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Igolnikov I, Gallagher RM, Hainline B. Sport-related injury and pain classification. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:423-430. [PMID: 30482370 DOI: 10.1016/b978-0-444-63954-7.00039-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pain is common in athletes, and pain management in sport has traditionally been equated with injury management. Although both pain and injury interfere with sport performance, they are not synonymous. Acute musculoskeletal injury commonly manifests as nociceptive pain, inflammatory pain, or both. Pain that persists beyond expected injury recovery must account for all potential contributors to pain, including ongoing biomechanical abnormalities, underlying pathophysiology, and psychosocial issues. Pain chronification involves multiple pathophysiologic and neurobehavioral processes that lead from acute injury-related pain to subacute and chronic pain, and must be distinguished from an ongoing biomechanical overuse pattern. The foundation of pain management in athletes is proper pain classification, which involves assessing for any combination of nociceptive/inflammatory pain, neuropathic pain, central sensitization, and autonomic/motor/affective manifestations of pain. Understanding this foundation is critical because there are scant evidence-based guidelines for the management of pain in sport. This chapter will explore the relationship of sport-related injury and pain, and will provide a management framework that is consistent with International Olympic Committee consensus.
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Affiliation(s)
- Ilya Igolnikov
- Penn Spine Center, Physical Medicine and Rehabilitation Department, University of Pennsylvania, Philadelphia, PA, United States
| | - Rollin M Gallagher
- Penn Pain Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Brian Hainline
- National Collegiate Athletic Association, Indianapolis, IN, United States
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Haukenes I, Löve J, Hensing G, Knudsen AK, Øverland S, Vahtera J, Sivertsen B, Tell GS, Skogen JC. Inequity in disability pension: an intersectional analysis of the co-constitution of gender, education and age. The Hordaland Health Study. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1469730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Inger Haukenes
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Jesper Löve
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ann Kristin Knudsen
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Simon Øverland
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Børge Sivertsen
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jens Christoffer Skogen
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
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Andreeva E, Brenner MH, Theorell T, Goldberg M. Risk of psychological ill health and methods of organisational downsizing: a cross-sectional survey in four European countries. BMC Public Health 2017; 17:758. [PMID: 28962605 PMCID: PMC5622469 DOI: 10.1186/s12889-017-4789-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The manner in which organizational downsizing is implemented can make a substantial difference as to whether the exposed workers will suffer from psychological ill health. Surprisingly, little research has directly investigated this issue. We examined the likelihood of psychological ill health associated with strategic and reactive downsizing. METHODS A cross-sectional survey included 1456 respondents from France, Sweden, Hungary and the United Kingdom: 681 employees in stable workplaces (reference group) and 775 workers from downsized companies. Reactive downsizing was exemplified by the exposures to compulsory redundancies of medium to large scale resulting in job loss or surviving a layoff while staying employed in downsized organizations. The workforce exposed to strategic downsizing was represented by surplus employees who were internally redeployed and supported through their career change process within a policy context of "no compulsory redundancy". Symptoms of anxiety, depression and emotional exhaustion were assessed in telephone interviews with brief subscales from Hospital Anxiety Scale (HADS-A), Hopkins Symptom Checklist (SCL-CD6) and Maslach Burnout Inventory (MBI-GS). Data were analyzed using logistic regression. RESULTS We observed no increased risk of psychological ill health in the case of strategic downsizing. The number of significant associations with psychological ill health was the largest for the large-scale reactive downsizing: surviving a layoff was consistently associated with all three outcome measures; returning to work after the job loss experience was related to anxiety and depression, while persons still unemployed at interview had elevated odds of anxiety. After reactive medium-scale downsizing, unemployment at interview was the only exposure associated with anxiety and depression. CONCLUSIONS The manner in which organizational downsizing is implemented can be important for the psychological wellbeing of workers. If downsizing is unavoidable, it should be achieved strategically. Greater attention is needed to employment and health policies supporting the workers after reactive downsizing.
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Affiliation(s)
- Elena Andreeva
- Centre for Applied Rehabilitation Research, Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany.
| | - M Harvey Brenner
- Department of Behavioral and Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Töres Theorell
- Institute for Stress Research, Stockholm University, Stockholm, Sweden
| | - Marcel Goldberg
- Inserm, Population-based Epidemiologic Cohorts Unit, UMS, 11, Villejuif, France.,Paris Descartes University, Paris, France
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Knardahl S, Johannessen HA, Sterud T, Härmä M, Rugulies R, Seitsamo J, Borg V. The contribution from psychological, social, and organizational work factors to risk of disability retirement: a systematic review with meta-analyses. BMC Public Health 2017; 17:176. [PMID: 28178966 PMCID: PMC5299735 DOI: 10.1186/s12889-017-4059-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 01/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies indicate that psychological, social, and organizational factors at work contribute to health, motivation, absence from work, and functional ability. The objective of the study was to assess the current state of knowledge of the contribution of psychological, social, and organizational factors to disability retirement by a systematic review and meta-analyses. METHODS Data sources: A systematic literature search for studies of retirement due to disability in Medline, Embase, and PsychINFO was performed. Reference lists of relevant articles were hand-searched for additional studies. DATA EXTRACTION Internal validity was assessed independently by two referees with a detailed checklist for sources of bias. Conclusions were drawn based on studies with acceptable quality. DATA SYNTHESIS We calculated combined effect estimates by means of averaged associations (Risk ratios) across samples, weighting observed associations by the study's sample size. Thirty-nine studies of accepted quality were found, 37 of which from the Nordic countries. RESULTS There was moderate evidence for the role of low control (supported by weighted average RR = 1.40; 95% CI = 1.21-1.61) and moderate evidence for the combination of high demands and low control (although weighted average was RR = 1.45; 95% CI = 0.96-2.19) as predictors of disability retirement. There were no major systematic differences in findings between the highest rated and the lowest rated studies that passed the criterion for adequate quality. There was limited evidence for downsizing, organizational change, lack of employee development and supplementary training, repetitive work tasks, effort-reward imbalance to increase risk of disability pension. Very limited evidence was found for job demands, evening or night work, and low social support from ones superior. CONCLUSIONS Psychological and organizational factors at work contribute to disability retirement with the most robust evidence for the role of work control. We recommend the measurement of specific exposure factors in future studies.
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Affiliation(s)
- Stein Knardahl
- Department of work psychology and physiology, National Institute of Occupational Health, Oslo, Norway
| | - Håkon A. Johannessen
- Department of Occupational Health Surveillance, National Institute of Occupational Health, Oslo, Norway
| | - Tom Sterud
- Department of Occupational Health Surveillance, National Institute of Occupational Health, Oslo, Norway
| | - Mikko Härmä
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jorma Seitsamo
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Vilhelm Borg
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Schnall PL, Dobson M, Landsbergis P. Globalization, Work, and Cardiovascular Disease. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:656-92. [DOI: 10.1177/0020731416664687] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiovascular disease (CVD), a global epidemic, is responsible for about 30% of all deaths worldwide. While mortality rates from CVD have been mostly declining in the advanced industrialized nations, CVD risk factors, including hypertension, obesity, and diabetes, have been on the increase everywhere. Researchers investigating the social causes of CVD have produced a robust body of evidence documenting the relationships between the work environment and CVD, including through the mechanisms of psychosocial work stressors. We review the empirical evidence linking work, psychosocial stressors, and CVD. These work stressors can produce chronic biologic arousal and promote unhealthy behaviors and thus, increased CVD risk. We offer a theoretical model that illustrates how economic globalization influences the labor market and work organization in high-income countries, which, in turn, exacerbates job characteristics, such as demands, low job control, effort-reward imbalance, job insecurity, and long work hours. There is also a growing interest in “upstream” factors among work stress researchers, including precarious employment, downsizing/restructuring, privatization, and lean production. We conclude with suggestions for future epidemiologic research on the role of work in the development of CVD, as well as policy recommendations for prevention of work-related CVD.
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Affiliation(s)
- Peter L. Schnall
- Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory Way, Irvine, California, USA
| | - Marnie Dobson
- Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory Way, Irvine, California, USA
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Sigursteinsdóttir H, Rafnsdóttir GL. Sickness and sickness absence of remaining employees in a time of economic crisis: A study among employees of municipalities in Iceland. Soc Sci Med 2015; 132:95-102. [DOI: 10.1016/j.socscimed.2015.03.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mousazadeh Y, Jannati A, Jabbari Beiramy H, AsghariJafarabadi M, Ebadi A. Advantages and disadvantages of different methods of hospitals' downsizing: a narrative systematic review. Health Promot Perspect 2013; 3:276-87. [PMID: 24688978 PMCID: PMC3963665 DOI: 10.5681/hpp.2013.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 11/05/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hospitals as key actors in health systems face growing pres-sures especially cost cutting and search for costeffective ways to resources management. Downsizing is one of these ways. This study was conducted to identify advantages and disadvantages of different methods of hospital' downsizing. METHODS The search was conducted in databases of Medlib, SID, Pub Med, Science Direct and Google Scholar Meta search engine by keywords of Downsizing, Hospital Downsizing, Hospital Rightsizing, Hospital Restructuring, Staff Downsizing, Hospital Merging, Hospital Reorganization and the Persian equivalents. Resulted 815 articles were studied and refined step by step. Finally, 27 articles were selected for analysis. RESULTS Five hospital downsizing methods were identified during searching. These methods were reducing the number of employees and beds, outsourcing, integration of hospital units, and the combination of these methods. The most important benefits were cost reduction, increasing patient satisfaction, increasing home care and outpatient services. The most important disadvantage included reducing access, reducing the rate of hospital admissions and increasing employees' workload and dissatisfaction. CONCLUSION Each downsizing method has strengths and weaknesses. Using different methods of downsizing, according to circumstances and applying appropriate interventions after implementation, is necessary for promotion.
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Affiliation(s)
- Yalda Mousazadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Jannati
- Tabriz Healthcare Management Research Center,Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Jabbari Beiramy
- Tabriz Health Services Management Research Center, Tabriz University of medical sciences, Tabriz, Iran
| | | | - Ali Ebadi
- Deputy of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Kokkinen L, Virtanen M, Pentti J, Vahtera J, Kivimäki M. Does transfer of work from a public sector organisation to a commercial enterprise without staff reductions increase risk of long-term sickness absence among the staff? A cohort study of laboratory and radiology employees. Occup Environ Med 2013; 70:585-7. [PMID: 23658426 DOI: 10.1136/oemed-2012-101174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Privatisations of public sector organisations are not uncommon, and some studies suggest that such organisational changes may adversely affect employee health. In this study, we examined whether transfer of work from public sector hospital units to commercial enterprises, without major staff reductions, was associated with an increased risk of long-term sickness absence among employees. METHODS A cohort study of 962 employees from four public hospital laboratory and radiology units in three hospitals which were privatised during the follow-up and 1832 employees from similar units without such organisational changes. Records of new long-term sick leaves (>90 days) were obtained from national health registers and were linked to the data. Mean follow-up was 9.2 years. RESULTS Age- and sex-adjusted HR for long-term sickness absence after privatisation was 0.83 (95% CI 0.68 to 1.00) among employees whose work unit underwent a change from a public organisation to a commercial enterprise compared with employees in unchanged work units. Further adjustments for occupation, socioeconomic status, type of job contract, size of residence and sick leaves before privatisation had little impact on the observed association. A sensitivity analysis with harmonised occupations across the two groups replicated the finding (multivariable adjusted HR 0.92 (0.70-1.20)). CONCLUSIONS In this study, transfer of work from public organisation to commercial enterprise did not increase the risk of long-term sickness absence among employees.
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Affiliation(s)
- Lauri Kokkinen
- The Centre of Expertise for Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere, Helsinki and Turku, Finland.
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Vie GÅ, Krokstad S, Johnsen R, Bjørngaard JH. The Health Hazards of Marriage. A cohort study of work related disability within 12,500 Norwegian couples - the HUNT Study. Scand J Public Health 2013; 41:500-7. [PMID: 23524409 DOI: 10.1177/1403494813482185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Work disability and sickness absence increase following partner's retirement, which similarities in spouses' health could explain. We therefore studied the risk of work disability within couples, taking account of baseline health, lifestyle and socioeconomic factors. METHODS A cohort of 12,511 couples from the HUNT Study (aged 20-67 years in HUNT2, 1995-1997) was linked to national registries, identifying all new cases of disability pension up until December 2007. Data were analysed with discrete time multilevel logistic regression and Cox regression models. Partners' disability pension was included as a time-varying covariate. Follow-up time was split to examine the association dependent of time. Analyses were adjusted for age only, adjusted for health, and for lifestyle and education along with health. RESULTS About 15% of an individual's propensity to receive a disability pension could be attributed couple similarity. There was an increased risk of work disability following the spouse's disability retirement [HR (hazard ratio) 1.43 (95% confidence interval 1.20-1.71) for men, HR 1.49 (95% confidence interval 1.28-1.74) for women]. The association was somewhat attenuated after adjustments for health, lifestyle and education. CONCLUSION There was a substantial clustering of disability pensions within couples, which cannot be explained by similarities in health, lifestyle and education. This suggests partners influence each other's work ability. From a clinical perspective, the family situation needs to be taken into account when addressing health promotion and work participation.
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Affiliation(s)
- Gunnhild Åberge Vie
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Claussen B, Næss Ø, Reime LJ, Leyland AH. Proof firm downsizing and diagnosis-specific disability pensioning in Norway. BMC Public Health 2013; 13:27. [PMID: 23311568 PMCID: PMC3655911 DOI: 10.1186/1471-2458-13-27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 01/03/2013] [Indexed: 11/23/2022] Open
Abstract
Background We wanted to investigate if firm downsizing is related to an increased rate of disability pensions among the former employed, especially for those with musculoskeletal and psychiatric diagnoses, and for those having to leave the firm. Methods Statistics Norway provided a linked file with demographic information and all social security grants from the National Insurance Administration for 1992–2004 for all inhabitants in Norway. Our sample was aged 30–55 years in 1995, being alive, employed and not having a disability pension at the end of 2000. Downsizing was defined as percent change in number of employed per firm from 1995 to end 2000. Employment data were missing for 25.6% of the sample. Results Disability pension rates in the next four years were 25% higher for those experiencing a 30-59% downsizing than for those not experiencing a reduction of the workforce. 1-29% and 60-100% downsizing did not have this effect. Stayers following down-sizing had higher disability pension rates than leavers. What we have called complex musculoskeletal and psychiatric diagnoses were relatively most common. Conclusion Moderate downsizing is followed by a significant increase in disability pension rates in the following four years, often with complex musculoskeletal and psychiatric diagnoses.
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Affiliation(s)
- Bjørgulf Claussen
- Institute of Health and Society, University of Oslo, P,O,Box 1130, Blindern, N0318, Norway.
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Knudsen AK, Øverland S, Hotopf M, Mykletun A. Lost working years due to mental disorders: an analysis of the Norwegian disability pension registry. PLoS One 2012; 7:e42567. [PMID: 22905150 PMCID: PMC3419710 DOI: 10.1371/journal.pone.0042567] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/09/2012] [Indexed: 11/18/2022] Open
Abstract
Objectives Mental disorders are prevalent diagnoses in disability benefit statistics, with awards often granted at younger age than for other diagnoses. We aimed to compare the number of lost working years following disability benefit award for mental disorders versus other diagnostic groups. Methods Data from the complete Norwegian official registry over disability benefit incidence, including primary diagnoses, were analyzed for the period 2001 to 2003 (N = 77,067), a time-period without any reform in the disability benefit scheme. Lost working years due to disability benefit award before scheduled age retirement at age 67 were calculated. Results Musculoskeletal disorders were the commonest reason for disability benefit awards (36.3%) with mental disorders in second place (24.0%). However, mental disorders were responsible for the most working years lost (33.8%) compared with musculoskeletal disorders (29.4%). Individuals awarded disability benefit for a mental disorder were on average 8.9 years younger (46.1 years) than individuals awarded for a musculoskeletal disorder (55.0 years), and 6.9 years younger than individuals awarded for any other somatic disorder (53.0 years). Anxiety and depressive disorders were the largest contributors to lost working years within mental disorders. Conclusion Age at award is highly relevant when the total burden of different diagnoses on disability benefits is considered. There is great disparity in total number of lost working years due to disability benefit award for different diagnostic groups. The high number of lost working years from mental disorders has serious consequences for both the individual and for the wider society and economy.
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Affiliation(s)
- Ann Kristin Knudsen
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.
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Støver M, Pape K, Johnsen R, Fleten N, Sund ER, Claussen B, Bjørngaard JH. Unemployment and disability pension--an 18-year follow-up study of a 40-year-old population in a Norwegian county. BMC Public Health 2012; 12:148. [PMID: 22369630 PMCID: PMC3305666 DOI: 10.1186/1471-2458-12-148] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 02/28/2012] [Indexed: 11/23/2022] Open
Abstract
Background This study explored the association of unemployment and an increased risk of receiving disability pension, and the possibility that this risk is attributed to municipality-specific characteristics. Methods A cohort of 7,985 40-42 year olds was followed for 18 years in national registers, identifying new episodes of unemployment and cases of disability pension. The association between an unemployment period and disability pension in the subsequent year was estimated using discrete time multilevel logistic regressions and clustering individuals by municipality. The association between unemployment and disability pension was adjusted for age in the follow up-period, sex, baseline health status, health behaviour and education level. A conditional intra-class correlation coefficient (ICC) was estimated as a measure of inter-municipality variance. Results In the follow-up period, 2784 (35%) of the participants were granted disability pension. The crude odds ratio for receiving disability pension after unemployment (adjusted for age in follow-up period and sex only) was 1.42 (95% CI 1.1-1.8). Adjusting for baseline health indicators reduced the odds ratio of unemployment to 1.33 (CI 1.1-1.7). A fully adjusted model, including education level, further reduced the odds ratio of unemployment to 1.25 (CI 1.00-1.6). The ICC of the municipality level was approximately 2%. Conclusions Becoming unemployed increased the risk of receiving subsequent disability pension. However, adjusting for baseline health status, health behaviour and education attenuated this impact considerably. The multilevel analysis indicated that a minor, yet statistically significant, proportion of the risk of disability pension can be attributed to the municipality of residence.
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Affiliation(s)
- Morten Støver
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, MTFS, 7491 Trondheim, Norway.
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Nilsen SM, Ernstsen L, Krokstad S, Westin S. Educational inequalities in disability pensioning - the impact of illness and occupational, psychosocial, and behavioural factors: The Nord-Trøndelag Health Study (HUNT). Scand J Public Health 2012; 40:133-41. [PMID: 22314253 DOI: 10.1177/1403494811435494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Socioeconomic inequalities in disability pensioning are well established, but we know little about the causes. The main aim of this study was to disentangle educational inequalities in disability pensioning in Norwegian women and men. METHODS The baseline data consisted of 32,948 participants in the Norwegian Nord-Trøndelag Health Study (1995-97), 25-66 years old, without disability pension, and in paid work. Additional analyses were made for housewives and unemployed/laid-off persons. Information on the occurrence of disability pension was obtained from the National Insurance Administration database up to 2008. Data analyses were performed using Cox regression. RESULTS We found considerable educational inequalities in disability pensioning, and the incidence proportion by 2008 was higher in women (25-49 years 11%, 50-66 years 30%) than men (25-49 years 6%, 50-66 years 24%). Long-standing limiting illness and occupational, psychosocial, and behavioural factors were not sufficient to explain the educational inequalities: young men with primary education had a hazard ratio of 3.1 (95% CI 2.3-4.3) compared to young men with tertiary education. The corresponding numbers for young women were 2.7 (2.1-3.1). We found small educational inequalities in the oldest women in paid work and no inequalities in the oldest unemployed/laid-off women and housewives. CONCLUSIONS Illness and occupational, psychosocial, and behavioural factors explained some of the educational inequalities in disability pensioning. However, considerable inequalities remain after accounting for these factors. The higher incidence of disability pensioning in women than men and the small or non-existing educational inequalities in the oldest women calls for a gender perspective in future research.
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Affiliation(s)
- Sara Marie Nilsen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Reduction in personnel and long-term sickness absence for psychiatric disorders among employees in Swedish county councils: an ecological population-based study. J Occup Environ Med 2011; 53:658-62. [PMID: 21654437 DOI: 10.1097/jom.0b013e31821aa706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to examine whether staff downsizing was related to long-term psychiatric sickness absence. METHODS We used aggregate data on sickness absence from AFA insurance, as well as information on staff numbers from the Swedish Association of Local Authorities and Regions. Bootstrap regression analyses were used to elucidate whether there was a relationship between reduction in personnel and changes in sickness rates. RESULTS A staff reduction of 1% increased the sickness rate, on average, by 9%. The associations were similar in men and women as well as in different age groups, although statistical significance was only reached in the groups of women and middle-aged employees. CONCLUSIONS Our findings suggest that downsizing may be related to subsequent increases in psychiatric sickness absence. The association appeared after a time-delay of several years.
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Westgaard RH, Winkel J. Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review. APPLIED ERGONOMICS 2011; 42:261-296. [PMID: 20850109 DOI: 10.1016/j.apergo.2010.07.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 07/09/2010] [Accepted: 07/11/2010] [Indexed: 05/29/2023]
Abstract
This literature review aims to identify occupational musculoskeletal and mental health effects of production system rationalization as well as organizational-level measures that may improve health outcome ("modifiers" in this review). A short review of the effect of ergonomic interventions is included as background and rationalization is discussed as a theoretical concept. Indicator variables for occupational musculoskeletal and mental health and related risk factors are presented. Variables with a generalized format were allowed in the literature searches (e.g., job satisfaction and absenteeism were accepted as risk factor and health indicator, respectively), suitable for the research fields of work sociology, organization science, human resource management (HRM) and economics research. One hundred and sixty-two studies of rationalization effects on health and risk factors and 72 organization-level modifier results were accepted into the final database. Entries were sorted by rationalization strategy and work life sector, and trends in outcome (positive, mixed, no effect, or negative effect on health and risk factors) were determined. Rationalizations have a dominant negative effect on health and risk factors (57% negative, 19% positive); the most negative effects were found for downsizing and restructuring rationalizations in general (71 studies negative, 13 positive) and for the health care sector in particular (36 studies negative, 2 positive). The rationalization strategy High Performance Work System (HPWS) was associated with the highest fraction positive outcome studies (6 of 10 studies). Other rationalization strategies (lean practices, parallel vs. serial production and mechanization level) reported intermediate results, in part dependent on work life sector, but also on the year when studies were carried out. Worker participation, resonant management style, information, support, group autonomy and procedural justice were modifiers with favourable influence on outcome. It is concluded that production system rationalization represents a pervasive work life intervention without a primary occupational health focus. It has considerable and mostly negative influence on worker health, but this can be reduced by attention to modifiers. The results create a basis for new priorities in ergonomic intervention research.
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Affiliation(s)
- R H Westgaard
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.
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Bohle P, Pitts C, Quinlan M. Time to Call it Quits? The Safety and Health of Older Workers. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2010; 40:23-41. [DOI: 10.2190/hs.40.1.b] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The workforces of many countries are aging, creating pressure for older workers to retire later despite greater vulnerability to various occupational safety and health (OSH) risks. Some specific risks to older workers arise from age-related physical or psychological changes, while others reflect exposures to poor work organization or employment conditions. This article reviews evidence on the nature of the OSH risks faced by older workers, focusing on work ability, contingent work, and working hours. Work ability, the capacity to meet the physical, mental, and social demands of a job, has been linked to positive health outcomes for older workers. However, work characteristics seem to be more critical than workers' individual capacities. Contingent work is generally associated with poorer OSH outcomes, and older workers are more likely to be contingent, with special implications for their safety and health. There has been limited research on age and working hours, but risks for many physical and mental health problems are known to increase with shift work experience, and physiological and psychosocial changes associated with age may also increase injury risks. The authors discuss organizational practices and regulatory policies to protect and enhance the OSH of older workers.
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Vahtera J, Laine S, Virtanen M, Oksanen T, Koskinen A, Pentti J, Kivimaki M. Employee control over working times and risk of cause-specific disability pension: the Finnish Public Sector Study. Occup Environ Med 2009; 67:479-85. [PMID: 19914911 DOI: 10.1136/oem.2008.045096] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the association between worktime control and subsequent disability pension among employees. METHODS Two scores of worktime control (self-assessed and co-worker assessed) were obtained from a survey in 2000-2001 (score range 1-5) among 30 700 public sector employees (78% women) aged 18-64 years. Information on cause-specific disability pension during follow-up was collected from national registers. RESULTS During a mean follow-up of 4.4 years, 1178 employees were granted disability pensions (incidence per 1000 person-years: 9.2 in women and 8.7 in men). The most common causes of a disability pension were musculoskeletal disorders (43% of all pensions), mental disorders (25%), tumours (8%) and diseases of the circulatory system (6%) and nervous system (6%). A one unit increase in self-assessed and co-worker assessed worktime control score was associated with a 41-48% decrease in risk of disabling musculoskeletal disorders in men and a 33-35% decrease in women. This association was robust to adjustment for 17 baseline covariates (in men and women combined, adjusted HR 0.76, 95% CI 0.67 to 0.87 and 0.64, 95% CI 0.51 to 0.79 per one unit increase in self-assessed and co-worker assessed worktime control, respectively). Self-assessed, but not co-worker assessed, worktime control was also associated with risk of disability retirement due to mental disorders in women. Disability pensions from other disease categories were not related to worktime control. CONCLUSIONS In these public sector employees, high worktime control was associated with reduced risk of early retirement caused by musculoskeletal disorders independent of baseline characteristics.
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Affiliation(s)
- Jussi Vahtera
- Finnish Institute of Occupational Health, Lemminkäisenkatu 14-18 B, Turku, Finland.
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Quinlan M, Bohle P. Overstretched and Unreciprocated Commitment: Reviewing Research on the Occupational Health and Safety Effects of Downsizing and Job Insecurity. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2009; 39:1-44. [DOI: 10.2190/hs.39.1.a] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Over the past two decades, a leading business practice has been often-repeated rounds of downsizing and restructuring (also referred to as reorganization, re-engineering, and a host of other euphemistic terms) by large private and public sector employers. Frequently associated with other practices such as outsourcing, privatization, and the increased use of temporary workers, downsizing/restructuring has increased the level of job insecurity among workers as well as leading to changes in work processes (including work intensification and multi-tasking) and management behavior. How has downsizing/restructuring and increased job insecurity affected the occupational health, safety, and well-being of workers, and what measures have employers, unions, and governments taken to address any adverse effects? The authors reviewed international studies of the occupational health and safety (OHS) effects of downsizing/restructuring and increased job insecurity undertaken over the past 20 years. After imposing quality filters, they obtained 86 studies. Analysis revealed that 73 (85%) of the studies found poorer OHS outcomes (using a range of measures). Studies were examined to see whether they provided clues as to the reasons for negative outcomes.
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Overland R, Overland S, Johansen KN, Mykletun A. Verifiability of diagnostic categories and work ability in the context of disability pension award: a survey on "gatekeeping" among general practitioners in Norway. BMC Public Health 2008; 8:137. [PMID: 18439251 PMCID: PMC2387147 DOI: 10.1186/1471-2458-8-137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 04/25/2008] [Indexed: 11/10/2022] Open
Abstract
Background Disability benefits exist to redeem social and financial consequences of reduced work ability from medical conditions. Physicians are responsible for identifying the medical grounds for benefit claims. The aim of this study was to explore physicians' views on verifiability of medical conditions and related work ability in this context. Methods Information on verifiability of diagnostic categories and work ability was obtained from a survey among a representative sample of general practitioners (GPs) in Norway (n = 500, 25.2% response rate). Verifiability was defined as to what extent the assessment is based on objective criteria versus on information from the patient. We enquired about the diagnostic categories used in official statistics on main disability benefit causes in Norway and elsewhere. Results On a scale from 0 (low verifiability) to 5 (high verifiability), the mean level of verifiability across all diagnostic categories was 3.7 (SD = 0.42). Degree of verifiability varied much between diagnostic categories, and was low in e.g. unspecified rheumatism/myalgia and dorsopathies, and high in neoplasms and congenital malformations, deformation and chromosomal abnormalities. Verifiability of work ability was reported to be more problematic than that of diagnostic categories. The diagnostic categories rated as the least verifiable, are also the most common in disability pension awards. Conclusion Verifiability of both diagnostic categories and work ability in disability assessments are reported to be moderate by GPs. We suggest that the low verifiability of diagnostic categories and related work ability assessments in the majority of disability pension awards is important in explaining why GPs find the gatekeeping-function problematic.
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Affiliation(s)
- Rein Overland
- Research centre for Health Promotion, University of Bergen, Norway.
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Peter R, Gässler H, Geyer S. Socioeconomic status, status inconsistency and risk of ischaemic heart disease: a prospective study among members of a statutory health insurance company. J Epidemiol Community Health 2007; 61:605-11. [PMID: 17568052 PMCID: PMC2465745 DOI: 10.1136/jech.2006.047340] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Inconsistency in social status and its impact on health have been a focus of research 30-40 years ago. Yet, there is little recent information on it's association with ischaemic heart disease (IHD) morbidity and IHD is still defined as one of the major health problems in socioeconomically developed societies. METHODS A secondary analysis of prospective historical data from 68 805 male and female members of a statutory German health insurance company aged 25-65 years was conducted. Data included information on sociodemographic variables, social status indicators (education, occupational grade and income) and hospital admissions because of IHD. RESULTS Findings from Cox regression analysis showed an increased risk for IHD in the group with the highest educational level, whereas the lowest occupational and income groups had the highest hazard ratio (HR). Further analysis revealed that after adjustment for income status inconsistency (defined by the combination of higher educational level with lower occupational status) accounts for increased risk of IHD (HR for men, 3.14 and for women, 3.63). An association of similar strength was observed regarding high education/low income in women (HR 3.53). The combination of low education with high income reduced the risk among men (HR 0.29). No respective findings were observed concerning occupational group and income. CONCLUSIONS Status inconsistency is associated with the risk of IHD as well as single traditional indicators of socioeconomic position. Information on status inconsistency should be measured in addition to single indicators of socioeconomic status to achieve a more appropriate estimation of the risk of IHD.
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Affiliation(s)
- Richard Peter
- Department of Epidemiology, University of Ulm, Helmholtzstrasse 22, DE-89081 Ulm, Germany.
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Kivimäki M, Honkonen T, Wahlbeck K, Elovainio M, Pentti J, Klaukka T, Virtanen M, Vahtera J. Organisational downsizing and increased use of psychotropic drugs among employees who remain in employment. J Epidemiol Community Health 2007; 61:154-8. [PMID: 17234876 PMCID: PMC2465644 DOI: 10.1136/jech.2006.050955] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Organisational downsizing is common in modern work life, but its effect on employees' mental health is not known. The authors examined whether working in downsizing organisations predicts use of psychotropic drugs among employees who remain in employment. DESIGN, SETTING AND PARTICIPANTS Prospective cohort study of municipal employees in Finland. 4783 employees worked in downsized units but kept their jobs after downsizing in 1993, 4271 employees lost their jobs during the downsizing, and 17 599 employees did not experience downsizing. The outcome was psychotropic drug prescriptions (antidepressants, anxiolytics and hypnotics) during 1994-2000 extracted from nationwide registers and linked to the data by means of each participant's personal identification number. MAIN RESULTS After adjustment for predownsizing characteristics, employees who were exposed to downsizing but kept their jobs were at a higher risk of being prescribed psychotropic drugs (rate ratio 1.49, 95% CI 1.10 to 2.02 in men and 1.12, 95% CI 1.00 to 1.27 in women) than those not exposed to downsizing. The association of downsizing was strongest with hypnotics among the men and with anxiolytics among the women. An increased rate of psychotropic prescriptions after downsizing was also seen in male workers who lost their job (rate ratio 1.64, 95% CI 1.19 to 2.25). CONCLUSIONS The association between organisational downsizing and increased use of psychotropic drugs suggests that this managerial strategy may pose mental health risks among employees.
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Affiliation(s)
- Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland.
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Heikkinen A, Launis V, Wainwright P, Leino-Kilpi H. Privacy and occupational health services. JOURNAL OF MEDICAL ETHICS 2006; 32:522-5. [PMID: 16943333 PMCID: PMC2563391 DOI: 10.1136/jme.2005.013557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Privacy is a key ethical principle in occupational health services. Its importance is emphasised in several laws, in ethical codes of conduct as well as in the literature, yet there is only very limited empirical research on privacy in the occupational health context. Conceptual questions on privacy in the occupational health context are discussed. The baseline assumption is that, in this context, privacy cannot be approached and examined only from the employee's (an individual) vantage point but the employer's (a group) point of view must also be taken into account, and that the concept has several dimensions (physical, social, informational and psychological). Even though privacy is a basic human need, there is no universally accepted definition of the concept and no consensus on whether an organisation can have privacy in the same way as people do. Many of the challenges surrounding privacy in the context of occupational health seem to be associated with the dual loyalties of occupational health professionals towards the employee and employer and with their simultaneous duties of disseminating and protecting information (informational privacy). Privacy is thus not an absolute value, but more research is needed to understand its multidimensional nature in the context of occupational health.
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Affiliation(s)
- A Heikkinen
- Department of Nursing Science, University of Turku, Finland.
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Overland S, Glozier N, Mæland JG, Aarø LE, Mykletun A. Employment status and perceived health in the Hordaland Health Study (HUSK). BMC Public Health 2006; 6:219. [PMID: 16939642 PMCID: PMC1560129 DOI: 10.1186/1471-2458-6-219] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 08/29/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most western countries have disability benefit schemes ostensibly based upon requiring (1) a work inhibiting functional limitation that (2) can be attributed to a diagnosable condition, injury or disease. The present paper examines to what extent current practice matches the core premises of this model by examining how much poorer the perceived health of disability benefit recipients is, compared to the employed and the unemployed, and further to examine to what extent any poorer perceived health among benefit recipients can be attributed to mental or somatic illness and symptoms. METHODS Information on disability benefit recipiency was obtained from Norwegian registry data, and merged with health information from the Hordaland Health Study (HUSK) in Western Norway, 1997-99. Participants (N = 14 946) aged 40-47 were assessed for perceived physical and mental health (Short Form-12), somatic symptoms, mental health, and self reported somatic conditions and diseases treated with medication. Differences associated with employment status were tested in chi-square and t-tests, as well as multivariate and univariate regression models to adjust for potential confounders. RESULTS Recipients of disability benefits (n = 1,351) had poorer perceived physical and mental health than employees (n = 13,156); group differences were 1.86 and 0.74 pooled standard deviations respectively. Self reported somatic diagnoses, mental health and symptoms accounted for very little of this difference in perceived health. The unemployed (n = 439) were comparable to the employed rather than the recipients of disability benefits. CONCLUSION Recipients of disability benefits have poor perceived health compared to both the employed and the unemployed. Surprisingly little of this difference can be ascribed to respondents' descriptions of their illnesses and symptoms. Even allowing for potential underascertainment of condition severity, this finding supports the increasing focus on non-disease oriented contributing factors. Rehabilitation efforts aiming at return to work should have a strong focus on the patients' perceptions of their health in addition to symptom relief and social factors.
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Affiliation(s)
- Simon Overland
- Research Centre for Health Promotion, University of Bergen, Norway
| | - Nicholas Glozier
- Division of Psychological Medicine, Institute of Psychiatry, Kings College London, UK
| | - John Gunnar Mæland
- The Department of Public Health and Primary Health Care, University of Bergen, Norway
| | - Leif Edvard Aarø
- Research Centre for Health Promotion, University of Bergen, Norway
| | - Arnstein Mykletun
- Research Centre for Health Promotion, University of Bergen, Norway
- Division of Psychological Medicine, Institute of Psychiatry, Kings College London, UK
- Norwegian Institute of Public Health, Division of Epidemiology, Department of Mental Health, Oslo, Norway
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Dragano N, Verde PE, Siegrist J. Organisational downsizing and work stress: testing synergistic health effects in employed men and women. J Epidemiol Community Health 2005; 59:694-9. [PMID: 16020648 PMCID: PMC1733120 DOI: 10.1136/jech.2005.035089] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE To systematically study the separate and combined effects of organisational downsizing and work related stress on a measure of health in "survivors of layoffs". DESIGN Using Rothman's approach, separate and combined effects of the two exposures in estimating the risk of poor self rated health (work related symptoms) are analysed in a large sample of male and female employees. SETTING 0.1% cross sectional sample of the German working population. PARTICIPANTS 12 240 men and 10 319 women, aged 16 to 59 years, surveyed in 1998-1999. MAIN RESULTS Compared with the reference group, the group of participants who were simultaneously exposed to downsizing and work related stress (effort-reward imbalance) exhibited odds ratios (OR) of three or more work related symptoms that were by far higher (OR 4.41 in men and OR 5.37 in women) than those associated with single exposures. Altogether 21% (men) and 31% (women) of the effect size of the combined exposure was attributable to synergistic interaction. CONCLUSION Although reduced health associated with organisational downsizing is partly attributable to an increase in work related stress these findings show an additional synergy effect produced by the combined exposure to both conditions.
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Affiliation(s)
- Nico Dragano
- Department of Medical Sociology, University of Duesseldorf, PO Box 10 10 07, D-40001 Duesseldorf, Germany.
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