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Work and organisational and psychosocial factors II


V. Rini, K. Philippe, M. Ina, G. Inge, V. Isolde, B. Lutgart.Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium

Background: Several epidemiological studies indicate a number of health risks in shift workers. New legislation in Belgium regarding a more stringent and intensified medical occupational surveillance of night and shift workers implies a greater focus on these health risks. Until now, few studies in Belgium have investigated the interaction between changed sleep patterns in these populations and (subjective) health.

Methods: A sample of 119 male shift workers received a self-administered questionnaire, of which 113 workers completed the questionnaire under the guidance of the company doctor or nurse, during working hours. The questionnaire contained, besides a number of general demographic and health parameters, two international standardised sleep questionnaires: the PSQI (Pittsburgh Sleep Quality Index) and the ESS (Epworth Sleeping Scale). The subjective health parameters were dichotomised and evaluated in relation to the tertiles of the scores of the two sleeping scales. Odds ratios (OR) were calculated with a 95% confidence interval (CI).

Results: Mean age was 37.0 years (SD 9.11). The average working time in a shift system was 13.1 years (SD 8.1). 43.8% of the workers smoked and average coffee intake per shift was 3.5 cups. The average PSQI was 7.89 (SD 3.18). The average ESS was 8.56 (SD 4.36). With regard to the PSQI: comparing the third tertile (T3) to the first (T1), logistic regression showed significant odds ratios for PSQI regarding stomach problems (OR = 4.19), musculoskeletal problems (OR = 3.76), fatigue (OR = 40.25), waking up tired (OR = 15.61), having trouble concentrating (OR = 10.43), and stress (OR = 6.18). With regard to the ESS: comparing T3 to T1, logistic regression only showed significant odds ratios for ESS regarding fatigue (OR = 8.80) and waking up tired (OR = 2.92).

Conclusion: In this small population, the sleep quality is quite poor and there is a (associated) high sleep propensity. Indicators of a poor sleep coincide with a significant higher number of subjective health complaints, parallel to what has been found in international studies. These findings stress the importance of health promotion in shift workers, in general and specifically with regard to their sleep quality.


K. Azam1, M. Pourmahabadian2, A. Rezaeian2.1Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran; 2Occupational Health Department, School of Public Health, Tehran University of Medical Sciences, Tehran

Introduction: Work related stress is a major health and safety issue. This type of stress is the result of a conflict between the role and needs of the individual employee and organisational, personal, or ergonomic factors in their workplace. There can also be an unacceptable tension between the demands of work and the individual’s life outside work. Stress is also often typified by a lack of control over conditions at work.

Methods: In this study a stress questionnaire improved and was used among 164 male workers (56 workers in day shift and 108 in rotational shift) in a vegetable oil production industry sections which include can making, packaging, storage, treatment facilities, energy supply, repair and maintenance, extraction, control, administrative, and facility services. This questionnaire contains 56 questions about factors such as personal characteristics and identities, family, workplace, economical, and sociocultural. Collected data were classified based on age, work experience, type of employment, shift working, marital status, and then statistically analysed by SPSS software package.

Results: The results of this study showed that 29.26% of workers were aged 36–40 years old, of whom 75% were married and 31.09% had 6–10 years’ work experience. In addition, frequency of rotational shift workers is 67%. It is found that the stress prevalence among all 164 staff is 91.5% in which official staff has 92.5% stress, while stress prevalence of 89.2% belongs to contract staff. Statistical Pearson correlation test results revealed that there is a significant difference between stress and age (r = 0.667, p<0.001) as well as between stress and work experience (r = 0.649, p<0.001). Also, significant differences were observed between stress in day shift and rotational shift workers (t = 2.77, p<0.007) and type of employment (t = 8.39, p<0.001) as well. Furthermore, no significant difference exists between types of work, stress effect level on work function with stress in all staff by ANOVA test. But significant differences found between stress and work sections in energy supply workers and can maker, packagers, controllers, repair and maintenance workers (p = 0.017, p = 0.021, p = 0.041, and p = 0.040, respectively) as well as between can makers and packagers with storage workers (p = 0.035 and p = 0.046, respectively). Finally, significant differences were observed between stress effect level on work function and work sections in energy supply workers and can makers, packagers, controllers, repair and maintenance workers (p = 0.016, p = 0.017, p = 0.025, p = 0.030) as well as in can makers and packagers with extractors (p = 0.041 and p = 0.043, respectively) in statistical t test.

Conclusion: This study highlighted that there is a direct relation between age, work experience, effects on work function, and shift working with stress. In addition, stress in day workers, married workers, and contract workers is more than rotational shift workers, singles, and official workers, respectively.


R. Toral-Villanueva1, G. Aguilar-Madrid2.1Zonal General Hospital 32 Villa Coapa, Mexican Institute of Social Security, Mexico; 2Occupational Health Coordination, Mexican Institute of Social Security, Mexico

Introduction: Burnout is associated with decreased job performance and commitment among medical professionals, but little is known about this syndrome in medical residents and its relation to patient care. The aim of this study was to investigate the burnout prevalence among residents and determine its relation to self-reported patient care practices and attitudes.

Methods: A cross sectional study was done from September 2003 to January 2004, in residents of three National Health System’s medical centers in Mexico City. Two questionnaires were carried out: Maslach Burnout Inventory (MBI), to measure burnout, which was defined as scores in the high range in the depersonalisation (DP) and the emotional exhaustion (EE) subscales; and other questionnaire which included questions to find different suboptimal practices and attitudes related to patient care; also, depression, drugs and alcohol use, smoking, and other residents’ demographic characteristics. Factorial analyses were performed; also, univariate analysis and ANOVA. A logistic regression model also was built.

Results: 312 residents participated: 177 (57%) were male (mean age 28.5 years, SD 2.51; range 20–42 years). The factorial analyses demonstrated that both questionnaires (MBI and suboptimal practices and attitudes) were valid (correlations>0.40). The prevalence of burnout was 40% (126 residents). Among them, 51 (40%) had high scores in both EE and DP subscales; 48 (38%) only in the EE subscale and 27 (22%) only in the DP subscale. Burned out residents had a higher risk to present suboptimal patient care practices monthly (OR = 5.5, p<0.001, 95% CI 2.7 to 11.2) and weekly (OR = 5.2, p = 0.005, 95% CI 1.6 to 16.3). Workdays >12 hours were associated to suboptimal practices (OR = 3.8, p<0.001: 95% CI 1.9 to 7.5). There was not colinearity between the variables. The logistic regression model included workdays >12 hours, current depression, former major depression, 1st and 2nd year resident, sex (male), civil state (single).

ResultsConclusions: Burnout was common among these medical residents. Workdays >12 hours are a risk factor for burnout in residents, and this syndrome impacts negatively in patient care. Further investigation of the causes, effects, prevention, and management of burnout in resident physicians is needed.


M. Cifuentes, L. Punnett, R. Gore, J. Boyer, J. Tessler, A. D’Errico.Department of Work Environment, University of Massachusetts Lowell, Massachusetts, USA

Introduction: An epidemiological study is underway of working conditions and health outcomes in relation to socioeconomic status (SES). A questionnaire about health and work was distributed in three participating healthcare facilities The response rate decreased with decreasing SES. SES might be serving as a proxy for working conditions; in particular, a more exhausted and busy worker would not have the disposition or opportunity to answer a survey. However, we have found no epidemiological literature about the impact of working conditions on the probability of answering a survey. The newly available O*NET (replacement for US Dictionary of Occupational Titles) offers detailed job characteristics for most of the job titles. This analysis aims to determine the association between both SES indicators and O*NET-based job strain with the probability of having answered the survey.

Methods: 1571 workers were targeted for the survey, which was distributed within the facility with multiple mail and telephone follow up contacts. Worker demographics and job title were obtained from the facility rosters; job title was coded by Standard Occupational Classification and crosswalked to the O*NET job codes. A series of multilevel logistic regression analyses was used to model the individual outcome (“answered the survey”) by using worker level demographic variables (age, sex, race/ethnicity) and job level SES indicators and job strain. Random intercept, random slopes for demographic variables, and fixed for SES and job strain indicators; iterative generalised least squares and 2nd order penalised quasi-likelihood for linear approximation transformation (MLwiN).

Results: Worker age (p<0.01), SES (p = 0.001), social position (p = 0.005), and hourly wage (p = 0.012) were predictors in separate models. The inclusion of job strain (range 0.42 to 1.74) made a substantial contribution to the models (average OR = 0.52, p 0.016–0.067) and made non-significant each of the SES indicators.

Conclusions: Despite substantial likely misclassification, job level job strain was a significant predictor of survey response by healthcare sector workers, even controlling for demographic and job level SES indicators. This has important implications for our ability to study the effects of working conditions on health among the most vulnerable sectors of the workforce.


S. B. Gudbergsson1, S. D. Fosså2, B. Sanne3, A. A. Dahl2.1Department of Psychosocial Oncology & Rehabilitation, Rikshospitalet-Radiumhospitalet Trust, University of Oslo, Montebello, 0310 Oslo, Norway; 2Department of Long Term Studies, Rikshospitalet-Radiumhospitalet Trust, University of Oslo, Montebello, 0310 Oslo; 3Center for Child and Adolescent Mental Health, University of Bergen, 5020 Bergen, Norway

Introduction: As more cancer patients survive after primary treatment their job status and occupational stress has increasingly become a focus for clinical research, but few studies have been done so far. We explored job status and occupational stress in Norwegian cancer survivors aged 25–57 years.

Methods: Our sample consisted of 234 women with breast cancer, 169 men with testicular cancer, and 59 men with prostate cancer who had finished primary treatment one to five years before the survey and were without signs of disease. They were compared with 613 sex and age matched controls drawn from the general population (331 women and 282 men). In both groups self-rating of job status and occupational stress was used. The latter was rated by the Job Demand-Control-Support Questionnaire (DCSQ), which contains three subscales: demands, control, and support.

Results: The cancer survivors did not differ significantly from controls as to job status, and they generally had no more occupational stress than the controls on any of the DSCQ subscales. However, breast cancer survivors reported significantly more support compared with controls.

Conclusions: Clinical implications of these findings are twofold. Most middle aged cancer survivors with no evidence of disease can expect normal job status and occupational stress after primary treatment. Survivors on long term sick leave or those who experience occupational stress should be identified for closer follow up.