Liver changes under combined effect of working environmental factors

The quest for interaction: studies on combined exposure

A literature review was performed on the subject of combined exposure to stressors in the working situation. A general, dynamic model of workload served as the theoretical framework for the study. In this model, every factor that triggers a physiological or psychological response in the worker is regarded as a stressor. Decision latitude plays an important role in the model. A quantitative and qualitative analysis was performed on the available literature. It was concluded that the stressors that appear in studies on combined exposure stem mostly from the physical, chemical and biological environment. The task contents, the labor conditions, social relationships at work and the decision latitude are considerably less often studied in relation to combined exposure. It is concluded that important concepts in the study of combined exposure (e.g. interaction, independence, synergism, antagonism) are often quite carelessly mentioned in the literature. Explicit definition of these concepts is lacking in many publications. Establishment of maximum exposure levels is not yet possible for most stressor combinations. Examples are given of combinations that do allow more or less definite conclusions. It is recommended that more studies should be interdisciplinary organized. More studies are necessary in the field, studying effects of long exposure periods in the working population instead of studying students in laboratory situations. Exposure of susceptible groups, such as older workers and partially disabled workers, deserves special attention.