Results of a pilot program for training bar staff in preventing aggression

One hundred and twenty-one staff from eight bars in Ontario, Canada participated in a three-hour training program that used a peer learning model to teach problem-solving skills regarding the prevention and management of aggressive behavior in bars. Participants showed significant positive changes in knowledge and attitudes regarding effective approaches to preventing aggression. The majority of participants reported that the training made them think about ways they handed problem situations and that they would change the way they handle problems in the future. Participants rated most aspects of the training as very useful, especially the group discussion. The program illustrates the potential for increasing skills and knowledge of bar staff in preventing aggression and associated injury.

Risk factors in school shootings

Nine incidents of multiple-victim homicide in American secondary schools are examined and common risk factors are identified. The literature dealing with individual, family, social, societal, and situational risk factors for youth violence and aggression is reviewed along with existing risk assessment methods. Checklists of risk factors for serious youth violence and school violence are used in reviewing each school shooting case. Commonalties among the cases and implications for psychologists practicing in clinical and school settings are discussed.

Beyond the three-process model of alertness: estimating phase, time on shift, and successive night effects

This paper starts by summarizing the development and refinement of the additive three-process model of alertness first published by Folkard and Akerstedt in 1987. It reviews some of the successes that have been achieved by the model in not only predicting variations in subjective alertness on abnormal sleep-wake schedules but also in accounting for objective measures of sleep latency and duration. Nevertheless, predictions derived from the model concerning alertness on different shifts, and over successive night shifts, are difficult to reconcile with published data on accident risk. In light of this, we have examined two large sets of alertness ratings with a view to further refining the model and identifying additional factors that may influence alertness at any given point in time. Our results indicate that, at least for the range of sleep durations and wake-up times commonly found on rotating shift systems, we may assume the phase of the endogenous circadian component of alertness (process C) to be "set" by the time of waking. Such an assumption considerably enhanced the predictive power of the model and yielded remarkably similar phase estimates to those obtained by maximizing the post-hoc fit of the model. We then examined the manner in which obtained ratings differed from predicted values over a complete 8-day cycle of two, 12-h shift systems. This revealed a pronounced "first night compensation effect" that resulted in shift workers rating themselves as progressively more alert than would be predicted over the course of the first night shift. However, this appeared to be achieved only at the cost of lowered ratings on the second night shift. Finally, we were able to identify a "time on shift" effect whereby, with the exception of the first night shift, alertness ratings decreased over the course of each shift before showing a modest "end effect." We conclude that the identification of these additional components offers the possibility that in the future we may be able to predict trends in accident risk on abnormal sleep-wake schedules.

Assessment of psychosocial work environment in primary care--development of a questionnaire

Recent studies have indicated deteriorated working conditions of health care personnel. To have an efficient health care organization requires good working conditions and the well-being of the personnel. Today there are no "gold-standard" assessment tools measuring psychosocial working conditions. The aim of this study was to develop two valid and reliable questionnaires, one generic and one specific, measuring psychosocial working conditions for general practitioners (GPs) and district nurses (DNs) in Sweden, with a special emphasis on organizational changes. The construction of the questionnaires were made after a stepwise developing phase including literature review, interviews, and a pilot study. The pilot study included GPs n = 42 and DNs n = 39. The questionnaires were later on used in a main study (GPs n = 465, DNs n = 465). A factor analysis was carried out and showed that there were fewer items in the main study that had factor loading > or = 0.40 in more than one factor, compared to the pilot study. The factors from the main study were easier to label and had good correspondence with other studies. After this stepwise development phase good construct validity and internal consistency were established for the questionnaire.

Work organization, job stress, and work-related musculoskeletal disorders

Recent studies indicate potential links among work organization, job stress, and work-related musculoskeletal disorders (WRMDs). In this paper we propose several pathways for a theoretical relationship between job stress and WRMDs. These pathways highlight the physiological, psychological, and behavioral reactions to stress that can affect WRMDs directly and indirectly. One model stipulates that psychosocial work factors (e.g., work pressure, lack of control), which can cause stress, might also influence or be related to ergonomic factors such as force, repetition, and posture that have been identified as risk factors for WRMDs. In order to fully understand the etiology of WRMDs, it is important to examine both physical ergonomic and psychosocial work factors simultaneously. Smith and Carayon-Sainfort (1989) have proposed a model of the work system for stress management that provides a useful framework for conceptualizing the work-related factors that contribute to WRMDs. Practical applications of this research include practitioners taking into account psychosocial work factors and job stress in their efforts to reduce and control WRMDs.

Association between burnout at work and leukocyte adhesiveness/aggregation

OBJECTIVE

This study examined whether burnout at work is associated with leukocyte adhesiveness/aggregation (LAA), a phenomenon known to be affected by stress.

METHODS

The LAA levels of 179 employees (68 men and 111 women) of Tel Aviv University were determined when the employees underwent their annual routine medical checkup. Blood pressure and toxic chemical exposure were also measured, and background data were retrieved from medical records. Information on burnout and somatic complaints (known to be a general marker of stress) was collected through a self-report questionnaire.

RESULTS

Total burnout and each of its subcomponents, emotional exhaustion, chronic fatigue, and cognitive weariness, was significantly associated with LAA levels, even after controlling for age, sex, and educational level. Burnout and somatic complaints intercorrelated positively, but somatic complaints were not significantly associated with LAA levels before or after controlling for the above possible confounders.

CONCLUSIONS

Burnout was positively associated with LAA levels. This finding is consistent with the growing evidence of the negative impact of burnout on physical health. The lack of an association between somatic complaints and LAA levels reinforces the claim that burnout and stress are two different concepts.

Exposure to New York City as a risk factor for heart attack mortality

OBJECTIVE

If New York City (NYC) residents' unusually high rate of ischemic heart disease (IHD) results from chronic exposure to that city, there might also be an effect of acute exposure among visitors to NYC. We explored this possibility and also whether IHD is reduced among NYC residents dying away from the city.

METHODS

Using all US death certificates for 1985-1994, we examined (correcting for age, race, and sex) IHD deaths in three groups: NYC residents who died in the city, non-NYC residents visiting the city, and NYC residents traveling out of the city.

RESULTS

IHD deaths among NYC residents dying in the city were 155% of the expected proportion (p < .0001). Among visitors to the city, such deaths were 134% of the expected proportion (p < .0001). The proportion of IHD deaths among NYC residents dying out of the city was only 80% of the expected value (p <.0001). These effects are not due to nearby commuters, recent immigrants, local classification practices, or socioeconomic status, and they do not appear in other US cities.

CONCLUSIONS

With both chronic and acute effects of exposure to NYC, these data are consistent with the hypothesis that the stress of NYC is linked to the high rate of IHD.

Stress, aging, and brain oxidative damage

Stress may contribute to aging acceleration and age-related degenerative diseases. Stress and adaptation to stress require numerous homeostatic adjustments including hormones, neurotransmitters, oxidants, and other mediators. The stress-induced hormones, neurotransmitters, and oxidants all have beneficial, but also harmful effects if out of balance. Therefore, the homeostasis of stress and adaptation should be governed by the hormone balance, neurotransmitter balance, and oxidant balance, as well as the interactions among these substances. The imbalance and the over-interaction of these balances may ultimately cause increased oxidant generation and oxidative damage to biomolecules. This increased oxidative damage may add to the oxidant burden associated with normal aerobic metabolism, which in itself, generates oxidants, causes accumulation of oxidative damage in mitochondria, and contributes to normal aging. Therefore, the stress-associated increase of oxidative damage may, in part, contribute to stress-associated aging acceleration and age-related neurodegenerative diseases.

Work stress and metabolic and hemostatic risk factors

OBJECTIVE

A high level of work stress has been associated with cardiovascular disease. However, the pathophysiological mechanisms underlying this association remain unclear. This study examined the effect of work stress on a cluster of metabolic and hemostatic risk factors.

METHODS

Blood was collected three times, on the first, third, and fifth day of a work week, from 124 middle-aged, white-collar workers. Metabolic measures were insulin, glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and total cholesterol. Hemostatic measures were fibrinogen, tissue-type plasminogen activator activity, tissue-type plasminogen activator antigen, and type 1 plasminogen activator inhibitor antigen. Chronic work stress was defined according to Siegrist's model as 1) a combination of high effort and low reward at work (effort-reward imbalance) or 2) high overcommitment (an exhaustive work-related coping style).

RESULTS

Overcommitment, but not imbalance or the imbalance-overcommitment interaction, was associated with an impaired fibrinolytic system, as reflected in decreased tissue-type plasminogen activator activity levels and increased type 1 plasminogen activator inhibitor antigen levels on all three measurement occasions. After controlling for body mass index, total cholesterol, triglycerides, high-density lipoprotein/low-density lipoprotein cholesterol ratio, glucose, and insulin, the relation between overcom-mitment and the fibrinolytic factors was attenuated but remained significant.

CONCLUSIONS

The results suggest that individuals with an exhaustive coping style at work have an impaired fibrinolytic capacity that is possibly due to the effects of chronic stress on insulin resistance.

Do episodes of anger trigger myocardial infarction? A case-crossover analysis in the Stockholm Heart Epidemiology Program (SHEEP)

OBJECTIVE

Our objectives were to study anger as a trigger of acute myocardial infarction (MI) and to explore potential effect modification by usual behavioral patterns related to hostility.

METHODS

This study was a case-crossover study within the Stockholm Heart Epidemiology Program. Exposure in the period immediately preceding MI was compared with exposure during a control period for each case. From April 1993 to December 1994, 699 patients admitted to coronary care units in Stockholm County were interviewed.

RESULTS

During a period of 1 hour after an episode of anger, with an intensity of at least "very angry," the relative risk of MI was 9.0 (95% CI, 4.4-18.2). In patients with premonitory symptoms, the time of disease initiation may be misclassified. When restricting the analyses to those without such symptoms, the trigger risk was 15.7 (95% CI, 7.6-32.4). The possibility of examining effect modification was limited by a lack of statistical power (eight exposed cases). Results of the analyses suggested, however, an increased trigger effect among subjects reporting nonhostile usual behavior patterns, nonovert strategies of coping with aggressive situations (not protesting when being treated unfairly), and nonuse of beta-blockers.

CONCLUSIONS

The hypothesis that anger may trigger MI is further supported, with an increased risk lasting for approximately 1 hour after an outburst of anger. It is suggested that the trigger risk may be modified by personal behavior patterns.

The role of the workplace in the production and containment of health costs: the case of stress-related disorders

Workplaces vary enormously in the amount of harmful stress they produce, even within specific economic sectors. Stress of certain kinds and at certain levels tend to produce health harms and costs that are borne not only by individual employees and employers but also by families and society at large. Variations in stress levels within economic sectors can be traced to variations in management practices that govern key conditions of work involving demand, effort, control and reward. The costs of stress-related disorders produced by adverse governance practices are transferred outside the workplace in varying degrees. The actual extent of this cost transfer depends on policies and programs within the workplace. We can characterize workplaces according to a typology in which the key dimensions are commitment to abate harm through participatory management practices and the effectiveness and efficiency of harm containment through programs such as employee assistance and health promotion. The most health-promoting and cost-avoiding workplaces foster high control, high reward conditions and support employees with employee assistance and health promotion programs. The policy implications of this observation are drawn out.

Work design and management--the older worker

It will soon be important to retain older workers in the workforce for longer and to ensure they are both healthy and productive. This paper argues, on theoretical and empirical grounds, that in doing so it is important to consider the role of work design and management. This is an under-researched area of work and organizational psychology. Based on a review of the available evidence and on a consideration of the methodological challenges involved, it is proposed that a future research agenda should (1) establish life span models of work design and management as opposed to "age-free" models; (2) place more emphasis on contextual research, and less emphasis on broad-brush, epidemiological models; and (3) embark on more evaluated workplace interventions, and less on cross-sectional studies.

Predictors of good general health, well-being, and musculoskeletal disorders in Swedish dental hygienists

The aim of the present study was to examine how different personal, physical, and psychosocial work-associated factors are related to good general health, well-being, and musculoskeletal disorders in dental hygienists. A questionnaire was mailed to 575 dental hygienists who were randomly sampled from the Swedish Dental Hygienists' Association (86% responded). Data were analyzed with multiple-logistic regression models. The results showed that high clinical-practice fraction, active leisure, and high management support increased the odds for good general health, while work and family overload decreased the odds. Management support and mastery of work increased the odds for well-being, while work and family overload and high work efficiency decreased them. Scaling work increased the odds for general and work-related musculoskeletal disorders in all parts of the upper body and arms but not in the lower back. In the upper body, active leisure decreased the odds for general musculoskeletal disorders, while the odds for work-related musculoskeletal disorders increased from work and family overload and decreased from many weekly working hours. Many years in the profession increased the odds for general finger disorders. In conclusion, the results suggest that active leisure and several psychosocial work factors strongly influence good general health and well-being. Physical tasks influence musculoskeletal disorders more than active leisure and psychosocial work factors.

The role of health risk factors and disease on worker productivity

The costs attributed to employee health problems are usually measured by employers in terms of direct health care costs, such as medical plan claims. Although it has been understood that employee health problems also produce indirect costs for employers, their measurement has been far less frequent. At best, studies have recorded one component of indirect health costs: the time lost to employee absenteeism and disability. The study presented here includes a measure of the actual decrease in the productivity of employees while they are on the job, in addition to measures of absenteeism and disability. These three measurements were combined to produce a Worker Productivity Index (WPI). The WPIs of 564 telephone customer-service agents were correlated with the employees' number and type of health risks, as measured by a Health Risk Appraisal. Additionally, the WPI was also examined across different disease states in the same population of employees. As the number of health risks increased, an employee's productivity decreased. The nature of the health risk may also differentially affect the pattern of the decrease. Finally, disease states were also associated with different patterns of productivity reduction.

Individual and organizational well-being in psychiatric nursing: a cross-cultural study

Although health care systems around the world are undergoing rapid changes, there is an absence of comparative studies of how these changes affect nurses' well-being and work life. The purpose of this study was (i) to identify and describe possible differences between the psycho-social work environments of English and Swedish mental health nurses, and (ii) to attempt to explain these differences. 1016 psychiatric nurses from Stockholm (Sweden) and Birmingham (England) responded to a postal questionnaire on their psycho-social work environment and feelings of professional fulfillment, mental energy and work-related exhaustion. The study was given ethical clearance in Stockholm and Birmingham. Results indicated that while the English nurses rated their organizational well-being more favourably, Swedish psychiatric nurses reported greater individual well-being than their counterparts. Multiple regression analyses indicated that self-esteem was important for explaining mental energy and work-related exhaustion, but less so for explaining professional fulfillment, which was predicted primarily by organizational factors. When controlling for self-esteem, which was higher amongst the Swedish nurses, the differences in professional fulfillment and mental health were no longer significant. Reasons for the differences in self-esteem and experiences of the workplace are discussed. Low response rate may have contributed to a selection bias.

Psychosocial correlates of dietary intake: advancing dietary intervention

Psychosocial variables that predict dietary behavior become important targets for change in nutrition education programs. Psychosocial variables in models with higher predictability provide more effective levers to promote healthy dietary change. A review of the literature on models with psychosocial variables predicting dietary fat and fruit and vegetable consumption revealed generally low predictiveness, R2 < 0.3 (where R2 is the squared multiple correlation of the statistical model). No single theory provided models that regularly out-predicted others. When models predicted narrower categories of behavior (e.g. milk or salad consumption), predictiveness tended to be higher. Substantial problems were revealed in the psychometrics of both the independent and dependent variables. Little theory-based research has been conducted with adolescents, and the few studies done with children had low predictiveness. In order to increase the predictiveness of models, future research should combine variables from several theories, attend to the psychometrics of all variables, and incorporate variables that moderate the relationship of psychosocial to dietary behavior (e.g. genetics of taste, stage in the life course). Refinements on current research would include longitudinal designs and use of non-self-report methods of dietary behavior to supplement the self-report methods. Improved understanding of dietary behavior should lead to more effective dietary behavior change interventions.

The relationship between stress and health care use: an investigation of the buffering roles of personality, social support and exercise

The main and interactive effects of social support, physical exercise, and personal hardiness on objective measures of health were investigated using a longitudinal research design. Data were collected from 192 working adults. Results showed main effects for hardiness and exercise on the dependent variables of health care costs and the number of health insurance claims filed. Hardiness appeared to be associated with fewer health problems. Contrary to prediction, those who exercised more appeared to have greater health care use. Three-way interactions suggested that health care use was lowest for those high in all three resistance resources: exercise: hardiness: and social support. But, the converse of this reasoning, that absence of these resources is associated with higher levels of illness, was not entirely supported. The interactions suggested that hardiness in the absence of exercise and social support was associated with the highest health care costs. The highest number of claims was apparent for those exhibiting hardiness and exercise. Thus, the presence of exercise, hardiness, and social support seemed to decrease health care use, but the factors contributing to greater health costs and claims were more complicated to interpret.

Distress and reduced fertility: a follow-up study of first-pregnancy planners

OBJECTIVE

To assess the effect of psychological distress on time to first pregnancy.

DESIGN

A follow-up study of time to pregnancy with prospective data on distress, with controlling for potential confounding variables.

SETTING

Two university hospitals.

PATIENT(S)

Danish couples (n = 430) who were planning their first pregnancy and had no previous reproductive experience were followed for six menstrual cycles. Psychological distress was measured in each menstrual cycle by the General Health Questionnaire.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

A clinically recognized pregnancy or a biochemical pregnancy detected in urine samples from each period of vaginal bleeding.

RESULT(S)

For cycles with the highest distress score (General Health Questionnaire score >80th percentile), the probability of conception per cycle was 12.8%, compared with 16.5% in other cycles (adjusted odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4-1.0). The effect of distress was found almost exclusively among women with long menstrual cycles (OR 0.1; 95% CI 0.01-0.4 and OR 0.9; 95% CI 0.5-1.4 for women with cycles of > or =35 and <35 days, respectively). An increased incidence of early embryonal loss was also found among highly distressed women with long cycles, but was based on a small number of observations.

CONCLUSION(S)

Psychological distress may be a risk factor for reduced fertility in women with long menstrual cycles.

Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination

Investigating effects of discrimination upon health requires clear concepts, methods, and measures. At issue are both economic consequences of discrimination and accumulated insults arising from everyday and at times violent experiences of being treated as a second-class citizen, at each and every economic level. Guidelines for epidemiologic investigations and other public health research on ways people embody racism, sexism, and other forms of social inequality, however, are not well defined, as research in this area is in its infancy. Employing an ecosocial framework, this article accordingly reviews definitions and patterns of discrimination within the United States; evaluates analytic strategies and instruments researchers have developed to study health effects of different kinds of discrimination; and delineates diverse pathways by which discrimination can harm health, both outright and by distorting production of epidemiologic knowledge about determinants of population health. Three methods of studying health consequences of discrimination are examined (indirect; direct, at the individual level, in relation to personal experiences of discrimination; at the population level, such as via segregation), and recommendations are provided for developing research instruments to measure acute and cumulative exposure to different aspects of discrimination.

Excess catecholamine syndrome. Pathophysiology and therapy

In addition to genetic factors, lifestyle has a predominant influence on primary hypertension and noninsulin-dependent diabetic mellitus (NIDDM). We initiated studies using radiotelemetry for characterizing molecular events linked with excess calorie intake and psychologic stress. An increased calorie intake was associated with raised (p < 0.05) systolic and diastolic blood pressure as well as heart rate independent of day-night cycle. Sympathetic activity was in excess when related to the unchanged motility. The hyperkinetic hypertension is expected to result in adverse remodeling of resistance vessels and to aggravate insulin resistance. To examine adverse effects of psychological stress, rats were subjected to intermittent food pellet feeding. Urinary catecholamines and cardiac norepinephrine stores were increased (p < 0.05). The depressed (p < 0.05) rate of Ca2+ uptake of sarcoplasmic reticulum is expected to contribute to cellular Ca2+ overload. These lifestyle influences strengthen the notion of an excess catecholamine syndrome which requires selective reduction of sympathetic outflow of the brain by I1-receptor agonists.

Chronic burnout, somatic arousal and elevated salivary cortisol levels

Burnout syndrome, comprised of the symptoms of emotional exhaustion, physical fatigue, and cognitive weariness, is believed to be a result of ineffective coping with enduring stress. This study of 111 nonshift blue-collar workers free of cardiovascular disease (CVD) examined whether chronic burnout is associated with a state of somatic and physiological hyperarousal. Results showed that 37 workers exhibited symptoms of chronic burnout, with symptoms lasting at least 6 months. These workers, compared to those with no burnout symptoms (n = 52) or nonchronic burnout symptoms (n = 22), had higher levels of tension at work, postwork irritability, more sleep disturbances and complaints of waking up exhausted, and higher cortisol levels during the work day. These results suggest that chronic burnout is associated with heightened somatic arousal and elevated salivary cortisol levels. This may be part of the mechanism underlying the emerging association between burnout and risk of CVD.

Gender, race, and class in organizational contexts

Creating settings that support diversity has been a long-standing concern of community psychology. In this paper, I propose two qualities as important aspects of organizational contexts that support the meaningful participation of diverse groups: (a) a culture of connection and (b) recognition of multiple "realities." For each theme, I first examine countervailing values that can undermine meaningful participation of nondominant groups. I suggest that organizational values for independence and a press for sameness can contribute to settings where members of traditionally oppressed groups will be prevented from meaningful participation. I also suggest that fostering a culture of connectedness that actively legitimizes multiple realities is a constructive alternative. To illustrate these points, I share observations based on experiences in manufacturing, educational, and community-based settings. Then, I explore two dynamics that are important when confronting the countervailing values and building more inclusive contexts: (a) accountability for impact and (b) privilege dynamics. Last, I turn to some possibilities for change through a stance of connected disruption.

Association between job characteristics and plasma fibrinogen in a normal working population: a cross sectional analysis in referents of the SHEEP Study. Stockholm Heart Epidemiology Program

STUDY OBJECTIVE

To explore the association between job characteristics and plasma fibrinogen concentrations.

DESIGN

Cross sectional design.

SETTING

The Greater Stockholm area.

SUBJECTS

A total of 1018 men and 490 women aged 45-70 who were randomly selected from the general population during 1992-1994. They were all employed and had no history of myocardial infarction.

MAIN RESULTS

The self reported job characteristics were measured by a Swedish version of the Karasek demand-control questionnaire. For inferred scoring of job characteristics, psychosocial exposure categories (job control and psychological demands) were assigned by linking each subject's occupational history with a work organisation exposure matrix. Job strain was defined as the ratio between demands and control. In univariate analyses, expected linear trends were found in three of four tests of association between high plasma fibrinogen and low control (the self reported score for women and the inferred score for both sexes), in one of four tests of association between high plasma fibrinogen and high demands (the inferred score for women) and in two of four tests of association between high plasma fibrinogen and job strain (the inferred score for both sexes). Multiple logistic regression analyses showed that men in the inferred job strain group have an increased risk of falling into the increased plasma fibrinogen concentration group (above median level of the distribution) (odds ratio (OR) 1.2; 95% CI 1.0, 1.5) after adjustment for the variables that were associated with plasma fibrinogen in the univariate analyses. In women, low self reported control, high inferred demand, and inferred job strain were significantly associated with increased plasma fibrinogen concentration (OR 1.3; 95% CI 1.0, 1.8, OR 1.5; 95% CI 1.0, 2.2, OR 1.5; 95% CI 1.1, 2.2, respectively).

CONCLUSIONS

These results indicate that adverse job characteristics may be related to plasma fibrinogen concentrations and this relation is more relevant in female workers. The clearest evidence for psychosocial effects on plasma fibrinogen seems to be with job control and the associations are clearer for the objective than for the self report variables.

The incorporation of different demand concepts in the job demand-control model: effects on health care professionals

This paper reports a study of 212 health care professionals that focuses on job characteristics as predictors of employee health. By means of covariance structure modelling (LISREL 8) we tested the interactive assumptions of the Karasek (1979) Job Demand-Control (JD-C) Model [Karasek, R.A., Jr., 1979. Job demands, job decision latitude, and mental strain: implications for job redesign. Administrative Science Quarterly, 24, 285-307.] using three different concepts of job demands (i.e. psychological job demands, physical demands and emotional demands) in combination with a more focused measure of decision latitude (i.e. job autonomy) to predict employee health (i.e. job satisfaction, job involvement, emotional exhaustion and psychosomatic health complaints). Controlling for gender and age, the results partly support the JD-C hypotheses by finding three out of twelve assumed interaction effects. More specifically, different outcome variables are predicted by different combinations of job autonomy with the three kinds of job demands, respectively. In conclusion, although we refute the central hypotheses of the JD-C model to a large extent, the current (interactive) findings are quite illuminating and will be discussed in the context of their theoretical and practical implications. Researchers as well as practitioners have to broaden their perspective on 'job demands' in health care work and need to focus on different kinds of job demands to capture the complexity of this work setting.

Relation between job strain and myocardial infarction: a case-control study

OBJECTIVES

To study the influence of different job related and socioeconomic factors for development of myocardial infarction (MI).

METHOD

The study was a case-control study of 76 male wage earners who had been admitted to hospital with MI. As a control group 176 male wage earners not admitted to hospital who were residents of the same county were used. Both groups were interviewed with an extensive questionnaire on job related conditions. Several indices on job related psychosocial factors were established in accordance with Karasek's job strain model as well as the extension of the model, the isostrain model.

RESULTS

The most significant findings were consistent with Karasek's job strain model in that mean with a high degree of demand combined with a low degree of control at work had a significantly increased odds ratio (OR) 95% confidence interval (95% CI) of 2.1 (1.2 to 3.8) for MI after adjustment for age compared with men with a low degree of demand and a high degree of control at work. Further adjustment for smoking, socioeconomic status, employment sector, job category, and social network did not affect the OR substantially (OR 2.3 (1.2 to 4.4)). Other factors significantly associated to MI were job category (blue collar workers v white collar workers, OR 2.8 (1.6 to 5.8)), and employment sector (private v public, OR 3.1 (1.8 to 6.1)).

CONCLUSIONS

Thus, the study confirmed the job strain model as well as the well known association between socioeconomic status and risk of MI, whereas the finding of an increased risk among employees in the private sector has not previously been described.

Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study

OBJECTIVES

The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants.

METHODS

In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases.

RESULTS

Low social support at work and low decision authority, high job demands and effort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score.

CONCLUSIONS

Social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive effects on mental health in working populations.

Downsizing, role demands, and job stress

This is a cross-sectional study consisting of self-administered survey instruments to measure psychological distress and stress-inducing work demands after 6 months of rumors about an upcoming corporate downsizing event. The workforce consisted predominantly of white males who were married, college-educated, and nonsmokers. Higher stress levels were seen among older, more educated workers, who had longer company tenure. Role boundary problems, noxious physical environments, and company tenure were retained in the final multivariable model predicting distress level. The ongoing time delay for management to implement the threatened layoff and peer rankings for a new job performance appraisal contributed to a decline in worker solidarity because of concerns about career and job security. These uncertainties reduced worker productivity and effective teamwork.

Defining elder care

This study was a beginning effort to clarify the different types of elder care and to understand which type of elder care, i.e., giving time or giving money, might be more closely associated with employed persons' health. Giving time, compared to giving money, to provide care may be weakly associated with emotional health (r = .05) and physical health (r = .04) as N = 2,269 (cf. rs of .00, .01); giving money may not be associated with either. Investigations of elder care and its consequences should be very specific when measuring this construct.

Distribution of rest days in 12 hour shift systems: impacts on health, wellbeing, and on shift alertness

OBJECTIVES

To investigate of the effects of distribution of rest days in 12 hour shift systems. Although several studies have examined the effects of compressing work schedules by comparing 8 and 12 hour shift systems, there is little published research examining the various forms of 12 hour shift system.

METHODS

An abridged version of the standard shiftwork index which included retrospective alertness ratings was completed by a large sample of industrial shiftworkers. The respondents worked 12 hour shift systems that either did or did not incorporate breaks of > 24 hours between the blocks of day and night shifts. For the purposes of the analysis, each of these two groups were further subdivided into those who started their morning shift at 0600 and those who started at 0700.

RESULTS

Systems which incorporated rest days between the day and night shifts were associated with slightly higher levels of on shift alertness, slightly lower levels of chronic fatigue, along with longer sleep durations when working night shifts and between rest days. Early changeovers were associated with shorter night sleeps between successive day shifts, but longer and less disturbed day sleeps between night shifts. These effects of changeover time were broadly in agreement with previous research findings.

CONCLUSIONS

The distribution of rest days in 12 hour shift systems had only limited effects on the outcome measures, although the few modest differences that were found favoured systems which incorporated rest days between the day and night shifts. It is conceded that the design of the study may have obscured some subtle differences between the shift systems. Nevertheless, it is concluded that the impact of distribution of rest days seems to be minor relative to previously found effects of other features of shift systems--for example, shift duration.

Effect of family responsibilities and job strain on ambulatory blood pressure among white-collar women

OBJECTIVE

This study was conducted to determine whether large family responsibilities and their combination with high job strain were associated with an increase in ambulatory blood pressure (BP) among white-collar women.

METHODS

A cross-sectional study was conducted in a stratified random sample of 199 white-collar women with or without children who were employed full time in jobs involving high or low strain. These women were selected from a population of 3183 women of all ages, employed in eight organizations in Quebec City, Canada. Subjects wore an ambulatory BP monitor for 24 hours during a working day. Mean BPs were calculated. Different measures of family responsibilities were used, based on the number of children and their ages, and domestic work. Job strain was measured using the Job Content Questionnaire recommended by Karasek.

RESULTS

Family responsibility measures were significantly related to diurnal BP among women holding a university degree (N=69). Indeed, women having large family responsibilities had increases in systolic and diastolic BPs of 2.7 to 5.7/1.8 to 4.0 mm Hg (p< or =.05). Among women holding a university degree, increases in diurnal systolic and diastolic BPs reached 8.1 to 10.9/5.5 to 7.1 mm Hg (p< or =.01) among women having both large family responsibilities and high job strain. These results were independent of confounders. There was no significant association among women without a university degree (N=130).

CONCLUSIONS

Large family responsibilities were associated with significant increases in diurnal systolic and diastolic BPs among white-collar women holding a university degree. In these women, the combined exposure of large family responsibilities and high job strain tended to have a greater effect on BP than the exposure to only one of these factors.

Perceived control systems, work conditions, and efficiency among Swedish dentists: interaction between two sides of human resource management

Two aspects of Human Resource Management (HRM), a main trend in modern personnel management, are considered in this study: A 'hard' version stressing performance monitoring and competition, and a 'soft' version stressing communication with employees. The aim of the investigation was to examine whether these two aspects of modern management are reflected in dentists' perceptions of differences in work conditions compared with other professionals. A questionnaire was answered by 312 publicly employed dentists and 3,600 other professionals in Sweden. The response rate was 66-77%. Effects from HRM on work, conditions and perceived efficiency were confirmed. The interaction effects, reflecting the duality of HRM, resulted in poorer work conditions, e.g. worse balance between effort and reward and worse opportunities for developing competence and collaboration in the workplace. This pertains especially in the case of dentists, where the positive effects of 'soft' HRM did not compensate for the negative effects of 'hard' HRM. Dentists in Sweden's Public Dental Health Service appear as a vulnerable group among Swedish professionals.

Work and Family Stress and Well-Being: An Examination of Person-Environment Fit in the Work and Family Domains

Research indicates that work and family are significant sources of stress. However, this research has underemphasized the cognitive appraisal process by which work and family generate stress. This study used person-environment fit theory to examine how the comparison of work and family experiences to the person's values relates to stress and well-being. Using data from 1758 employees, we assessed fit regarding autonomy, relationships, security, and segmentation for both work and family, and examined the relationship of fit with work and family satisfaction, anxiety, depression, irritation, and somatic symptoms. In general, well-being improved as experiences increased toward values and improved to a lesser extent as experiences exceeded values. Well-being was also higher when experiences and values were both high than when both were low. These relationships were generally strongest for within-domain fit and well-being (i.e., work fit and work satisfaction, family fit and family satisfaction), and several relationships were moderated by work and family centrality. Copyright 1999 Academic Press.

Distressed and stress resistant nurses

This study examines the relative contribution of personality, coping, and family support to adaptation to stress in nursing. The sample (N = 1,043, mean age = 33.8 years) were nurses from three large public hospitals in Singapore. The findings indicated that stress resistant nurses who adapted to high work stress with good mental health status as measured by the General Health Questionnaire (GHQ-12) developed by Goldberg (1972) had a higher self-esteem and were more internal in locus of control than the distressed nurses who reported poor mental health status under high work stress. The use of negative emotion focused coping was less frequent among the stress-resistant nurses who also had greater supports from family relationships. Discriminant function analysis revealed that behavioral coping (e.g., enhancement of ability and physical health) had greater contribution to stress resistance than cognitive coping (e.g., acceptance of situations or change of perspectives). The findings were discussed with reference to the high level of performance demanded by nursing.

Psychophysiological correlates of organizational change and threat of unemployment among police inspectors

The study examined psychosocial work-conditions and physiological reactions among thirty-six police inspectors (median age 45 years, 81% males) who participated in a reorganization. At this time, subjects were threatened by unemployment and had to re-apply for their positions in a new police district. Data were collected during the reorganization and at three years follow-up, by means of questionnaires (Stress Profile) and blood samples. The blood samples were used to determine serum levels of gamma-glutamyltransferase (GGT), glucose, lipids, prolactin, testosterone and cortisol. The results show a positive association between worry about employment and symptoms of burnout during the reorganization. Mean scores for the Stress Profile sub-scales worry about employment (p<.01) and work-load (p<.05) decreased between measurements, but an impairment in relationships with management was noticed (p<.05). No significant changes were observed in terms of self-rated health complaints. Significant decreases in total cholesterol (p<.0001), LDL-cholesterol (p<.0001), LDL/HDL-ratio (p<.01), prolactin (p<.0001), as well as increases in testosterone (p<.01) and cortisol (p<.001) were observed for the whole sample. Glucose decreased with marginal significance (<.07). Controlling for age and gender, multivariate regression analyses showed that subjects who reported deteriorations in satisfaction with work manifested the most modest decreases in prolactin (p<.05). Also, the decrease in glucose was larger for subjects who experienced impairments in satisfaction with work (p<.05), information (p<.05), task-oriented leadership, (p<.05), and respect and dignity (p<.05). Subjects who perceived deteriorations in the ethical and moral standards of the organization increased their cortisol level to a lower degree than their counterparts (p<.05). Favorable changes in employment status and psychosocial work environment seem to be related to improved physiological functioning.