Study of the validity of a job-exposure matrix for psychosocial work factors: results from the national French SUMER survey

Objective  To construct and evaluate the validity of a job-exposure matrix (JEM) for psychosocial work factors defined by Karasek’s model using national representative data of the French working population. Methods  National sample of 24,486 men and women who filled in the Job Content Questionnaire (JCQ) by Karasek measuring the scores of psychological demands, decision latitude, and social support (individual scores) in 2003 (response rate 96.5%). Median values of the three scores in the total sample of men and women were used to define high demands, low latitude, and low support (individual binary exposures). Job title was defined by both occupation and economic activity that were coded using detailed national classifications (PCS and NAF/NACE). Two JEM measures were calculated from the individual scores of demands, latitude and support for each job title: JEM scores (mean of the individual score) and JEM binary exposures (JEM score dichotomized at the median). Results  The analysis of the variance of the individual scores of demands, latitude, and support explained by occupations and economic activities, of the correlation and agreement between individual measures and JEM measures, and of the sensitivity and specificity of JEM exposures, as well as the study of the associations with self-reported health showed a low validity of JEM measures for psychological demands and social support, and a relatively higher validity for decision latitude compared with individual measures. Conclusion  Job-exposure matrix measure for decision latitude might be used as a complementary exposure assessment. Further research is needed to evaluate the validity of JEM for psychosocial work factors.     

Importance of psychosocial work factors on general health outcomes in the national French SUMER survey

AIM: To examine the associations between psychosocial work factors and general health outcomes, taking into account other occupational risk factors, within the national French working population. METHODS: The study was based on a large national sample of 24 486 women and men of the French working population who filled in a self-administered questionnaire in 2003 (response rate: 96.5%). Psychosocial work exposures included psychological demands, decision latitude, social support, workplace bullying and violence from the public. The three health indicators studied were self-reported health, long sickness absence (>8 days of absence) and work injury. Adjustment was made for covariates: age, occupation, work status, working hours, time schedules, physical, ergonomic, biological and chemical exposures. Men and women were studied separately. RESULTS: Low levels of decision latitude, and of social support, and high psychological demands were found to be risk factors for poor self-reported health and long sickness absence. High demands were also found to be associated with work injury. Workplace bullying and/or violence from the public also increased the risk of poor health, long sickness absence and work injury. CONCLUSION: Psychosocial work factors were found to be strong risk factors for health outcomes; the results were unchanged after adjustment for other occupational risk factors. Preventive efforts should be intensified towards reducing these psychosocial work exposures.     

职业伤害与社会经济影响因素的关系

目的　分析化工行业职业伤害的社会经济影响因素。方法　采用 1∶2配对病例对照研究 ,应用单因素条件Logistic回归、主成分分析以及主成分条件Logistic回归对病例与对照的有关社会经济影响因素进行统计分析。结果　单因素分析结果有显著性意义的变量为年龄、性别、文化程度、就业类型、技术等级、就业地点、工作变换、月均工资、家庭年收入、企业规模、企业性质、安全防护设备、安全操作规程和安全教育制度。主成分分析提取的 4个主成分较好地反映了原 11个指标的信息 ,累计贡献率为 77.36 %。第一主成分解释了原变量信息的 4 6 .6 9% ,是职业伤害的指示因子 ,第二主成分是职业活动因子 ,第三主成分是工作稳定性因子 ,第四主成分是性别因子。多因素条件Logis tic分析结果显示 ,第一、第二主成分有显著性意义 (P <0 .0 1) ,在众多原变量影响因素中 ,作用较明显的因素有性别、就业类型、经济收入、企业规模和企业性质等。结论　职业伤害的社会经济影响因素较多且相互作用。职业伤害的防治应从加强安全生产教育、增强职工自我保护意识和提高企业经营者的生产安全意识等方面综合考虑。     

某泵类加工企业2010-2012年职业病危害因素检测及职业健康检查结果分析

目的了解某泵类加工企业职业病危害情况,为职业病的防治工作提供科学依据。方法对2010-2012年该企业职业病危害因素检测与健康检查情况进行统计分析。结果工作场所职业病危害因素检测合格率为91.67%,其中,二甲苯、木粉尘的短时间接触浓度超标、噪声无齿锯岗位超标;职业健康体检异常率随年龄的增加而上升。结论职业病危害不容忽视,企业应加强原辅料和通风设施的改进,注重生产设备的维护保养,提高个人防护用品的有效使用,真正做到保护劳动者健康权益。     

Patient cost sharing and social inequalities in access to health care in three western European countries

This study evaluates the association between social class and health services use in France, Germany and Spain, three countries with universal health coverage but with different cost-sharing systems. In France, patients share the cost of both physician visits and hospitalization, in Germany they share the cost of hospitalization, and in Spain there is no system of patient cost sharing. The data were obtained from national health surveys carried out in each of these countries during the last decade of the 20th century. We found that persons belonging to a low social class had fewer physician visits than those belonging to a high social class in France, whereas the opposite occurred in Germany and Spain. After adjusting for a measure of the need for health care, the results in France changed little, whereas no significant differences by social class were seen in Germany and Spain. Persons of low social class had more hospital admissions than those of high social class in France and Spain, while no statistically different differences were seen in Germany. After adjusting for need, no significant differences were seen in any of the three countries. Although other factors related with the structure of the health system can not be ruled out, our findings suggest that patient cost sharing reduces the frequency of physician visits and that this decrease is greater in the low social classes, whereas the effect of co-payment for hospitalization on the frequency of hospital admission is not clear.     

Contribution of occupational factors to social inequalities in self-reported health among French employees

Objectives

Social inequalities in health have been widely demonstrated. However, the mechanisms underlying these inequalities are not completely understood. The objective of the study was to examine the contribution of various types of occupational exposures to social inequalities in self-reported health (SRH).

Methods

The study population was based on a random sample of 3,463 men and 2,593 women of the population of employees in west central France (response rate: 85–90 %). Data were collected through a voluntary network of 110 occupational physicians in 2006–2007. Occupational factors included biomechanical, physical, chemical and psychosocial exposures. All occupational factors were collected by occupational physicians, except psychosocial work factors, which were measured using a self-administered questionnaire. Social position was measured using occupational groups.

Results

Strong social gradients were observed for a large number of occupational factors. Marked social gradients were also observed for SRH, manual workers and clerks/service workers being more likely to report poor health. After adjustment for occupational factors, social inequalities in SRH were substantially reduced by 76–134 % according to gender and occupational groups. The strongest impacts in reducing these inequalities were observed for biomechanical exposures and decision latitude. Differences in the contributing occupational factors were observed according to gender and occupational groups.

Conclusion

This study showed that poor working conditions contributed to explain social inequalities in SRH. It also provided elements for developing specific preventive actions for manual workers and clerks/service workers. Prevention towards reducing all occupational exposures may be useful to improve occupational health and also to reduce social inequalities in health.     

The contribution of job characteristics to socioeconomic inequalities in incidence of myocardial infarction

The current study estimated the contribution of job characteristics to socioeconomic inequalities in incidence of myocardial infarction (MI) during a 12-year follow-up period. Data were from the working population (aged 25-64 years) in the Netherlands longitudinal GLOBE study (N=5757). Self-reported information was available from baseline measurement (in 1991) for education, occupation, job demand, job control, fear of becoming unemployed, adverse physical working conditions, and smoking and alcohol use. Information on hospital admissions for MI among study participants was available until 2003, and was linked to baseline data via record linkage. Cox regression analyses were performed to estimate the hazard of MI in different socioeconomic groups before and after adjustment for job characteristics and health-related behaviours. Lower educated and manual workers had a higher risk of MI during follow-up, after adjusting for age, sex and marital status than higher educated and non-manual workers, respectively. After adjustment for occupation, the lowest educated still had an elevated risk of MI. After adjustment for education, no significant association of occupation with MI was observed. Job control and adverse physical working conditions were not significantly associated with MI after adjustment for socioeconomic position. These results suggest that the reduction of the socioeconomic position-MI association after adjustment for the two specific job characteristics reflect the effect of other unobserved factors closely related to both socioeconomic position and job characteristics. The results of this study point toward education as being the stronger predictor of hospital admitted MI, compared to occupational position and job characteristics, in the Dutch working population.     

A national survey of psychosocial job stressors and their implications for health among working people in Taiwan

Objectives: The prevalence of job stress, distributions of major job stressors, and the associations of job stress with multiple self-reported health complaints were examined in a national survey conducted in 1994 in Taiwan. Methods: A total of 9,746 men and 5,599 women who were employed at the time of the survey and aged between 25 and 65-years were studied. Information on employment status, perceived level of job stress, major job stressors, and health complaints were obtained by a self-administered questionnaire. Results: Overall, 7.6% of men and 6.5% of women reported often or always feeling very stressed at work. Higher levels of perceived job stress were found among subjects who were younger, with higher education level, working in a larger firm, working for longer hours per week, and who were administrators or managers. Problems with individual job content were ranked as the most important job stressor in men across all employment categories and in most women. Other major job stressors included problems with monetary rewards and lack of career prospects. The patterns of major job stressors appear to vary by employment grade and by gender. After adjustment for age and education, employees who perceived higher levels of job stress had significantly increased risks of multiple health problems, including strained eyes, ringing ears, chronic cough with phlegm, chest tightness, stomach problems, headache, and musculoskeletal discomfort. Conclusions: These results suggest that psychosocial stress in the workplace has profound impacts on health. This study identified high-risk groups and major types of job stressors for further investigation. Received: 18 August 2000 / Accepted: 7 May 2001     

2019—2021年淄博市重点职业病监测与职业健康风险分析

目的 分析淄博市2019—2021年重点职业病监测和工作场所职业病危害因素监测结果,为制定和调整本市重点职业病防治策略提供技术参考。方法 通过相关监测信息系统收集淄博市2019—2021年重点职业病监测和工作场所职业病危害因素监测数据,用率、构成比和χ²检验进行描述性分析重点监测职业病危害作业劳动者体检情况、企业现场危害因素检测情况、职业病报告情况。结果 2019—2021年淄博市存在重点监测的职业病危害因素的企业24 384家,监测接害劳动者457 899人次,接受职业健康检查331 706人次,实检率为72.44%(331 706/457 899),其中疑似职业病检出率为0.03%(92/331 706),各职业病危害因素可能导致的疑似职业病检出率差异有统计学意义(χ²危害=271.400,P_危害<0.001),但年度变化趋势不显著(趋势χ²年度=0.000,P_年度=0.991);职业禁忌证检出率为2.20%(7 308/331 706),各职业病危害因素接触劳动者禁...     

Listening to the rural health workers in Papua New Guinea - the social factors that influence their motivation to work

Despite rural health services being situated and integrated within communities in which people work and live, the complex interaction of the social environment on health worker motivation and performance in Low Middle Income Countries has been neglected in research. In this article we investigate how social factors impact on health worker motivation and performance in rural health services in Papua New Guinea (PNG). Face-to-face in-depth interviews were conducted with 33 health workers from three provinces (Central, Madang, and Milne Bay) in PNG between August and November 2009. They included health extension officers, community health workers and nursing officers, some of whom were in charge of the health centres. The health centres were a selection across church based, government and private enterprise health facilities. Qualitative analysis identified the key social factors impacting on health worker motivation and performance to be the local community context, gender roles and family related issues, safety and security and health beliefs and attitudes of patients and community members. Our study identified the importance of strong supportive communities on health worker motivation. These findings have implications for developing sustainable strategies for motivation and performance enhancement of rural health workers in resource poor settings.     

The lack of social gradient of health behaviors and psychosocial factors in Northern Italy

Summary. Objectives: To examine inequalities in health behaviors and psychosocial factors in Northern Italy.Methods: The study was based on a computer-assisted telephone interview (CATI) of 4 002 non-institutionalized adults living in the Veneto region of Italy.Results: Cigarette smoking, binge drinking, fruit and vegetables consumption and stress failed to show a social gradient. Only physical activity was significantly associated with social class. Stress was a significant predictor of physical inactivity, smoking and low fruit and vegetable intake. Lack of emotional support was associated with smoking and physical inactivity among males, and low fruit and vegetable intake for both genders.Conclusions: Three proposed explanations may account for the lack of consistent social gradient of health behaviors in Northern Italy: a) socio-economic context; b) uncompleted epidemiological transition of behavioral risk factors across social classes; c) lack of systematic health promotion efforts. Future research is needed to examine the plausibility of such explanations.

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Zusammenfassung. Das Fehlen eines Sozialgradienten bei Gesundheitsverhalten und psychosozialen Faktoren in NorditalienFragestellung: Untersuchen der Ungleichheiten von Gesundheitsverhalten und psychosozialen Faktoren in Norditalien.Methoden: Die Studie basierte auf 4002 computerassistierten Telefoninterviews (CATI) mit Erwachsenen, die nicht in Institutionen leben, in der Veneto-Region in Italien.Ergebnisse: Für Zigarettenrauchen, exzessiven Alkoholkonsum, Frucht- und Gemüseverzehr und Stress liess sich kein Sozialgradient erkennen. Einzig bei physischer Aktivität zeigte sich ein signifikanter Zusammenhang mit sozialer Klasse. Stress war hingegen ein signifikanter Prädiktor für körperliche Inaktivität, Rauchen und kleinen Frucht- und Gemüseverzehr. Mangel an emotionaler Unterstützung stand in Zusammenhang mit Rauchen und körperlicher Inaktivität bei Männern und geringer Frucht- und Gemüseeinnahme bei beiden Geschlechtern.Schlussfolgerungen: Drei konkurrierende Erklärungen können das Fehlen eines Sozialgradienten bei Gesundheitsverhalten in Norditalien begründen: a) der sozioökonomische Kontext; b) unvollständige epidemiologische Durchdringung von Verhaltensrisikofaktoren aller sozialer Klassen; c) Mangel an systematischen Bestrebungen in der Gesundheitsförderung. Weitere Forschung ist erforderlich, um die Plausibilität solcher Erklärungen zu untersuchen.

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Résumé. Manque de gradient social pour les comportements en matière de santé et les facteurs psychosociaux en Italie du NordObjectifs: Examiner les inégalités face aux comportements de santé et aux facteurs psychosociaux en Italie du Nord.Méthodes: L’étude a interrogé par téléphone (Computer Assistsed Telephone Interview (CATI)) 4 002 adultes non institutionnalisés et vivant dans la région italienne de la Vénétie.Résultats: Le tabagisme, l’alcoolisation excessive, la consommation de fruits et légumes ainsi que le stress n’ont pas montré de gradient social. Seule l’activité physique était significativement associée avec la classe sociale. Le stress était un prédicteur significatif de l’inactivité physique, du tabagisme et d’une consommation limitée de fruits et de légumes. Le manque de support émotionnel était associé avec le tabagisme et avec l’inactivité physique chez les hommes, ainsi qu’avec une consommation limitée de fruits et de légumes chez les deux sexes.Conclusions: Trois explications complémentaires pourraient expliquer cette absence de gradient social des comportements de santé en Italie du Nord: a) le contexte socio-économique, b) le fait que la transition épidémiologique des facteurs de risques comportementaux ne soit pas encore achevée à travers toutes les classes sociales, c) un manque d’efforts systématiques en promotion de la santé. Des recherches supplémentaires sont nécessaires pour corroborer ou non ces potentielles explications.

     

The influence of psychosocial factors at work and life style on health and work ability among professional workers

OBJECTIVES: The purpose of this article is to explore the associations of psychosocial factors at work, life style, and stressful life events on health and work ability among white-collar workers. METHODS: A cross-sectional survey was conducted among workers in commercial services (n = 1141). The main outcome variables were work ability, measured by the work ability index (WAI), and mental and physical health, measured by the Short-Form Health Survey (SF-12). Individual characteristics, psychosocial factors at work, stressful life events, and lifestyle factors were determined by a questionnaire. Maximum oxygen uptake, weight, height, and biceps strength were measured during a physical examination. RESULTS: Work ability of white-collar workers in commercial services industry was strongly associated with psychosocial factors at work such as teamwork, stress handling, and self-development and, to a lesser extent, with stressful life events, lack of physical activity, and obesity. Determinants of mental health were very similar to those of work ability, whereas physical health was influenced primarily by life style factors. With respect to work ability, the influence of unhealthy life style seems more important for older workers, than for their younger colleagues. CONCLUSION: Among white-collar workers mental and physical health were of equal importance to work ability, but only mental health and work ability shared the same determinants. The strong associations between psychosocial factors at work and mental health and work ability suggest that in this study population health promotion should address working conditions rather than individual life style factors.     

Behavioural and structural factors in the explanation of socio-economic inequalities in health: an empirical analysis

The aim of this study was to investigate the importance of ‘cultural/behavioural’ and ‘materialist/structuralist’ explanations for socio-economic inequalities in health, and to examine the interrelationship between them. We used data from a survey among a sample of the population in the southeastern part of the Netherlands. When analysed separately, both behavioural and structural factors contributed substantially to observed inequalities in health. In a simultaneous analysis, both groups of factors had a substantial part of their contribution in common. We denned the overlap as an indirect contribution of structural conditions, through behaviour. If that overlap is ignored, this could lead to an overestimation of the behavioural explanation. In our analysis, the total (direct plus indirect) contribution of structural factors is larger than that of behavioural factors. However, because of, in particular, the cross-sectional character of the data, these analyses must not be considered a final answer as to the question of the relative contribution of behavioural and structural factors. Instead, they are an illustration of the way their importance could be assessed, taking the effect of structural conditions on lifestyle into consideration.     

Social capital in its place: using social theory to understand social capital and inequalities in health

Social capital has been controversially linked to public health benefits, particularly as an explanation for the relationship between economic inequalities and health. This paper focuses on social capital in this context, particularly a recent emphasis on social capital in neighbourhoods and growing use of Bourdieu's social theory in empirical investigations. A review of some of this work is used to suggest the need for a more coherent theoretical approach to using Bourdieu and to introduce an ethnographic study of social connections in New Zealand. Forty-six residents of, a rural town, a deprived city suburb, or an affluent suburb, volunteered to be interviewed about their social connections. Their talk was transcribed and analysed in terms of everyday practice. The results of this study suggest that social connections are not necessarily located in neighbourhoods, and that social capital will be better understood in a broader social context which includes competition for resources between deprived and non-deprived groups, and the practices of all citizens across neighbourhoods. When considering social capital, an exclusive focus on deprived neighbourhoods as sites for research and intervention is not helpful.     

Measuring inequalities in health: an analysis of mortality patterns using two social classifications

The paper investigates relationship between mortality and social class as measured by the Erikson-Goldthorpe schema, a validated measure of employment conditions, and compares this with differentials found using the Registrar General's social classes. Two cohorts of men aged 15/16–64 were drawn from the OPCS Longitudinal Study for 1971 and 1981. Mortality differences between social classes were estimated using deaths occurring between 1976 and 1980 in the first cohort and 1986 and 1989 in the second. The two classification were formally compared by means of the Relative Index of Dissimilarity and a likelihood-based statistic. Similar mortality differentials were found using both classifications in the two time periods. The Erikson-Goldthorpe schema showed a clear pattern of higher mortality in those groups without a career structure and with lower discretion over their work. The paper concludes that inequalities in health are seen when a validated social class schema based on employment conditions is used. The use of validated measures will make it possible for health differences to be more clearly interpreted in policy terms.     

某固体废弃物填埋场的职业有害因素及对从业人员健康的危害

目的 分析某大型固体废弃物填埋场的职业有害因素及其对从业人员健康的危害.方法 按国家相关标准方法测定固体废弃物填埋作业场所粉尘、有害气体和物理性有害因素,连续2年进行填埋场作业人员的一般体检和肺功能测定、听力检查、神经系统及嗅觉检查,测定尿样中铅、镉和汞含量,采用彗星试验方法测定作业人员外周血淋巴细胞DNA损伤.结果 固体废弃物填埋场主要职业有害因素为粉尘、有害气体、高温和噪声.其中,某些作业岗位氧化物、一氧化碳、噪声和夏季气温超过国家职业卫生接触限值.对作业人员健康状况分析显示,一线工人和现场技术管理人员的呼吸道炎症患病率为21.1%,肺功能下降率为11.5%,明显高于行政管理人员(7.1%和0),差异有统计学意义(P＜0.05);一线工人和现场技术管理人员出现神经系统异常的百分率为50.0%,明显高于行政管理(26.7%),差异有统计学意义(P＜0.05).10.3%的推土机司机由于长期接触高强度噪声引起听力下降.此外,外周血淋巴细胞DNA损伤者中75%是一线工人.结论 固体废弃物填埋行业的职业危害因素对作业人员存在明确的健康危害,应加强防护.

Abstract：

Objective To determine occupational hazards in work sites of a large solid waste landfill and analyze their adverse health effects. Method The national standardized detection methods were used to determine dust concentration, harmful gas and physical factors in worksites. Routine physical examination,pulmonary function, hearing tests and nervous system test were performed in workers for 2 consecutive years.Urine lead, cadmium and mercury contents were detected. The comet assay was use to measure DNA damage in peripheral blood lymphocytes among workers. Result The main occupational hazard factors in this solid landfill are dust, harmful gas, high temperature and noise. The oxides, carbon monoxide, and noise and high temperatures in summer at some work sites exceeded the national occupational exposure limits. The prevalence of respiratory inflammation and rate of pulmonary function decrease among front-line workers and on-site technical managers are 21.2% and 11.5%, which are significantly higher than those among administrative staff (7.1% and 0)(P＜0.05). Nervous system abnormalities rate of front-line workers and on-site technical managers was 50.0%, which is significantly higher than that (26.7%) of administrative staff (P＜0.05). Because of long-term exposure to high intensity noice, hearing loss rate of bulldozer drivers was 10.3%. In addition, about 75% of workers with DNA damage in peripheral blood lymphocyte are front-line workers. Conclusion Adverse health effects from occupational hazards were observed among workers in this solid waste landfill.