 调查某油田工人工作心理控制源的一般状况及其与职业应激各因素的关系.方法 运用一般调查问卷和职业紧张测量工具对582名油田工人进行调查.结果 年龄≥30岁组与＜30岁组间工作心理控制源评分的差异有统计学意义(t=2.093,P=0.037);外控性强组在人际关系、对人的责任、提升、参与机会、任务一致性、工作自主性、工作挑战性、工作满意感、心理卫生、自尊心、应对策略的评分均低于内控性强组,而在角色模糊、工作前景、抑郁症状、社会支持的评分均高于内控性强组,差异均有统计学意义(P＜0.05).工作心理控制源评分与角色模糊、工作前景、抑郁症状、社会支持呈正相关;与人际关系、提升、参与机会、任务一致性、工作挑战性、工作满意感、心理卫生、自尊心、应付策略呈负相关.多元回归分析,工作心理控制源是工作满意感的主要预测因素.结论 工作心理控制源与职业应激多种因素有相关关系,油田工人中外控性强者比内控性强者经历更多的职业应激.     

某供电企业员工职业卫生知识认知与需求情况

目的调查某供电企业员工对职业卫生知识的认知和需求情况,为有针对性地开展供电作业场所健康促进工作奠定基础。方法随机整群抽取某供电企业400名员工,以调查问卷的方式进行职业卫生相关问题调查。结果员工对《中华人民共和国职业病防治法》知晓率为75．2％;员工对自己所在岗位存在的职业病危害因素知晓率为59．0％;35．2％的员工提出了防止职业病危害的建议措施;员工对职业病及工作相关疾病症状及防治知识的需求率为53．7％。结论员工对职业卫生知识认知度较高,但对职业病及其防治措施知识仍有较大的需求。供电企业应针对员工需求开展职业卫生相关领域知识培训,并进行健康促进干预。     

Towards a better understanding of work participation among employees with common mental health problems: a systematic realist review

ObjectivesCommon mental health problems (CMHP) represent a major health issue and burden to employees and employers. Under certain conditions work contributes to wellbeing and participation of employees with CMHP. Promoting work participation is important, however the specific conditions in which work participation occurs is complex and largely unclear. This calls for a novel, realistic approach to unravel the complex relationship between outcomes, context and underlying mechanisms of work participation.MethodsIn the present realist review, peer-reviewed studies conducted between 1995 and 2020 were systematically reviewed on the outcome measures ’stay at work’ (SAW) and ’work performance’ (WP). The database search from seven databases identified 2235 records, of which 61 studies met the selection criteria and methodological rigor.ResultsThe synthesis demonstrates how work participation is promoted by the following mechanisms and contextual factors: (i) organizational climate and leadership, (ii) social support, (iii) perceived job characteristics, (iv) coping styles, (v) health symptoms and severity, (vi) personal characteristics, and (vii) features of interventions. An explanatory framework, based on the Capability-for-Work model, presents a new set of capabilities leading to SAW and WP.ConclusionsThis systematic realist review revealed mechanisms and contextual factors that promote both SAW and WP among employees with CMHP. These show how the organizational climate, social support in the work context, job characteristics and certain capabilities enable employees with CMHP to participate at work. Our contributions and practical implications are discussed, providing valuable insights for employers, professionals and researchers in the development of evidence-based interventions.     

A review of empirical studies on the model of effort-reward imbalance at work: reducing occupational stress by implementing a new theory

The present study reviews empirical studies of a new occupational stress model of effort-reward imbalance at work to examine its validity as an occupational stress measure and the theory-based intervention approach to occupational stress reduction. The effort-reward imbalance model is valid for demonstrating a stressful work environment that reflects the current labor market and predicts health conditions among a wide range of working populations. The stressful aspects of work measured by the effort-reward imbalance model are different from those shown in the job demand-control model, and the adverse health effects are independent of each other, which suggests that the two models are complementary. The evidence indicates that it is efficient to select psychosomatic symptoms as short-range target outcomes and sick leave as a medium-range target outcome of the theory-based intervention. In addition, it would be preferable to simultaneously measure job satisfaction, morale, motivation, and performance as organizational level outcomes. Although employees engaged in diverse occupations can be target populations, high effectiveness is expected, particularly in service occupations that work shifts. Studies are necessary to determine how long and how intensely interventions are implemented. Target work environments are selected from the perspective of securing or improving employees' sense of fairness and reciprocity by approaching them. Since the theory-based intervention depends largely on organizational changes that are beyond the individual employees' ability, the cooperation of employers is necessary.     

Occupational stress in health service employees.

Levels of occupational stress were examined in 383 employees of various occupations in one health district, as a preliminary to devising a strategy to reduce the negative effects of stress in the workplace. In comparison with white collar and professional workers in industry, health workers reported significantly greater pressure at work, higher ratings of physical and mental ill health, lower job satisfaction, less internal control over their working environment but used more coping strategies. Approximately one in eight of the subjects has stress symptoms of equal magnitude to patients attending clinical psychology outpatient clinics. It was also found that job satisfaction and psychosomatic ill health were related to sickness absence amongst health employees. The implications of these findings and the consequent challenges facing health service managers are discussed.     

An investigation into the effects of vacations on the health status in male white-collar workers

There are many stress factors in occupational settings, and the lack of vacations could be one of factors in the context of work stress. The authors have been studying the relationship between workload and employee health. This time, an investigation into the effects of leisure vacations on worker health status using male white-collar employees aged 20–60 years engaged in a manufacturing company was conducted. The subjects were questioned on work stress factors including vacations and modifiers in their occupational settings, and on psychological and physiological stress reactions; that is, how often they were able to take leisure vacations every year, their average working hours a day and work stress factors from the Demand-Control-Support model. The questions also examined other factors concerning the employees such as type-A behavior and lifestyles as modifiers, diseases of the employees, physical complaints, feelings about sleep, perceived stress, job and life satisfaction, and stress reactions as measured by physiological examination. Correlation and logistic regression analysis were conducted with the 551 eligible subjects. The results were as follows: Leisure vacation was decreasingly related to some of psychological stress reactions after adjustment was made for working hours and for modifiers. Less vacation was increasingly related to the workers’ diseases especially among the employees aged 20–34, though the association was not statistically significant. Vacations did not show obvious association with physiological measures. These findings demonstrate the effectiveness and possibility of leisure vacation in controlling fatigue and maintaining the health of workers. Vacation should always be taken into consideration as a stress factor in a survey of the health problems of white-collar workers.     

石油作业工人心理健康状态与工作能力关系的研究

目的：研究石油作业工人心理健康状态与工作能力的关系。方法：抽取122个不同工种石油作业工人1230人，填写职业紧张调查问卷（OSQ）、SCL－90和工作能力指数（WAI）问卷表。结果：心理健康状态与工作能力呈明显负相关，工作满意度与工作能力呈明显正相关。缺勤率有随职业紧张水平的增加而增加的趋势。结论：职业紧张所致工人心理状态的变化业已影响到作业工人的工作能力。     

Job stress, ill health and job satisfaction among health service employees.

The study examined the effects of occupational stressors, perceived locus of control, Type A behaviour pattern and use of coping strategies on well-being and job satisfaction of 1,176 health service employees. Several stressors were identified as having a negative impact on health and job satisfaction although these differed between the various occupational groups included in the study. The interactionist model of stress used in the study, and the diagnostic tool used (the Occupational Stress Indicator) proved to be useful in suggesting means of intervening to reduce ill health and increase job satisfaction among health service employees.     

综合性职业卫生服务模式实践效果分析

目的探索综合性职业卫生服务模式对于电池厂铅污染的控制效果。方法以某铅酸电池厂为实践对象,制定和实施综合性工作场所环境改善措施、铅作业员工健康促进措施,分析干预前、后作业场所空气中铅浓度、员工职业卫生相关知识知晓率、个人防护用品使用情况及血铅浓度的变化。结果通过综合干预,工人铅中毒相关知识知晓率有所提高。干预后车间空气中铅浓度下降,工人血铅浓度下降（P〈0．01）。结论综合性职业卫生服务对于降低蓄电池厂的铅污染具有较好效果,对合适的企业可以选择使用。     

Burnout and occupational stress in nurses

BACKGROUND: In the last few years there has been a growing interest in the psychosocial work environment of health care workers, since they are both at high risk of burnout, role conflict and job dissatifaction. Burnout, as a type of prolonged response to chronic job-related stress, has a special significance in health care settings, where staff experience both psychological--emotional and physical stress. OBJECTIVES: The present study investigated the interrelationship between burnout, occupational stress and personality characteristics in a sample of 120 nurses employed in the Infectious Diseases Department and the Department of Medical Oncology of two major hospitals in Messina, Italy. METHODS: Three questionnaire surveys were administered: The Maslach Burnout Inventory (MBI) to estimate the job stress level, Occupational Stress Inventory to measure occupational stress and the Comrey Personality Scale to identify major personality characteristics. RESULTS: The results showed a significant statistical diference regarding the burnout levels in the two groups under study, with a higher burnout level in the Medical Oncology staff with respect to the Infectious Diseases Staff. The latter group also showed a higher occupational stress compared to the second group, with a significant statistical difference regarding "stress sources", coping strategies" and psychological health". Concerning the CPS results, some personality characteristics, as predictors for burnout syndrome, were found in the Medical Oncology staff. CONCLUSIONS: The study results underline the importance of the role ofpsychosocial work environment and the interrelationships between burnout, occupational stress and psychosomatic health in health care workers. In addition, in order to reduce a burnout risk, the Authors suggest improving the psychosocial work environment as a preventive measure.     

Occupational stress and work-related upper extremity disorders: concepts and models

BACKGROUND: While research has suggested that interventions targeted at occupational stress (job stress) factors may improve clinical and work outcomes related to work-related musculoskeletal disorders, the emerging hypotheses relating occupational stress to work-related upper extremity disorders (WRUEDs) are not particularly well known among occupational health providers and researchers. METHODS: Generic job stress and health models and multivariable models of WRUEDs were described and evaluated. RESULTS: Models on occupational stress and health/WRUEDs offer unique perspectives on the role of occupational stressors on WRUEDs. However, the limited support for the structure and proposed mechanisms of these models suggest that investigations examining and validating proposed biobehavioral pathways are still needed. DISCUSSION: Difficulties in conceptualizing occupational stress have, in the past, hindered its systematic incorporation into occupational health research and prevention/intervention strategies. The present paper provides a common basis for researchers and practitioners with diverse backgrounds to understand job stress and its relation to WRUEDs in order to enhance future efforts. Given the present limitations in the field and the need for comprehensive approaches to WRUEDs, there is great potential for occupational health researchers and clinicians to advance knowledge in this area.     

Developing programmes to achieve a healthy society: creating healthy workplaces in Northern Ireland

Healthy workplaces help to prevent occupational disease and injury as well as promoting positive healthy lifestyle behaviours. The concept of creating healthy workplaces through workplace health promotion has been identified as a legitimate area of activity for public health policy in Northern Ireland, supporting as it does, the settings approach as a means of improving the health and well-being of the population at large. Benefits accrue to businesses, organizations and individuals from the enhancement of positive healthy lifestyle messages in addition to reinforcing the principles of good occupational health practices. Developing a framework for the creation of healthy workplaces is part of a joint initiative between the Northern Ireland Health Promotion and Health and Safety Agencies. Commitment to delivering the concept is required from all the key players who include: employers, employees, trade union groups and health and safety professionals. A healthy workplace model needs to be created which is flexible and adaptable to suit all types of business and in particular the needs of small businesses which predominate in Northern Ireland. The principles underpinning the Business Excellence Model may be a useful vehicle for delivering workplace health promotion onto an organization's agenda.     

Lifestyle, stress and work: Strategies for health promotion

Much work today inhibits positive health practices. To be successful,workplace health promotion strategies must focus on the natureof the work itself, as well as upon the worker. Approaches tolifestyle-change range from changes in legislative policy, asin Norway, to community health education, organizational development,occupational safety and health and, increasingly in the U.S.and Canada, worksite wellness programmes. Contrasts betweenthe European and North American approaches to lifestyle, stressand work are apparent. European efforts are often directed towardsstructural and legislative changes. Unions, rather than topmanagement, have taken the lead. The primary focus has beenupon stressors–toxic chemicals, work design, man-machinesystems. In contrast, North American efforts have generallybeen initiated by senior management, and have focussed on changesin personal health practices such as cigarette smoking, nutrition,exercise, and stress management. These contrasts will blur asmanagement and labour begin to collaborate on the developmentand implementation of comprehensive health promotion programmes.The paper concludes with examples of some successful programmesand recommendations for would-be programme developers.     

Systolic blood pressure in relation to occupation and perceived work stress

This paper outlines the methods used in a five-year prospective study of 4,607 Australian government employees and presents initial cross-sectional results examining associations between systolic blood pressure, occupation, and subjects' perceptions of work stress as ascertained in a questionnaire survey. The questionnaire items were grouped by means of principal component analysis into six factors representing adverse job characteristics. There were appreciable occupational differences in the mean scores for all six factors and in systolic blood pressure. The differences in systolic blood pressure among men from different occupational categories could not be explained by variation in the level of occupational stress perceived and reported by the subjects. Age, occupation, body mass index, and level of perceived stress arising from financial problems were significantly associated with systolic blood pressure level. A multiple linear regression model was used to determine the relationship between systolic blood pressure, age, and occupation after adjustment for the effects of the other variables.     

某热电厂工人自尊感与职业紧张相关因素的关系

[目的]探讨热电厂工人自尊感与职业紧张相关因素的关系。[方法]采用整群抽样方法对某热电厂875名工人进行调查,用职业紧张测量工具、工作内容问卷和付出-回报失衡问卷等测试电厂员工的自尊感、职业紧张因素、紧张反应、个体特征、应付策略和社会支持。[结果]不同性别、文化程度、婚姻状况、吸烟、饮酒、年龄和工龄组间自尊感评分比较,差异无统计学意义（P〉0.05）。相关分析结果表明,自尊感与提升机会、决定水平、工作稳定、回报、心理卫生、正性情绪、工作满意感、上级支持及同事支持呈正相关（P〈0.01或P〈0.05）,与角色模糊、角色冲突、工作前景、躯体需求、负性情绪、抑郁症状、每日紧张感和工作心理控制源呈负相关（P〈0.01或P〈0.05）。方差分析结果显示,自尊感评分低、中、高水平组间提升机会、决定水平、工作稳定性、回报、心理卫生、正性情绪、工作满意感、上级支持、同事支持、控制策略和支持策略、角色冲突、角色模糊、工作前景未知性、躯体需求、工作心理控制源、抑郁症状、负性情绪评分差异具有统计学意义（P〈0.001或P〈0.05）。多因素logistic回归分析结果表明,高自尊感可减少心理健康不佳、抑郁症状和每日紧张感的发生（OR值=0.162~0.340）。[结论]自尊感与职业紧张因素、缓解因素和紧张反应的感知有关,增加自尊感可减少职业紧张。