Moral distress measurement in animal care workers: a systematic review

OBJECTIVES

The mental health of veterinary and other animal health professionals is significantly impacted by the psychological stressors they encounter, such as euthanasia, witnessing animal suffering and moral distress. Moral distress, initially identified in nursing, arises when individuals are aware of the right action but are hindered by institutional constraints. We aimed to review existing research on moral distress scales among animal care workers by focusing on the identification and psychometric validity of its measurement.

DESIGN

Two-step systematic review. First, we identified all moral distress scales used in animal care research in the eligible original studies. Second, we evaluated their psychometric validity, emphasising content validity, which is a critical aspect of patient-reported outcome measures (PROMs). This evaluation adhered to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

DATA SOURCES

PubMed, EMBASE and PsycINFO to search for eligible studies published between January 1984 and April 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included original (primary) studies that (1) were conducted in animal care workers; (2) describing either the development of a moral distress scale, or validation of a moral distress scale in its original or modified version, to assess at least one of the psychometric properties mentioned in COSMIN guidelines.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used standardised methods to search, screen and code included studies. We considered the following information relevant for extraction: study reference, name and reference of the moral distress scale used, psychometric properties assessed and methods and results of their assessments. The collected information was then summarised in a narrative synthesis.

RESULTS

The review identified only one PROM specifically adapted for veterinary contexts: the Measure of Moral Distress for Animal Professionals (MMD-AP), derived from the Measure of Moral Distress for Healthcare Professionals (MMD-HP). Both MMD-HP and MMD-AP were evaluated for the quality of development and content validity. The development quality of both measures was deemed doubtful. According to COSMIN, MMD-HP's content validity was rated as sufficient, whereas MMD-AP's was inconsistent. However, the evidence quality for both PROMs was rated low.

CONCLUSION

This is the first systematic review focused on moral distress measurement in animal care workers. It shows that moral distress is rarely measured using standardised and evidence-based methods and that such methods should be developed and validated in the context of animal care.

PROSPERO REGISTRATION NUMBER

CRD42023422259.

Prevalence of work-related musculoskeletal disorders and associated factors affecting emergency medical services professionals in Jordan: a cross-sectional study

OBJECTIVES

Emergency medical services (EMSs) personnel are at high risk for developing work-related musculoskeletal disorders (WMSDs). However, no studies have yet investigated the prevalence and effect of these disorders on the Jordanian EMS personnel. Therefore, this study aimed to determine the prevalence of WMSDs among Jordanian EMS personnel and its associated factors.

DESIGN

This study used a cross-sectional design. Participants were asked to complete a self-administrated and validated questionnaire to measure the WMSDs, including a demographic survey and the Nordic Musculoskeletal Questionnaire. Descriptive and multivariable regression analyses were used.

SETTING

The Jordanian Civil Defence stations in the main cities of Jordan.

PARTICIPANTS

The sample consisted of 435 EMS workers which were obtained across the country of Jordan. A total of 79.0% of the participants were male, with a mean age of 27.9 (±4.3 SD) years.

RESULTS

The pain in the lower back (308, 70.8%) and neck (252, 57.9%) were the most reported in the last 12 months. Furthermore, about half of the participants reported having pain in their upper back (234, 53.8%), knee (227, 52.2%) and shoulder (226, 52.0%) pain in the last 12 months. Overall, WMSDs in at least one body part were significantly associated with age, experience, being a male, increased body mass index and lower educational level.

CONCLUSIONS

There is a high prevalence of musculoskeletal complaints among EMS personnel. Multiple variables may be incorporated into a national prevention campaign and professional development programme to educate EMS personnel on avoiding WMSDs.

A cross-sectional survey of the mental health of midwives in Ontario, Canada: Burnout, depression, anxiety, stress, and associated factors

PROBLEM

Burnout and the psychological co-morbidities stress, anxiety and depression have a significant impact on healthcare providers, including midwives. These conditions impact the quality of care provided to women, and midwives' ability to remain in the profession.

BACKGROUND

There is growing concern regarding the retention of maternity care providers in Canada, particularly midwives. Nationally, 33% of Canadian midwives are seriously considering leaving practice; impacts of the profession on work-life-balance and mental health being commonly cited reasons. Burnout has been shown to contribute to workplace attrition, but little is known concerning burnout among Canadian midwives.

AIM

To assess levels of stress, anxiety, depression, and burnout among midwives in Ontario, Canada and potential factors associated with these conditions.

METHODS

A cross-sectional survey of Ontario midwives incorporating a series of well-validated tools including the Copenhagen Burnout Inventory and the Depression, Anxiety and Stress Scale.

FINDINGS

Between February 5, and April 14, 2021, 275 Ontario midwives completed the survey. More than 50% of respondents reported depression, anxiety, stress, and burnout. Factors associated with poor mental health outcomes included having less than 10-years practice experience, identifying as a midwife with a disability, the inability to work off-call, and having taken a prior mental health leave.

DISCUSSION & CONCLUSION

A significant proportion of Ontario midwives are experiencing high levels of stress, anxiety, depression, and burnout, which should be a serious concern for the profession, its leaders, and regulators. Investment in strategies aimed at retaining midwives that address underlying factors leading to attrition should be prioritized.

Assessment of the prevalence and associated factors of lower back pain (LBP) among three different professionals in Bangladesh: Findings from a face-to-face survey

OBJECTIVES

This study aims to evaluate the prevalence and associated factors of lower back pain (LBP) among farmers, rickshaw pullers and office workers in Bangladesh, while also investigating potential contributors within these occupational groups.

DESIGN

This cross-sectional study aimed to determine the prevalence of LBP, associated factors and management procedures among farmers, rickshaw pullers and office workers in Bangladesh through face-to-face interviews.

SETTING

The study was conducted in different parts of the Bogura district in Bangladesh.

PARTICIPANTS

A total of 396 participants were included in the final analysis, all the participants were men and adult in age.

MAIN OUTCOME MEASUREMENTS

Data were collected using a semi-structured questionnaire based on previous research. Bivariate and multivariable logistic regression analyses were performed to identify significant associations.

RESULTS

The prevalence of LBP was found to be 42.7% among the participants. Farmers and rickshaw pullers had approximately four-times and three-times higher odds of experiencing LBP compared with office workers. Other significant factors associated with LBP included living in a nuclear family, having a normal body weight, lacking professional training, having a chronic disease, having a family history of LBP and experiencing numbness in the legs or feet. The majority of respondents sought medical attention and took medication for their LBP.

CONCLUSION

The study underscores occupational differences in LBP prevalence, emphasising the necessity for tailored interventions and occupational health policies. Identifying specific risk factors and management practices in these professions can aid in developing effective prevention strategies and enhancing healthcare services.

Work environment and hypertension in industrial settings in Benin in 2019: a cross-sectional study

OBJECTIVE

To determine the association between occupational factors, particularly psychosocial factors, and hypertension.

DESIGN

Descriptive and analytical cross-sectional study using logistic multivariate regression.

SETTING

Fifteen cotton ginning plants in Benin.

PARTICIPANTS

Permanent and occasional workers in the cotton ginning industry.

DATA COLLECTION

Data on sociodemographic, occupational, behavioural and clinical history characteristics were collected using a number of standardised, interviewer-administered questionnaires. These questionnaires were based on the WHO's non-communicable disease questionnaire, Karasek questionnaire and Siegrist questionnaire. Weight, height and blood pressure were measured. Any worker with systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg according to the WHO criteria was considered hypertensive, as was any subject on antihypertensive treatment even if blood pressure was normal.

RESULTS

A total of 1883 workers were included, with a male to female ratio of 9.08. Of these, 510 suffered from hypertension (27.1%, 95% CI 25.1 to 29.2). In the multivariate analysis, the risk factors identified were occupational stress (adjusted OR (aOR)=3.96, 95% CI 1.28 to 12.2), age ≥25 years (aOR=2.77, 95% CI 1.55 to 4.96), body mass index of 25-30 kg/m2 (aOR=1.71, 95% CI 1.32 to 2.2), body mass index >30 kg/m2 (aOR=2.74, 95% CI 1.84 to 4.09), permanent worker status (aOR=1.66, 95% CI 1.44 to 2.41) and seniority in the textile sector >5 years (aOR=2.18, 95% CI 1.7 to 2.8). Recognition at work emerged as an effect-modifying factor subject to stratification.

CONCLUSIONS

Occupational factors, particularly job strain and recognition at work, are modifiable factors associated with hypertension in the ginning plants sector and deserve to be corrected through occupational health promotion and prevention.

Role of physical activity in the relationship between recovery from work and insomnia among early childhood education and care professionals: a cross-sectional study

OBJECTIVES

This study aimed to investigate the association between recovery from work and insomnia and the role of objectively measured leisure-time physical activity and occupational physical activity in this association.

DESIGN

Cross-sectional.

SETTING AND PARTICIPANTS

Study with female early childhood education and care professionals (N=224) in Finland was conducted between April 2017 and September 2018.

METHODS

Recovery from work was measured with the Need for Recovery scale and insomnia with the Jenkins Sleep Scale. Physical activity was measured with an accelerometer for 7 days and analysed to represent leisure-time physical activity and occupational physical activity (min/day).

RESULTS

Both Jenkins Sleep Scale and occupational physical activity significantly predicted Need for Recovery (β=0.29; 95% CI 0.17 to 0.42 and β=0.14; 95% CI 0.01 to 0.27, respectively). A low relationship was observed between the Need for Recovery and Jenkins Sleep Scale (r=0.32, 95% Cl 0.19 to 0.44). After categorising participants into four groups based on median splits of occupational and leisure-time physical activity, relationships between the Need for Recovery and Jenkins Sleep Scale were low to moderate in the high occupational physical activity and leisure time physical activity group (r=0.38, 95% Cl 0.14 to 0.61), and in the high occupational physical activity and low leisure-time physical activity group (r=0.40, 95% Cl 0.18 to 0.63).

CONCLUSION

Both insomnia and physical activity at work seem to be relevant in recovery from work. To enhance recovery, especially those involved in high physical activity at work, should seek methods to improve recovery, by incorporating activities that promote recuperation both during their workday and in their leisure time. Further research on the relevance of physical activity in recovery with longitudinal setting is warranted.

TRIAL REGISTRATION NUMBER

NCT03854877.

Role of motivation and well-being indicators in interventions to improve well-being at work among primary care physicians: a systematic review

OBJECTIVE

The well-being of primary care physicians (PCPs) has become an object of concern for governments due to staff shortages and high staff turnover. The objective of this study was to carry out a systematic review of individualised interventions aimed at improving the well-being of PCPs, which allowed us to determine (1) the type of interventions being carried out; (2) the well-being indicators being used and the instruments used to assess them; (3) the theories proposed to support the interventions and the mechanisms of action (MoA) put forward to explain the results obtained and (4) the role that individual motivation plays in the interventions to improve well-being among PCPs.

DESIGN

Systematic review.

ELIGIBILITY CRITERIA

Clinical trials on interventions aimed at improving the well-being of PCPs.

INFORMATION SOURCES

a search of studies published between 2000 and 2022 was carried out in MEDLINE/PubMed, SCOPUS and Web of Science (WOS).

RESULTS

From the search, 250 articles were retrieved. The two authors each reviewed the articles independently, duplicate articles and those that did not meet the inclusion criteria were discarded. A total of 14 studies that met the criteria were included: 6 randomised clinical trials, 4 controlled clinical trials and 4 unique cohorts, with a before-and-after assessment of the intervention, involving a total of 655 individuals participating in the interventions. A meta-analysis was not possible due to the heterogeneity of the studies.

CONCLUSIONS

The information evaluated is insufficient to accurately assess which outcomes are the best indicators of PCPs well-being or what role plays in the individual motivation in the results of the interventions. More studies need to be carried out on the subject to determine the MoA of the different interventions on the results and the motivation of the participating PCPs.

Prevalence and drivers of nurse and physician distress in cardiovascular and oncology programmes at a Canadian quaternary hospital network during the COVID-19 pandemic: a quality improvement initiative

OBJECTIVES

To assess the prevalence and drivers of distress, a composite of burnout, decreased meaning in work, severe fatigue, poor work-life integration and quality of life, and suicidal ideation, among nurses and physicians during the COVID-19 pandemic.

DESIGN

Cross-sectional design to evaluate distress levels of nurses and physicians during the COVID-19 pandemic between June and August 2021.

SETTING

Cardiovascular and oncology care settings at a Canadian quaternary hospital network.

PARTICIPANTS

261 nurses and 167 physicians working in cardiovascular or oncology care. Response rate was 29% (428 of 1480).

OUTCOME MEASURES

Survey tool to measure clinician distress using the Well-Being Index (WBI) and additional questions about workplace-related and COVID-19 pandemic-related factors.

RESULTS

Among 428 respondents, nurses (82%, 214 of 261) and physicians (62%, 104 of 167) reported high distress on the WBI survey. Higher WBI scores (≥2) in nurses were associated with perceived inadequate staffing (174 (86%) vs 28 (64%), p=0.003), unfair treatment, (105 (52%) vs 11 (25%), p=0.005), and pandemic-related impact at work (162 (80%) vs 22 (50%), p<0.001) and in their personal life (135 (67%) vs 11 (25%), p<0.001), interfering with job performance. Higher WBI scores (≥3) in physicians were associated with perceived inadequate staffing (81 (79%) vs 32 (52%), p=0.001), unfair treatment (44 (43%) vs 13 (21%), p=0.02), professional dissatisfaction (29 (28%) vs 5 (8%), p=0.008), and pandemic-related impact at work (84 (82%) vs 35 (56%), p=0.001) and in their personal life (56 (54%) vs 24 (39%), p=0.014), interfering with job performance.

CONCLUSION

High distress was common among nurses and physicians working in cardiovascular and oncology care settings during the pandemic and linked to factors within and beyond the workplace. These results underscore the complex and contextual aspects of clinician distress, and the need to develop targeted approaches to effectively address this problem.

How do they cope? A national cross-sectional study of coping in hospital doctors in Ireland

OBJECTIVES

To measure coping strategies and associated psychological distress, burnout and work ability in hospital doctors in Ireland.

DESIGN

National cross-sectional study of randomised sample of trainee and consultant hospital doctors.

SETTING

Irish publicly funded hospitals and residential institutions.

PARTICIPANTS

1749 doctors returned surveys (55% response rate).

OUTCOME MEASURES

Dependent variables were psychological distress (measured using 12-item General Health Questionnaire), burnout (Maslach Burnout Inventory) and work ability (single-item measure). Adaptive and maladaptive coping strategies (Brief Coping Orientation to Problems Experienced) were covariates.

RESULTS

The coping mechanism most frequently reported by this cohort was the adaptive strategy of active planning. Increased mean hours worked (MHW) (OR 1.02; 95% CI 1.01 to 1.03), a low Work Ability Score (OR 3.23; 95% CI 2.47 to 4.23) and maladaptive coping strategies (OR 1.26; 95% CI 1.22 to 1.31) were significantly associated with psychological distress. Adaptive coping was associated with decreased psychological distress (OR 0.98; 95% CI 0.97 to 1.00). Increased MHW (OR 0.98; 95% CI 0.97 to 0.99), insufficient work ability (OR 0.62; 95% CI 0.48 to 0.80) and maladaptive coping (OR 0.87; 95% CI 0.85 to 0.89) were significantly associated with burnout. Increased MHW (OR 0.99; 95% CI 0.98 to 1.00) and maladaptive coping (OR 0.90, 95% CI 0.88 to 0.92) were significantly associated with insufficient work ability.

CONCLUSIONS

Adaptive coping is associated with decreased psychological distress but does not mitigate the effect of increased work hours, which are associated with burnout, distress and insufficient work ability, regardless of a doctor's coping style. The burden of psychological distress on doctors cannot be mitigated meaningfully unless workplace factors are addressed.

How to improve newly qualified midwives' transition-into-practice. A Delphi study

BACKGROUND

In the Netherlands, newly qualified midwives start work as registered midwives without any formal transition support. Research shows that newly qualified midwives do not feel sufficiently confident and competent in their work during the period following graduation. This could impact the quality of care provided by newly registered midwives. The aim of this study is to seek consensus with stakeholders concerning viable components of support for newly qualified midwives working in midwifery care in the Netherlands.

METHODS

A Delphi study was conducted among maternity care stakeholders in the Netherlands. During two rounds, sixteen statements derived from a theoretical framework of organizational socialization theory and previous studies were assessed (round 1, n = 56; round 2, n = 52). Stakeholders (N = 61) were invited and completed an online questionnaire that included spaces for opinions and remarks.

RESULTS

Stakeholders agreed about an introductory support period for newly qualified midwives, involving performance feedback and regional-level backup from fellow midwives during shifts. They further agreed on the responsibilities of established professionals that they should support newcomers in practice and provide mentoring or group coaching, although they face organizational barriers for supporting newcomers.

CONCLUSIONS

Stakeholders found consensus upon several components of support at the workplace. In addition, a stable work environment seemed less important in their opinion while previous research suggests otherwise. Practice organisations need to improve the employment conditions and support for newly qualified midwives to ensure the quality of midwifery care is guaranteed.

Nurses' experience with presenteeism and the potential consequences on patient safety: a qualitative study among nurses at out-of-hours emergency primary care facilities

OBJECTIVES

This study aimed to gain new insight and knowledge on out-of-hours emergency primary care nurses' experience of presenteeism in their workplace and their outlook on the impact they recognised the phenomenon to have on patient safety when caring for acute patients.

DESIGN

An explorative qualitative study.

SETTING

The study was conducted at three out-of-hours primary care facilities in southwest Norway.

PARTICIPANTS

A total of 10 female nurses were recruited as interviewees. Nurses providing direct patient care were included in the study.

RESULTS

The analysis resulted in four major themes: strong work ethics influence the decision to attend work unwell; work environment factors have a negative impact on nurses' health; nurses' awareness of consequences on the quality of care and patient safety and nurses make use of coping strategies when engaging in presenteeism.

CONCLUSION

Presenteeism is a common experience among nurses at out-of-hours emergency primary care clinics, with work-related stress being a significant contributing factor. Despite recognising a decrease in performance while engaging in presenteeism, nurses displayed adaptive behaviour. They were confident that their suboptimal health issues did not significantly impact patient safety while caring for acute patients. However, the true impact of presenteeism on patient safety in an out-of-hours emergency care setting remains uncertain due to the reliance on subjective reporting systems as quality indicators. More research is needed to understand the phenomenon and its implications on patient safety fully.

Effects of consecutive workdays and days off on low back pain, fatigue and stress: prospective cohort study among warehouse and construction workers

OBJECTIVES

Limited knowledge exists about day-to-day changes in physical and mental symptoms in warehouse and construction workers. This study investigated the associations between consecutive workdays and days off with low back pain (LBP) intensity, bodily fatigue and mental stress.

METHODS

Participants (n=224) received daily questions for 21 days about LBP, fatigue, stress (outcome, 0-10 scales), and workdays and days off (exposure). We tested associations between 1-3 workdays (n=148) and 1-2 days off (n=158) with LBP intensity, bodily fatigue and mental stress after work and the following morning using linear mixed models with repeated measures controlling for relevant confounders.

RESULTS

Consecutive workdays led to progressively increased LBP intensity, with three workdays increasing LBP intensity by 1.76 (95% CI 1.48 to 2.03) points. Bodily fatigue and mental stress increased after one workday (2.06 (95% CI 1.80 to 2.32) and 0.97 (95% CI 0.77 to 1.17) points, respectively) and remained stable for three workdays. After 1 day off, bodily fatigue and mental stress decreased -1.82 (95% CI -2.03 to -1.61) and -0.88 (95% CI -1.05 to -0.71) points, respectively, without decreasing further. In contrast, LBP intensity decreased progressively -1.09 (95% CI -1.27 to -0.91) and -1.45 (95% CI -1.67 to -1.24) points after 1 and 2 days off, respectively.

CONCLUSIONS

Workdays and days off affected the outcome variables differently. LBP intensity progressively increased with consecutive workdays, while workers needed 2 days off to recover. This study provides valuable knowledge about how to organise the workweek to prevent LBP, fatigue and stress, potentially reducing labour market withdrawal.

Feasibility of biomarkers to measure stress, burnout and fatigue in emergency nurses: a cross-sectional study

INTRODUCTION

Retaining nurses in the workforce is an urgent concern in healthcare. Emergency nurses report high levels of stress and burnout, however, there is no gold standard of how to measure these responses. This study aims to measure stress, burnout, and fatigue in emergency nurses using biomarkers and psychometric instruments. Biomarkers will be used to better understand nurses' levels of stress and burnout and to assess the feasibility of using biomarkers as a viable stress measurement tool in a real-world setting.

METHODS AND ANALYSIS

A two stage cross-sectional design to measure stress, burnout and fatigue in emergency nurses while they work is proposed. All registered and enrolled nurses working in the emergency department from four hospitals in Australia will be invited to participate. Validated psychometric tools will be used in stage 1 to measure depression, anxiety, acute stress, chronic stress, burnout and fatigue. Biomarkers comprising hair cortisol, saliva alpha amylase and heart rate variability will be collected as an objective measure of stress and burnout in stage 2 over one working shift per participant. Written consent will be sought for stage 2 where nurses will provide one hair sample, wear a heart rate sensor and be asked to collect their saliva at three different time points of one shift. Data analysis will measure the domains of acute stress, chronic stress and burnout and explore relationships and correlation between psychometric measures and biomarkers.

ETHICS AND DISSEMINATION

Ethics approval obtained from the Human Research Ethics Committee of the Hunter New England Local Health District (approval number: HREC/2020/ETH01684) and University of Newcastle HREC (H-2022-0169). Results will be reported in peer-reviewed publications using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Public dissemination will occur by presenting at conferences and to the participating local health district.

Cooling vest improves surgeons' thermal comfort without affecting cognitive performance: a randomised cross-over trial

OBJECTIVES

Surgeons become uncomfortable while performing surgery because heat transfer and evaporative cooling are restricted by insulating surgical gowns. Consequently, perceptions of thermal discomfort during surgery may impair cognitive performance. We, therefore, aimed to evaluate surgeons' thermal comfort, cognitive performance, core and mean skin temperatures, perceptions of sweat-soaked clothing, fatigue and exertion with and without a CoolSource cooling vest (Cardinal Health, Dublin, Ohio, USA).

METHODS

Thirty orthopaedic surgeons participated in a randomised cross-over trial, each performing four total-joint arthroplasties with randomisation to one of four treatment sequences. The effects of cooling versus no cooling were measured using a repeated-measures linear model accounting for within-subject correlations.

RESULTS

The cooling vest improved thermal comfort by a mean (95% CI) of -2.1 (-2.7 to -1.6) points on a 0-10 scale, p<0.001, with no evidence of treatment-by-period interaction (p=0.94). In contrast, cooling had no perceptible effect on cognition, with an estimated mean difference (95% CI) in Cleveland Clinic Cognitive Battery (C3B) Processing Speed Test score of 0.03 (95% CI -2.44 to 2.51), p=0.98, or in C3B Visual Memory Test score with difference of 0.88 (95% CI -2.25 to 4.01), p=0.57. Core temperature was not lower with the cooling vest, with mean difference (95% CI) of -0.13 (-0.33°C to 0.07°C), p=0.19, while mean skin temperature was lower, with mean difference of -0.23 (95% CI -0.40°C to -0.06°C) lower, p=0.011. The cooling vest significantly reduced surgeons' perceptions of sweat-soaked clothing, fatigue and exertion.

CONCLUSIONS

A cooling vest worn during surgery lowered core and skin temperatures, improved thermal comfort, and decreased perceptions of sweating and fatigue, but did not improve cognition. Thermal discomfort during major orthopaedic surgery is thus largely preventable, but cooling does not affect cognition.

TRIAL REGISTRATION NUMBER

NCT04511208.

Association between prolonged exposure to long working hours and stroke subtypes in the CONSTANCES cohort

BACKGROUND

Though there is increasing evidence on the effect of long working hours (LWH) and stroke, few studies have distinguished stroke subtypes. We examined the associations between LWH and ischaemic or haemorrhagic stroke after adjusting for cardiovascular risk factors.

METHODS

From a national population-based cohort CONSTANCES, baseline questionnaires and initial health examinations were used to retrieve sociodemographic and cardiovascular risk factors from 2012 to 2018. LWH were defined as self-reported working time≥10 hours daily for at least 50 days per year. Incident cases of stroke were collected using International Classification of Disease codes recorded in the National Health Data System. Associations between LWH and stroke were investigated using multinomial models adjusted for cardiovascular risk factors.

RESULTS

Among the 160 751 participants who were free from stroke at baseline, exposure to LWH≥10 years was reported by 20 723 participants, and 190 incident cases of stroke were identified, including 134 ischaemic and 56 haemorrhagic. Exposure to LWH was associated with an elevated odds of ischaemic stroke (OR=1.61 (1.04-2.49)) and haemorrhagic stroke (OR=2.50 (1.38-4.53)) in unadjusted models. In adjusted multivariable models, only the LWH association with haemorrhagic stroke remained significant (aOR=1.92 (1.01-3.09)).

CONCLUSIONS

LWH were associated with stroke, though it remained significant for haemorrhagic stroke only after adjustments. Differences in direct and indirect biological pathways and lack of power in the ischaemic subgroup may explain these results and further studies on the impact of mediating and effect measure modifying factors are needed. Nevertheless, policies that attenuate effects of both LWH and cardiovascular risks factor are warranted.

Do different job demands interact as predictors of long-term sickness absence? A register-based follow-up on 55 467 Danish workers

OBJECTIVES

To assess interactions between combinations of quantitative demands, emotional demands, unclear and contradictory demands, and violence/threats of violence in the prospective association with risk of long-term sickness absence (LTSA).

METHODS

We included 55 467 employees from the 2012, 2014 and 2016 waves of the Work Environment and Health in Denmark (WEHD) survey. We measured the four independent variables in the WEHD survey and assessed risk of LTSA in a national register during 12 months of follow-up. Using Cox proportional hazards models, adjusted for age, sex, educational attainment and job group, we estimated risk of LTSA and assessed deviation from additivity using relative excess risk due to interaction (RERI).

RESULTS

For combinations of high emotional demands and high quantitative demands (HR 1.50; 95% CI 1.33 to 1.70; RERI 0.06; 95% CI -0.15 o 0.26) and high emotional demands and violence/threats of violence (HR 1.76; 95% CI 1.53 to 2.02; RERI 0.12; 95% CI -0.43 to 0.66) we found no indications of deviations from additive effects in predicting LTSA. For combinations of violence/threats of violence and high quantitative demands (HR 1.90; 95% CI 1.64 to 2.20; RERI 0.36; 95% CI 0.01 to 0.71) and unclear and contradictory demands and high quantitative demands (HR 1.46; 95% CI 1.31 to 1.62; RERI 0.23; 95% CI 0.04 to 0.42) the results indicated an excess risk of LTSA above additivity (ie, superadditivity).

CONCLUSIONS

Participants reporting high quantitative demands combined with either violence/threats of violence or unclear and contradictory demands showed a higher risk of LTSA than expected, indicating superadditivity. Results have implications for preventing negative health effects related to adverse psychosocial working conditions.

The Effect of Occupational Stress and Concerns about the COVID-19 Pandemic on Secondary Traumatic Stress Syndrome among Iranian Frontline Nurses: A Mediating Model

Objective: With the increasing effects of stress caused by the COVID-19 pandemic and occupational stress on the mental health of frontline nurses, it is imperative to further investigate how these stresses affect nurses' mental health and secondary traumatic stress syndrome. This research aimed to investigate the relationship of nurses' occupational stress and concerns about COVID-19 with secondary traumatic stress syndrome, and also to investigate the mediating effect that concerns about the COVID-19 pandemic have on the relationship between nurses' occupational stress and secondary traumatic stress syndrome. Method : A cross-sectional design was adopted. The population of the study was defined as all front-line nurses in Shiraz hospitals, from which 225 nurses of two corona care hospitals were selected using convenience sampling. The degree of secondary traumatic stress, concerns about the COVID-19, and nurses' occupational stress were assessed using Bride's Secondary Traumatic Stress Scale (STSS), an adopted version of Level of Concerns about the COVID-19 questionnaire, and the Nurses' Occupational Stressor Scale (NOSS) among Hospital-based Healthcare Workers. Structural equation modeling (SEM) was used to examine the relationships among variables. Results: Results showed that nurses' occupational stresses presented a direct effect on nurses' level of concern about the COVID-19 pandemic (β = 0.85, P < 0.001), and concern about the COVID-19 pandemic was directly related to front-line nurse's secondary traumatic stress syndrome (β = 0.83, P < 0.001). In addition, nurses' level of concern about the COVID-19 pandemic fully mediated the effects of nurses' occupational stresses on their secondary traumatic stress (β = 0.70, P < 0.001). This indirect effect has explained 68% of the variance in nurses' secondary traumatic stress. Conclusion: These results emphasized the indirect effect of nurses' occupational stresses on secondary traumatic stress syndrome via mediating the level of concern about COVID-19. Therefore, to reduce the secondary traumatic stress of nurses who have dealt directly with COVID-19 patients, it seems necessary to pay serious attention to the sources of their occupational stress, which probably existed even before this pandemic and increased their concerns in pandemic conditions.

[Stress, anxiety, and depression in health workers during the COVID-19 pandemic]

BACKGROUND

Mental health is an integral part of health. Having some psychiatric condition without treatment predisposes to a poor quality of life. These alterations have been found with an incidence of up to 50% in the general population. There are very few studies in Mexico on these conditions in health workers during the COVID-19 pandemic.

OBJECTIVE

To determine the prevalence of stress, anxiety, and depression during the COVID-19 pandemic in health workers.

MATERIAL AND METHODS

A descriptive, cross-sectional observational study was conducted on health workers in a tertiary hospital, through the application of randomized and self-completed surveys, in search of levels of stress, anxiety, and depression during the COVID-19 pandemic.

RESULTS

44.7% of those surveyed showed depression, 83.1% anxiety, and 66.3% stress. The main groups affected were female staff, singles, and medical residents. Those with type 2 diabetes mellitus had higher anxiety and depression.

CONCLUSION

The prevalence of stress, anxiety, and depression in health workers is similar to that of the general population in our study. Depression was the alteration most found. The scrutiny of alterations in mental health in health workers is of the utmost importance, with greater emphasis in the context of the aforementioned pandemic.

Communication competence and resilience are modifiable factors for burnout of operating room nurses in South Korea

Background

Burnout negatively impacts the personal and professional life of nurses. Job stress and resilience have been determined to be associated with nurse burnout. Given the importance of communication competence in operating room (OR) nurses, the associations of job stress, resilience, and communication competence with burnout have not been examined.

Purpose

To determine the relationships of job stress, resilience, and communication competence to burnout of OR nurses in South Korea.

Methods

This was a cross-sectional, descriptive study of 146 OR nurses. A series of self-reported questionnaires was used to assess job stress, resilience, communication competence, and burnout. Pearson correlation coefficient and a hierarchical linear regression were used for data analysis.

Results

Communication competence was correlated with resilience (r = 0.65, p < .001) and burnout (r = -0.44, p < .001), and resilience was correlated with burnout (r = -0.48, p < .001). Resilience (β = -0.22, p = .027) and communication competence (β = -0.33, p < .001) were associated with burnout of OR nurses in a hierarchical linear regression (F = 6.28, p < .001).

Conclusions

Increased resilience and communication competence were associated with lower burnout of perioperative nurses. To prevent and reduce burnout of OR nurses, it is necessary to develop and implement a program targeting for communication competence and resilience.

Implications for nursing management

Nurse leaders should provide programs fostering communication competence and resilience to OR nurses and encourage them to actively participate in such job trainings.

Changes in the Health Indicators of Hospital Medical Residents During the Four-Year Training Period in Korea

BACKGROUND

In South Korea, the legal maximum working hours per week for medical residents is 88 hours, which are longer than those for other occupations, and the intensity of the workload is also remarkably high. Long working hours and job-related stress can worsen the health status of residents. This study aimed to analyze the four-year annual health checkup (AHC) data of residents to identify changes in their health indicators.

METHODS

This study included 457 male residents who received 4 years of training at a university hospital. They underwent an AHC every year during the training period. Changes in health indicators and related factors over the 4 years were investigated.

RESULTS

Body mass indices (BMI), blood pressures (BPs), liver function test (LFT) results, and total cholesterol (TC) levels were significantly worsened during the training period. The increases were the highest in the early training years, between the 2^nd and 1^st AHC. The working hours of the fourth-year residents were the shortest and showed low smoking and drinking rates and high regular exercise rates. On comparing by department, surgical residents showed the highest increases in BMI, diastolic BP, and fasting blood glucose (FBG), LFT enzyme, and TC levels during the training period, compared to residents from the medical and clinical support departments. Residents who were working ≥ 80 hours showed significantly higher FBG and LFT enzyme levels than those working < 80 hours.

CONCLUSION

This study is meaningful as it is the first study in Korea to investigate the changes in the health of residents through objective health indicators. The possibility of the 4-year training period adversely affecting the health of residents was confirmed. Health indicators were significantly worsened, especially in the early training period, in surgical residents, and in residents who worked for long hours. Efforts are needed to restrict long working hours and distribute workload during the 4-year training period.

Translation and Cultural Adaptation to European Portuguese of the "Measure of Moral Distress - Healthcare Professionals" Scale: A Cross-Sectional Multicenter Study

INTRODUCTION

Moral distress occurs when one knows the morally correct action to take but is constrained from taking that action. The aims of this study were to translate into European Portuguese and culturally adapt the "Measure of Moral Distress - Healthcare Professionals" questionnaire to the context of the Portuguese healthcare system and to explore the frequency and intensity of moral distress occurring among medical students.

MATERIAL AND METHODS

The "Measure of Moral Distress - Healthcare Professionals" questionnaire was translated and culturally adapted to European Portuguese, following the internationally accepted "COnsensus-based Standards for the selection of health Measurement INstruments". Afterwards, a web-based survey was conducted, following the "Checklist for Reporting Results of Internet E-Surveys" guidelines. Medical students were asked to rate potentially morally distressing situations on frequency and intensity.

RESULTS

Of approximately 4300 medical students, 939 (22%) completed the survey. Participants experienced, on average, 16 morally distressing situations. Median of composite score of moral stress was 79 (IQR 44 - 118). Only 31% of the students felt well prepared to handle a morally distressing situation, 26% considered leaving medical school and 28% thought about choosing a non-clinical specialty due to moral distress.

CONCLUSION

Despite a plethora of studies on this topic, the results suggested that moral distress is still a common phenomenon among medical students with a cumulative effect over time. These results emphasize the importance of a critical review of medical education, reducing the harmful effects of preventable psychological phenomena in clinical practice and in the lives of future healthcare professionals.

[Association between occupational stress and nicotine dependence in in health workers]

BACKGROUND

Stress is the result of the imbalance between the demands and pressures that the individual faces. Stress tests the individual's ability to cope with her activity, and this is a health problem for the worker.

OBJECTIVE

To explore the association between occupational stress and nicotine dependence in healthcare workers from the Family Medicine Unit No. 92 of the IMSS.

MATERIAL AND METHODS

Cross-sectional study that included 180 active smoking workers, occupational stress was evaluated with the Psychosomatic Problems for Occupational Stress questionnaire adapted by IMSS and nicotine dependence with the Fagerström questionnaire. Student's t tests and Fisher's Exact test were used. The statistical analysis was performed with the Stata 15 program.

RESULTS

The prevalence of occupational stress was 72.2% (42.8% mild, 20.6% moderate and 8.9% severe). Women presented greater work stress compared to men (76.1% vs. 56.0%; p = 0.008). Nicotine dependence was 49.4% mild, 35.6% moderate and 15.0% severe, the average of the Fagerström test was higher in women compared to men (3.75 vs. 2.83; p = 0.025), in addition an association was found between the work stress and nicotine dependence (p = 0.011).

CONCLUSIONS

72% of the workers presented work stress, in the same way the association between work stress and nicotine dependence was found. Identifying the main causes of work stress, together with the support of smoking cessation programs, would help in the well-being of health personnel in FMUs.

The relationship between occupational stress, job burnout and quality of life among surgical nurses in Xinjiang, China

BACKGROUND

Nursing is a high-risk occupation that involves exposure to stress. The physical and mental health of nurses is directly related to the quality of medical services, so the quality of life of nurses cannot be ignored. This study is a Chinese nursing study that investigated occupational stress, job burnout, and quality of life of surgical nurses in Xinjiang, China.

METHODS

This study employed the cluster random sampling method and carried out a questionnaire survey among 488 surgical nurses from five hospitals from May 2019 to September 2019. The study analyzed the relationship between occupational stress, job burnout and quality of life. The Effort-Reward Imbalance questionnaire (ERI), Maslach Burnout Inventory General Survey (MBI-GS) and the 36-item Short Form Health Survey (SF-36) were used to evaluate occupational stress, job burnout and quality of life among surgical nurses.

RESULTS

A total of 550 questionnaires were distributed in this study, and 488 were retrieved, with an effective recovery rate of 88.73 %. The results revealed that the quality of life score among surgical nurses was not high, and differences were observed in the quality of life score of patients according to gender, age, title, and frequency of night shifts (P < 0.05). There was a positive correlation between occupational stress and job burnout. Higher levels of occupational stress and job burnout were associated with a poorer quality of life score. Occupational stress and job burnout were identified as risk factors for quality of life, and the interaction between high levels of stress and burnout seriously reduced quality of life. The structural equation model revealed that occupational stress and job burnout had a direct impact on quality of life, occupational stress had a direct impact on job burnout, and job burnout was identified as a mediating factor in the relationship between occupational stress and quality of life.

CONCLUSIONS

Surgical nurses have a high level of occupational stress and burnout, and low quality of life score. Quality of life is correlated with occupational stress and job burnout. According to the individual characteristics and psychological state of nurses, managers can implement personalized intervention measures promptly and effectively to relieve their tension and burnout, and improve the quality of life of surgical nurses.

[Secondary Data Analysis on the Factors Influencing Premenstrual Symptoms of Shift Work Nurses: Focused on the Sleep and Occupational Stress]

PURPOSE

This study aimed to examine premenstrual symptoms (PMS) of shift nurses and identify the association between PMS, sleep, and occupational stress.

METHODS

This study was conducted with a secondary data analysis that used data from the Shift Work Nurse's Health and Turnover study. The participants were 258 nurses who were working in shifts including night shifts. PMS, sleep patterns (sleep time and sleep time variability), sleep quality, and the occupational stress of each participant were measured using the Moos Menstrual Distress Questionnaire, a sleep diary, an actigraph, the Insomnia Severity Index, and the Korean Occupational Stress Scale, respectively. Data were analyzed using SPSS 23 and STATA 15.1 to obtain descriptive statistics, Pearson's correlation coefficients, multiple linear regression with generalized estimating equations (GEE) and Baron and Kenny's mediating analysis.

RESULTS

The average PMS score, average sleep time, average sleep time variability, average sleep quality score, and average occupational stress score of the participants was 53.95 ± 40.45, 7.52 ± 0.89 hours, 32.84 ± 8.43%, 12.34 ± 5.95, and 49.89 ± 8.98, respectively. A multiple linear regression analysis with GEE indicated that sleep time variability (B = 0.86, p = .001), and sleep quality (B = 2.36, p < .001) had negative effects on nurses' PMS. We also found that sleep quality had a complete mediating effect in the relationship between occupational stress and PMS.

CONCLUSION

These findings indicate that both sleep time variability and sleep quality are important factors associated with PMS among shift work nurses. To improve shift nurses' PMS status, strategies are urgently needed to decrease sleep time variability and increase sleep quality.

Hospital-Based Health Care Worker Perceptions of Personal Risk Related to COVID-19

BACKGROUND

Health care workers treating Coronavirus disease 2019 (COVID-19) patients face significant stressors such as caring for critically ill and dying patients, physically demanding care requiring new degrees of personal protective equipment use, risk of contracting the disease, and putting loved ones at risk. This study investigates the stress impact from COVID-19 exposure and how nurses and medical providers (eg, physicians, nurse practitioners, physician assistants) experience these challenges differently.

METHODS

An electronic, self-administered questionnaire was sent to all hospital staff over 6 weeks surveying exposure to COVID-19 patients and degree of stress caused by this exposure. Responses from medical providers and nurses were analyzed for significant contributors to stress levels, as well as comparing responses from medical providers versus nurses.

RESULTS

Stress levels from increased risk of disease contraction while on the job, fear of transmitting it to family or friends, and the resulting social stigma were highest in medical staff during the COVID-19 pandemic. Compared with medical providers, nurses had nearly 4 times the odds of considering job resignation due to COVID-19. However, most health care workers (77.4% of medical providers and 52.9% of nurses) strongly agreed or agreed with the statements indicating high levels of altruism in their desire to treat COVID-19 patients.

CONCLUSION

The significant stress burden placed on nurses likely contributes to increased thoughts of job resignation. However, health care providers displayed high levels of altruism during this time of extreme crisis, despite their personal risks of caring for COVID-19 patients.

[Predictors of Blood and Body Fluid Exposure and Mediating Effects of Infection Prevention Behavior in Shift-Working Nurses: Application of Analysis Method for Zero-Inflated Count Data]

PURPOSE

This study aimed to identify the predictors of blood and body fluid exposure (BBFE) in multifaceted individual (sleep disturbance and fatigue), occupational (occupational stress), and organizational (hospital safety climate) factors, as well as infection prevention behavior. We also aimed to test the mediating effect of infection prevention behavior in relation to multifaceted factors and the frequency of BBFE.

METHODS

This study was based on a secondary data analysis, using data of 246 nurses from the Shift Work Nurses' Health and Turnover study. Based on the characteristics of zero-inflated and over-dispersed count data of frequencies of BBFE, the data were analyzed to calculate zero-inflated negative binomial regression within a generalized linear model and to test the mediating effect using SPSS 25.0, Stata 14.1, and PROCESS macro.

RESULTS

We found that the frequency of BBFE increased in subjects with disturbed sleep (IRR = 1.87, p = .049), and the probability of non-BBFE increased in subjects showing higher infection prevention behavior (IRR = 15.05, p = .006) and a hospital safety climate (IRR = 28.46, p = .018). We also found that infection prevention behavior had mediating effects on the occupational stress-BBFE and hospital safety climate-BBFE relationships.

CONCLUSION

Sleep disturbance is an important risk factor related to frequency of BBFE, whereas preventive factors are infection prevention behavior and hospital safety climate. We suggest individual and systemic efforts to improve sleep, occupational stress, and hospital safety climate to prevent BBFE occurrence.

Work fatigue among Lebanese community pharmacists: prevalence and correlates

Objective:

To assess work fatigue and its associated factors among community pharmacists in Lebanon.

Methods:

This cross-sectional study was conducted between March and July 2018. A proportionate sample of 435 community pharmacists was selected from all regions of Lebanon. A standardized self-administered questionnaire, distributed by trained interviewers, was used to assess the studied variables.

Results:

The results showed that 50.12% of the pharmacists had emotional work fatigue [95%CI 0.454-0.549], 55.01% had mental work fatigue [95%CI 0.503-0.597], and 54.78% had physical work fatigue [95%CI 0.501-0.595]. Higher mental work fatigue was significantly associated with higher stress (Beta=0.185) and having a master’s degree compared to a bachelor’s degree (Beta=2.23). Higher emotional work fatigue was significantly associated with higher stress (Beta=0.219), working more than 40 hours compared to ≤ 16 hours (Beta=2.742), and having 6 months to less than 1 year of practice compared to less than 6 months (Beta=-5.238). Higher physical work fatigue was significantly associated with higher stress (Beta=0.169) and having better soft skills (Beta=-0.163).

Conclusions:

Work-related fatigue is high among community pharmacists and touches all aspects: physical, mental, and emotional. In our study, community pharmacists’ fatigue levels were associated with educational level, years of experience, working hours, stress, depression, and soft skills, while no relation was found with gender, age, position in the pharmacy, and economic status. Interventions are recommended to tackle this public health problem that affects pharmacists, and eventually, patients.

Work-related stress in cycle rickshaw taxi drivers from Mexico City's Historic Downtown

BACKGROUND

In Mexico, neither the pathological profile nor the health/illness conditions of the cycle rickshaw taxi drivers have been studied. Therefore, the factors that influence the physical and mental health of this labor group are unknown.

OBJECTIVE

To describe the characteristics of working and health/illness conditions that influence the stress level of the cycle rickshaw taxi drivers from Mexico City’s Historic Downtown.

MATERIAL AND METHODS

90% (n = 110) of the workers participated in a cross-sectional study of a correlational type, in which a survey on working conditions and health was applied. Stress was analyzed using the Aro Symptomatic Scale, and vital signs, somatometry and a blood test were measured to analyze lipids and glucose.

RESULTS

16% of drivers were assessed with a high level of stress. No association was found with conditions related to physical and behavioral health, such as hypertension, dyslipidemia, diabetes, overweight, smoking and alcohol consumption. Therefore, the perception of violence risk (odds ratio [OR]: 1.19), the risks associated with the vehicle (OR: 1.18), having had a work accident (OR:38.2) and musculoskeletal complaints —mainly, in the elbow (OR: 1.20) and wrists (OR: 1.11)— are the factors that most influence the level of stress.

CONCLUSIONS

The main cause of stress in drivers is related to the risks of their activity and musculoskeletal conditions, so interventions and action protocols are suggested to help preventing and face the risks of workers.

Job Satisfaction and Its Associated Factors Among General Practitioners in China

OBJECTIVES

Investigation is scare on job satisfaction among general practitioners (GPs) in China. This study aimed to investigate job satisfaction of GPs in China and explore its determinants.

METHODS

A multistage-stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs (response rate, 99.8%) working in community health institutions in China between October 2017 and February 2018. Multiple linear stepwise regression analysis was used to analyze the associated factors with job satisfaction among GPs.

RESULTS

Among these respondents, 1215 (37.5%), 352 (10.9%), and 1669 (51.6%) GPs were dissatisfied, moderate, and satisfied for their current job, respectively. Male GPs, a higher education level, at a higher professional title, at a lower level of income, and those with heavy work stress had a lower job satisfaction. In addition, GPs who often worked overtime, who were at a higher level of emotional exhaustion, at a higher level of depersonalization, at a lower level of personal accomplishment, and who had less occupational development opportunities reported a lower level of job satisfaction.

CONCLUSION

These findings suggest that job satisfaction among Chinese GPs is at a moderate level. Region, sex, professional title, education level, working overtime, income level, emotional exhaustion, depersonalization, personal accomplishment, work stress, and occupational development opportunities were significant predictors of job satisfaction.

Sources of Stress and Psychological Health Outcomes Among U.S. Air Force Total Force Distributed Common Ground System Operators

U.S. Air Force Distributed Common Ground Station (DCGS) intelligence (Intel) operators sustain 24/7 battlefield situational awareness and facilitate precision-strike operations. DCGS operations are global, synergistic, Total Force (TF) endeavors by active duty, Air National Guard (ANG) and Reserve units, providing combatant commanders with critical real-time intelligence and shaping operational and tactical decisions. Continual surveillance of this community's psychological health is important to its military leaders. This study re-examines the most frequently reported occupational stressors, as well as the prevalence of occupational burnout (i.e., high-emotional exhaustion and cynicism, and low professional efficacy), and psychological distress within this population. Active duty (n = 1717), ANG (n = 139), and Reserve (n = 173) Intel operators participated in a comprehensive, online, occupational health assessment. Results reveal that occupational stressors contributing to elevated rates of distress, regardless of TF status (i.e., low manning, long work hours, excessive workload, and organizational communication concerns) are consistent with previous research. The prevalence of high-emotional exhaustion (AD: 29%/ANG: 25%/RES: 14%) and psychological distress (AD: 19%/ANG: 17%/RES: 5%) are above estimates for other military communities. These findings combined with demographic and occupational risk factors lay the foundation for improving psychological health within this Total Force community.

[Effects of Personality and Psychological Acceptance on Medical Workers' Occupational Stress]

Objective: To assess psychological acceptance and occupational stress of medical staff, analyze the relationship among personality, psychological acceptance and occupational stress and discuss the direct or indirect effects of personality to occupational stress. Methods: Eysenck Personality Questionnaire (EPQ-RSC) , Acceptance and Action Questionnaire-II (AAQ-Ⅱ) and Revised Occupational Stress Inventory (OSI-R) were administered to 749 medical staff. Results: The level of occupational stress of medical staff was high, the score of PSY was 26.8±7.13 and the score of PHS was 24.3±6.50. Personality and psychological acceptance can predict occupational stress. Psychological acceptance was a protective factor of occupational stress. Medical staff with personality of introversion, neuroticism and psychoticism suffered higher occupational stress. Personality have both direct and indirect effects on occupational stress. Neuroticism have the strongest effect on occupational stress with effect size of 0.496 (psychological stress) and 0.431 (physical strain) . Conclusion: Medical staff have heavier occupational stress. There is a significant correlation between personality and occupational stress. Measures depending on personality should be taken to deal with this situation.

Work-related stress and quality of life among Iranian blue-collar workers with self-reported low back pain

Background: Impairment in quality of life and mental health had been reported in the previous studies as the results of musculoskeletal disorders among workers. Mental health has a wide concept and contains different disorders including anxiety, depression or even decreased quality of life, all of which having challengeable impacts on work- related characters such as work productivity and absensism. The present study aimed at evaluating work- related stress and quality of life among Iranian blue-collar workers of Fars ABFA Company with selfreported low back pain. Methods: In the present study, we focused on the low back pain among 451 blue-collar workers and assessed their work- related stress and quality of life status using DASS-21 and short form questionnaire (SF-36), respectively. Independent sample t-test was used to compare the qualitative variables, and chi-square test was utilized for statistical analysis of the qualitative variables. Results: Mean of the total score of quality of life among workers with low back pain was significantly lower than in those workers without low back pain. The mean of work- related stress score was significantly higher in workers with low back pain than in workers without low back pain. The mean quality of life subdomains in patients with low back pain was significantly lower than in workers without low back pain. Conclusion: Findings of the present study revealed that workers with low back pain had lower quality of life score and higher work- related stress score. These findings should be considered in designing preventive programs rather than controlling the pain.

Radiation Protection Knowledge, Attitude and Practice (RP-KAP) as Predictors of Job Stress Among Radiation Workers in Tehran Province, Iran

Background

In recent years, much attention has been paid to occupational stress, but relatively little or no research has been conducted on the influence of knowledge, attitude, and practice of radiation protection (RP-KAP) on job stress among radiation workers

Objectives

This study aims to assess job stress among health care workers in Iran who are occupationally exposed to radiation in order to determine the effects of KAP on self-protection against radiation on their job stress.

Materials and Methods

The population in this descriptive cross-sectional study comprised 670 healthcare workers, including 428 staff with a degree in radiology and 242 other medical personnel who were working in 16 hospitals affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran. The census method was used to sample the workers. In total, 264 staff with a degree in radiology and 149 other medical personnel completed the job content questionnaire (JCQ) and the RP-KAP questionnaire from May to November 2014.

Results

The prevalence rate of job stress was 22.5% based on calculation formulas and possible scores on the JCQ. Sex, RP-knowledge, attitude, practice, and in-service training predicted 41.8% of the variance in job stress. According to the results of the binary logistic regression, workers with higher scores on knowledge (OR = 0.82, 95% CI: 0.75 - 0.90), attitude (OR = 0.71, 95% CI: 0.63 - 0.82), and practice (OR = 0.78, 95% CI: 0.72 - 0.86) and those who had participated in training programs had significantly lower rates of job stress (OR = 0.51, 95% CI: 0.28 - 0.93).

Conclusions

The effects of RP knowledge, attitude, and practice on job stress were significant. In order to reduce job stress in radiation environments, ongoing training programs related to self-care and protection principles are recommended.

High occupational stress and low career satisfaction of Korean surgeons

Surgery is a demanding and stressful field in Korea. Occupational stress can adversely affect the quality of care, decrease job satisfaction, and potentially increase medical errors. The aim of this study was to investigate the occupational stress and career satisfaction of Korean surgeons. We have conducted an electronic survey of 621 Korean surgeons for the occupational stress. Sixty-five questions were used to assess practical and personal characteristics and occupational stress using the Korean occupational stress scale (KOSS). The mean KOSS score was 49.31, which was higher than the average of Korean occupational stress (45.86) or that of other specialized professions (46.03). Young age, female gender, long working hours, and frequent night duties were significantly related to the higher KOSS score. Having spouse, having hobby and regular exercise decreased the KOSS score. Multiple linear regression analysis showed that long working hours and regular exercise were the independent factors associated with the KOSS score. Less than 50% of surgeons answered that they would become a surgeon again. Most surgeons (82.5%) did not want to recommend their child follow their career. Korean Surgeons have high occupational stress and low level of career satisfaction.

Role of occupational stress and burnout in prevalence of musculoskeletal disorders among embassy personnel of foreign countries in iran

Background:

Occupation is one of the major parts of our daily lives that might cause a great amount of stress. Stress and job burnout are linked together. The association between musculoskeletal disorders (MSD) and burnout syndrome as a psychosocial factor was investigated previously.

Objectives:

The aim of this study was to identify the role of occupational stress and burnout in musculoskeletal complaint among diplomatic employees of different embassies in Iran.

Materials and Methods:

In a cross-sectional study, we assessed 200 employees of the foreign countries embassies in Iran. The participants were selected randomly from all the embassy personnel. Study questionnaires were delivered to the participants and finally 161 questionnaires were returned to the researchers (response rate: 80.5%). An assessment of burnout and MSD were made using the Maslach Burnout Inventory (MBI) and Nordic questionnaires. The work place stress was measured by the work place stress questionnaire.

Results:

Mean occupational stress was significantly higher among embassy personnel with MSD than among the personnel without this syndrome during the preceding week (17.18 ± 3.42 and 16.06 ± 2.19, respectively; P = 0.02) and the preceding year (17.17 ± 3.11 and 16.74 ± 3.03, respectively; P < 0.01) to the study. Only smoking and occupational stress were identified as independent predictors of MSD among embassy personnel.

Conclusions:

It seems that association between musculoskeletal complaints and burnout syndrome was more complex than being attributed to only occupation stress. Further studies are recommended to determine other related factors to this association.

Occupational stress and turnover intention: implications for nursing management

BACKGROUND

The main purpose of this study was to explore the status of occupational stress among hospital nurses in Isfahan, Iran. It also aimed to examine the relationship between nurses' occupational stress and their intention to leave the hospital.

METHODS

The study employed a cross-sectional research design. A validated questionnaire was used to collect data from 296 nurses. Respondents were asked to rate the intensity of 30 common occupational stressors using a five-point scale.

RESULTS

A third of hospital nurses rated their occupational stress high. The major sources of stress were inadequate pay, inequality at work, too much work, staff shortage, lack of promotion, job insecurity and lack of management support. More than 35% of nurses stated that they are considering leaving the hospital, if they could find another job opportunity. Occupational stress was positively associated with nurses' turnover intentions.

CONCLUSION

Hospital managers should develop and apply appropriate policies and strategies to reduce occupational stress and consequently nurses' turnover intention.

Relationship between Occupational Stress and Gastric Disease in Male Workers

Background

Physical and mental health of workers is threatened due to various events and chronic occupational stress. This study was conducted to investigate the relationship between occupational stress and gastric disease in male workers of the shipbuilding industry.

Methods

Occupational stress measured among a total of 498 workers of a shipbuilding firm who visited the hospital for health examination using the Korean Occupational Stress Scale (KOSS)-short form, and the relationship between sociodemographic factors, health-related behaviors, occupational stress, and gastric disease, and the distribution of occupational stress by sociodemographic factors in the gastric disease group was examined.

Results

There was no significant association between gastric disease and total occupational stress score and its seven sub-factors. The analysis showed that risk of gastric disease was significantly higher in the Q1 group in which the stress caused by occupational discomfort among seven sub-factors was lowest than that in the Q4 group (odds ratio, 2.819; 95% confidence interval, 1.151 to 6.908). Analysis only on the gastric disease group showed that the stress score of laborers was higher in the four sub-factors than that of office workers (P < 0.05). Analysis on educational background showed that the scores of the three sub-factors were lower in subjects who's highest level of education was high school (P < 0.01).

Conclusion

This study suggests that it is necessary to improve the culture of Korean collectivism in the workplace and to manage the occupational stress in the low-educated and laborers. It is recommended for future studies to confirm the causal relationship between occupational stress and gastric disease by large scale studies using a KOSS which appropriately reflects workplace culture.