Organisational downsizing and musculoskeletal problems in employees: a prospective study

Job satisfaction and job security as moderators in the relationships among job demands, musculoskeletal symptoms, and work performance

PURPOSE

This study examined whether job satisfaction and job security moderate the path from physical demands and job strain to impaired work performance via musculoskeletal symptoms in the upper extremities (MSUE). Moderation effects on five paths were examined: (1) from job strain to MSUE; (2) from job strain to work performance; (3) from physical demands to MSUE; (4) from physical demands to work performance; (5) from MSUE to work performance.

METHODS

This was a cross-sectional study of 669 full-time workers from 9 manufacturing and 3 healthcare facilities. Data were collected via health interviews, on-site physical exposure assessments, and computation of the Strain Index by ergonomists, and self-administered questionnaires on psychosocial factors. Structural equation modeling and zero-inflated negative binomial regression analysis were performed to examine the moderation effect on each path.

RESULTS

Job satisfaction moderated the relationship between MSUE and impaired work performance (B = - 0.09, 95% CI: - 0.15, - 0.04) and job security moderated the relationship between physical demands and MSUE (B = - 0.64, 95% CI: - 1.17, - 0.11). Interaction between job satisfaction and MSUE was significant on both the occurrence (OR: 0.92, 95% CI: 0.87, 0.97) and the degrees of impaired work performance (mean ratio: 0.99, 95% CI: 0.97, 0.99), while the interaction between job security and physical demands was significant only on the degrees of MSUE (mean ratio: 0.94, 95% CI: 0.89, 0.99).

CONCLUSION

Job satisfaction and job security can, respectively, mitigate the adverse impacts of working with MSUE and physical demands on work performance. Workplace interventions to improve workers' job satisfaction and job security can contribute to their musculoskeletal health and work performance.

Changes of depression and job stress in workers after merger without downsizing

Background

Since the 1980s, restructuring, which includes downsizing, closures, mergers, and privatization, has expanded worldwide, and various studies have investigated its effect on health. However, previous studies have mainly focused on restructuring accompanied by massive lay-offs, and the effect of a merger on workers’ health is still controversial. This study aims to investigate changes in worker depression and job stress after a merger without downsizing, which is unusual in Korea.

Methods

Repeated surveys were done in April 2014, April 2015, and April 2016 involving the participation of 209 subjects. Participants were divided into two groups, which were comprised of blue-collar workers (104) and white-collar workers (105). Sociodemographic characteristics, including age, education level, job tenure, gender, marital status, smoking status, and alcohol consumption, were measured via a survey. To determine the level of depression, the Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D) was employed, and to investigate job stress, the Korean Occupational Stress Scale-Short Form (KOSS-SF) was used. For statistical analyses, Pearson’s chi-square test, the Student’s t-test, and repeated measure analysis of variance (ANOVA) were performed.

Results

The results showed that depression (CES-D, F[2, 400] = 0.466, p = 0.628) was changed but without significance and job stress (KOSS-SF, F[1.899, 379.831] = 3.192, p = 0.045) were significantly different. The between-group difference in the CES-D score between the blue- and white-collar workers by survey administration time was not statistically significant (F = 0.316, p = 0.574). The interaction between the survey time and occupational group was also not statistically significant (F = 0.967, p = 0.381). The between-group difference in the KOSS-SF total score was not statistically significant (F = 1.132, p = 0.289), and the interaction between the survey administration time and occupational group was also not significant (F = 0.817, p = 0.437). In the job stress subgroup analyses Job insecurity and Lack of reward showed a significant difference by survey administration time.

Conclusion

This study showed that a merger without massive downsizing can cause negative health effects such as an changes in depression and increase in job stress. To improve the health of workers, both the immediate negative effects on health, and the long-term effects or their resolution over time should be considered prior to the merger.

Relationship between simultaneous exposure to ergonomic risk factors and work-related lower back pain: a cross-sectional study based on the fourth Korean working conditions survey

Background

It is well known that ergonomic risk factors and back pain are related. However, few studies have examined the relationship between simultaneous exposure to these risk factors and back pain in a Korean population. We aimed to investigate the relationship between simultaneous exposure to ergonomic risk factors and work-related lower back pain (LBP) based on the fourth Korean Working Conditions Survey (KWCS).

Method

The fourth KWCS (2014) was used for this study. Chi-square tests and logistic regression were used to assess relationship between 5 ergonomic risk factors and work-related LBP. We also analyzed the relationship between simultaneous exposure to 2 risk factors and work-related LBP.

Results

All 5 ergonomic risk factors (fatigue-inducing and painful posture; lifting or moving people; dragging, pushing, or moving heavy objects; standing posture; and repetitive hand or arm movements) were significantly correlated with work-related LBP in the severe exposure group (adjusted odd ratios [aOR] 5.09, 95% confidence interval [CI] 4.46–5.83; aOR 1.98, 95% CI 1.62–2.42; aOR 2.09, 95% CI 1.82–2.40; aOR 1.79, 95% CI 1.60–2.01; aOR 2.04, 95% CI 1.82–2.30, respectively). When exposed to 2 risk factors simultaneously, the relationship between exposure and work-related LBP was not greater than exposure to only 1 risk factor in our study (usually exposed to ‘fatigue-inducing or painful posture’ aOR 2.17, 95% CI 2.02–2.34; high exposure to both ‘fatigue-inducing or painful posture’ and ‘dragging, pushing, or moving heavy objects’ aOR 2.00, 95% CI 1.82–2.20).

Conclusions

There was a strong relationship between severe exposure to each ergonomic risk factor and work-related LBP. However, when exposed to 2 ergonomic risk factors simultaneously, the relationship between exposure and work-related LBP was not stronger than when exposed to only 1 risk factor in our study.

Work-Life Imbalance and Musculoskeletal Disorders among South Korean Workers

Employed workers often have family responsibilities such as childcare or homemaking. This dual burden may increase work-related health problems, particularly if there are conflicts between work and family responsibilities. This study assessed whether difficulty in work–life balance is associated with musculoskeletal disorders (MSD) among Korean employees. Data from the population-based Korean Working Conditions Survey of 2011, including 28,640 male and 21,392 female workers, were used. Men and women were analyzed separately to investigate gender differences. MSD were defined as pain in the back, neck, shoulder, or extremities during the past year. Self-assessed difficulty in work–life balance was defined as a work–life conflict (WLC). Adjustments for physical factors, as well as other occupational and socio-demographic variables, were made using multiple logistic regression analysis. Interaction terms including WLCs and key covariates were also incorporated. WLC was significantly associated with increased frequency of MSD in both men (OR: 1.49) and women (OR: 1.50). There were significant interaction effects between WLC and some key covariates (job stress for men and job stress, work hours, physical demand, and frequent overtime work for women). We suggest that having the flexibility to coordinate work and family life is important to prevent MSD among employees.

Exploring work-related attributions of sickness absence during organizational change

Purpose

The purpose of this paper is to review the literature on the relationship between organizational change and sickness absence and to map and describe the prevailing “trends” in the field. In particular, the paper focuses on the indirect links between change and sickness absence and identifies knowledge gaps and novel research opportunities.

Design/methodology/approach

A scoping review was conducted seeking to generate a wide-ranging overview of relevant studies. To this end, research articles were collected through different sources of landmark articles, bibliographies and databases.

Findings

The association between organizational change and sickness absence is often explained by adverse changes in work characteristics. Such potential mediation or moderation effects, however, are rarely statistically tested. Including such variables in the analyses may represent an important avenue for future research. Additionally, earlier studies have mainly emphasized organization-wide episodic changes. Recently, however, researchers have focused on smaller and frequently implemented changes. Accordingly, the field of organizational change and occupational health may advance by incorporating greater diversity of change type.

Originality/value

The paper demonstrates that attention to the potential health effects of organizational change will remain important as the field of workplace health management proceeds. Research needs to develop beyond attributions of the relationship between change and sickness absence and focus more on statistical testing of linking variables. The unique contribution of this review is therefore that it identifies knowledge gaps and novel avenues for prospective research.

The impact of moderate and major workplace expansion and downsizing on the psychosocial and physical work environment and income in Sweden

Aims: To describe the effect of organizational change (moderate and major expansion and downsizing) on psychosocial work characteristics, physical hazards, and income in a representative sample of larger workplaces in Sweden. Methods: Annual changes in workforce size for the years 1991—1996 were derived from tax registry data. Work environment characteristics were measured in a sub-set of participants from the biennial Swedish Work Environment Surveys for 1991, 1993, and 1995. Income data were derived from national registries. Results: Not all organizational change resulted in a poorer work environment. The number of beneficial outcomes associated with moderate downsizing and moderate expansion in the public sector outweighed the number of adverse outcomes. However, in the private sector the overall effect of moderate organizational change was a poorer work environment. Major downsizing was associated with a better psychosocial work environment for private-sector men and major expansion with a poorer environment for public-sector women and private-sector men. Otherwise, associations between major organizational change and the psychosocial work environment were mixed across sex and sector, although major organizational change was consistently associated with a greater risk of physical hazards. Low income was associated exclusively with organizational downsizing in the private sector. Conclusions: More research is needed to determine whether the work environment can explain observed associations between organizational change and health. Data limitations prevented the authors from examining this in the present study. Their findings indicate that future research on the work environment should pay more attention to physical hazards.

Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey

OBJECTIVES

The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors, and to identify worker groups with an increased vulnerability for low back pain in the United States.

METHODS

The data used for this cross-sectional study came from the 2010 National Health Interview Survey, which was designed to collect data on health conditions and related risk factors from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% confidence interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment, and job insecurity. Work hours, occupation, and other work organizational factors (nonstandard work arrangements and alternative shifts) were also examined.

RESULTS

The prevalence of self-reported low back pain in the previous 3 months among workers in the United States was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15-1.41), exposure to hostile work (OR 1.39, CI 1.25-1.55), and job insecurity (OR 1.44, CI 1.24-1.67), while controlling for demographic characteristics and other health-related factors. Older workers who had nonstandard work arrangements were more likely to report low back pain. Women who worked 41 to 45 hours per week and younger workers who worked >60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including male health care practitioners, female and younger health care support workers, and female farming, fishing, and forestry workers, had an increased risk of low back pain.

CONCLUSIONS

This study linked low back pain to work-family imbalance, exposure to a hostile work environment, job insecurity, long work hours, and certain occupation groups. These factors should be considered by employers, policymakers, and health care practitioners who are concerned about the impact of low back pain in workers.

Consequences of Job Insecurity on the Psychological and Physical Health of Greek Civil Servants

The aim of this study was to estimate the short term consequences of job insecurity associated with a newly introduced mobility framework in Greece. In specific, the study examined the impact of job insecurity on anxiety, depression, and psychosomatic and musculoskeletal symptoms, two months after the announcement of the mobility framework. In addition the study also examined the "spill over" effects of job insecurity on employees not directly affected by the mobility framework. Personal interviews using a structured questionnaire were conducted for 36 university administrative employees awaiting repositioning, 36 coworkers not at risk, and 28 administrative employees of a local hospital not at risk. Compared to both control groups the employees in the anticipation phase of labor mobility had significantly worse scores for perceived stress, anxiety, depression, positive affect, negative affect, social support, marital discord, common somatic symptoms, and frequency of musculoskeletal pain. This study highlights the immediate detrimental effects of job insecurity on the physical, psychological, and social functioning of employees. There is a need for the development of front line interventions to prevent these effects from developing into chronic conditions with considerable cost for the individual and society in general.

Job stress as a risk factor for absences among manual workers: a 12-month follow-up study

This study was conducted to evaluate the impact of job stress on absence from work caused by illnesses and accidents through a prospective research design. A total of 2,349 manual workers were included in this analysis. In the first survey, job stress was determined using the Korean Occupational Stress Scale-Short Form. In the second survey, information on absence due to accidents or illnesses during the past one year was obtained through a questionnaire. The relationship was analyzed using a logistic regression model with multiple imputation. After adjusting for confounding variables for males, absence due to accidents was statistically associated with high job demand, insufficient job control, inadequate social support, and organizational injustice. In addition, high job demands and organizational injustice were related to increased absence due to illnesses in both genders. A lack of reward was associated with increased absence due to illnesses among female workers. We found that job stress was associated with a higher risk of absence caused by accidents or illnesses of manual workers.

Manager Characteristics and Employee Job Insecurity around a Merger Announcement: The Role of Status and Crossover

Most existing research theorizes individual factors as predictors of perceived job insecurity. Incorporating contextual and organizational factors at an information technology organization where a merger was announced during data collection, we draw on status expectations and crossover theories to investigate whether managers' characteristics and insecurity shape their employees' job insecurity. We find having an Asian as opposed to a White manager is associated with lower job insecurity, while managers' own insecurity positively predicts employees' insecurity. Also contingent on the organizational climate, managers' own tenure buffers, and managers' perceived job insecurity magnifies insecurity of employees interviewed after a merger announcement, further specifying status expectations theory by considering context.

Short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health: results from the Whitehall II study

OBJECTIVE

To investigate short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health for women and men in different employment grades.

METHODS

Minor psychiatric disorder and self-rated health among 6710 British civil servants (1993 women and 4717 men) in three employment grades from the Whitehall II study were examined from 1985 to 1988 under stable employment conditions. The short-term effects of organisational change were investigated in 1991-1993 after a time of major restructuring aiming at increasing the influence of market forces in the civil service and the long-term effects were investigated in 1997-1999.

RESULTS

Those who had experienced organisational change and those who anticipated organisational change reported more negative short-term health effects (minor psychiatric disorder and poor self-rated health) compared with those who reported no change. No major differences were found depending on employment grade or gender. The negative health effects had diminished during 1997-1999 for those who reported that a major change had happened before 1991-1993. Those who anticipated an organisational change in 1991-1993 still reported more ill-health in 1997-1999 (both minor psychiatric disorder and self-reported health) than those in the comparison group.

CONCLUSIONS

The results indicate that organisational change affects employees' health negatively in the short term but also that it is possible to recover from such negative effects. As it was not possible to discern any definite difference between the gender and grades, the results point at the importance of working proactively to implement organisational change for women and men at all levels.

Dismissals - a major concern, but only one among others?

The Finnish forest industry has undergone extensive transition in recent years. This study investigates the effect of restructuring on the well-being of blue-collar employees who continued working in the organization after the changes. All six factories selected for the study were in the process of restructuring between baseline and the follow-up survey. The factories were grouped according to personnel reduction (dismissals): Change group 1 - no dismissals; and Change group 2 - dismissals. The majority of the analyses were carried out using longitudinal data (n=382). The associations between the changes in personnel and functional and psychological well-being were analysed using ANCOVA (adjusted for age, gender, education, and outcome at baseline). In both change groups the level of functional well-being improved after restructuring, but the level of psychological well-being decreased. The content of the changes, regardless of whether they involved personnel dismissals, did not affect the magnitude of the decrease in psychological well-being. It seems that the effect of restructuring on the psychological well-being of employees working in the restructuring organization is considerable, even when no dismissals are involved. The impact of change on functional well-being seems to be different.

Leading during change: the effects of leader behavior on sickness absence in a Norwegian health trust

Background

Organizational change often leads to negative employee outcomes such as increased absence. Because change is also often inevitable, it is important to know how these negative outcomes could be reduced. This study investigates how the line manager’s behavior relates to sickness absence in a Norwegian health trust during major restructuring.

Methods

Leader behavior was measured by questionnaire, where employees assessed their line manager’s behavior (N = 1008; response rate 40%). Data on sickness absence were provided at department level (N = 35) and were measured at two times. Analyses were primarily conducted using linear regression; leader behavior was aggregated and weighted by department size.

Results

The results show a relationship between several leader behaviors and sickness absence. The line managers’ display of loyalty to their superiors was related to higher sickness absence; whereas task monitoring was related to lower absence. Social support was related to higher sickness absence. However, the effect of social support was no longer significant when the line manager also displayed high levels of problem confrontation.

Conclusions

The findings clearly support the line manager’s importance for employee sickness absence during organizational change. We conclude that more awareness concerning the manager’s role in change processes is needed.

Enterprise restructuring and the health of employees: a cohort study

OBJECTIVE

To examine the influence of enterprise restructuring on general health and emotional exhaustion, and to investigate which factors explain the relation between restructuring and these outcomes.

METHODS

Longitudinal data of the Netherlands Working Conditions Cohort Study were used. At baseline and after 12 months, 9076 employees filled out a questionnaire. Logistic regression analysis was applied.

RESULTS

Prolonged exposure to restructuring increased the likelihood of poor general health, and its influence was partly explained by job insecurity. Emotional exhaustion was more likely among employees that experienced prolonged exposure to restructuring or restructuring during the past year. Job insecurity explained the influence of prolonged restructuring, together with job demands and supervisor's support.

CONCLUSIONS

Prolonged exposure to restructuring adversely affects general health and emotional exhaustion in employees, and its influence seems to be explained by job insecurity.

Reduction in personnel and long-term sickness absence for psychiatric disorders among employees in Swedish county councils: an ecological population-based study

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.

Involvement and structure: a qualitative study of organizational change and sickness absence among women in the public sector in Sweden

Background

Organizational changes in modern corporate life have become increasingly common and there are indications that they often fail to achieve their ends. An earlier study of 24,036 employees showed that those who had repeatedly been exposed to large increases in staffing during 1991-1996 had an excess risk of both long-term sickness absence and hospital admission during 1997-1999, while moderate expansion appeared to be protective. The former was most salient among female public sector employees. We used qualitative interviews to explore work environment factors underlying the impact of organizational changes (moderate and large expansions in staffing) on sickness absence from an employee perspective.

Method

We interviewed 21 strategically selected women from the earlier study using semi-structured telephone interviews focusing on working conditions during the organizational changes. We identified 22 themes which could explain the association between organizational changes and sickness absence. We then used Qualitative Comparative Analysis (QCA) to reduce the number of themes and discover patterns of possible causation.

Results

The themes that most readily explained the outcomes were Well Planned Process of Change (a clear structure for involvement of the employees in the changes), Agent of Change (an active role in the implementation of the changes), Unregulated Work (a lack of clear limits and guidelines regarding work tasks from the management and among the employees), and Humiliating Position (feelings of low status or of not being wanted at the workplace), which had been salient throughout the analytic process, in combination with Multiple Contexts (working in several teams in parallel) and Already Ill (having already had a debilitating illness at the beginning of 1991), which may indicate degree of individual exposure and vulnerability. Well Planned Process of Change, Agent of Change and Multiple Contexts are themes that were associated with low sickness absence. Unregulated Work, Humiliating Position and Already Ill were associated with high sickness absence.

Conclusions

These findings suggest that promising areas for future research and improvement in change management could be the structured involvement of the employees in the planning of organizational changes, and the development of methods to avoid highly unregulated working conditions.

Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review

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.

Emotional support predicts more sickness absence and poorer self assessed work ability: a two-year prospective cohort study

BACKGROUND

While back pain and stressful work environment are shown to be important causes of sickness absence the effect of psychosocial resources on sickness absence, and on self assessed work ability, is less commonly investigated. The aim of this study was to assess these associations in a two-year follow-up study.

METHODS

341 working people aged 45 to 64, randomly drawn from the population, responded to a questionnaire at baseline and at a two-year follow-up. Poisson regression was used to analyse the association of psychosocial factors (psychosocial instruments on work environment, emotional support and psychological resources) and previous back pain (low back and/or neck) at baseline with sickness absence (spells and days) at follow-up, controlling for effects of age, sex, BMI, smoking, alcohol, occupation, disease and previous sickness absence. Logistic regression was used to study the associations of psychosocial factors and previous back pain at baseline with self assessed prognosis of poor work ability six months from follow-up. Finally, a multivariate analysis tested the independent effects of previous back pain and 3 psychosocial factors derived in a factor analysis: 1. work environment; 2. emotional support; 3. psychological resources, on work ability and absence days and spells.

RESULTS

80% of the sickness absence spells within the last 12 months before follow-up were short-term (≤ 14 days). In the final model, high emotional support predicted more sickness absence spells (RR 1.36; 1.11-1.67) and days (RR 1.68, 1.22-2.31). Previous back pain (OR 2.56; 1.13-5.81), high emotional support (OR 1.58; 1.02-2.46), and low psychological resources (OR 0.62; 0.44-0.89) were related to poorer self assessed prognosis of work ability at follow up.

CONCLUSIONS

In a general middle aged working population high emotional support was related to more sickness absence and also poorer self assessed prognosis of work ability. Our findings suggest that both sickness absence and self assessed work ability are dependent of life outside work and can be affected by a person's close community.

Job insecurity and change over time in health among older men and women

OBJECTIVES

We estimated associations between job insecurity and change over time in the physical and psychological health of older adult men and women.

METHODS

We conducted secondary analyses of longitudinal data from men and women (N = 190) born between 1935 and 1952 in the Chicago Health, Aging, and Social Relations Study. We used multivariate regression techniques to test the association of job insecurity with changes in physical health (self-reported global health, resting blood pressure, and urinary catecholamines [epinephrine]) and psychological health (depressive symptoms, hostility, loneliness, and personal stress). We controlled for individual characteristics and baseline measures of the outcomes.

RESULTS

Men who experience job insecurity rate themselves in significantly poorer physical health and have higher blood pressure and higher levels of urinary catecholamines compared with men who do not experience job insecurity and women who do. Women who experience job insecurity show higher depressive symptoms and report more hostility, loneliness, and personal stress compared with women who do not experience job insecurity and men who do.

DISCUSSION

The correlation between job insecurity and health is different in men and women but may be clinically significant in both populations and is a potentially important threat to older adults' health and well-being.

Psychosocial work environment and emotional exhaustion--does a service provision model play a role?

OBJECTIVES

To investigate whether outsourcing of primary health care (PHC) services has affected the psychosocial work environment and emotional exhaustion.

METHODS

Panel mail study 2000-2002 in Finland, 369 PHC employees. Comparison between Southern municipality (SM) after outsourcing PHC services to a not-for-profit organization and three municipalities with municipal service providers.

RESULTS

Despite the positive development of the psychosocial work environment in SM, emotional exhaustion had increased there like in the comparison municipalities. However, in 2002 emotional exhaustion was at a lower level in SM than in one of the comparison municipalities. This difference could not be attributed to the production model itself but rather to baseline levels and changes in work demands and work resources.

CONCLUSIONS

Outsourcing of PHC services may improve employee health and thus effectiveness of health care if a new service provider emphasizes employee health more than a previous one and is more flexible to improve the quality of the psychosocial work environment. However, change itself may be stressful, and frequent changes of service providers should be avoided.

Ergonomics contributions to company strategies

Managers usually associate ergonomics with occupational health and safety and related legislation, not with business performance. In many companies, these decision makers seem not to be positively motivated to apply ergonomics for reasons of improving health and safety. In order to strengthen the position of ergonomics and ergonomists in the business and management world, we discuss company strategies and business goals to which ergonomics could contribute. Conceptual models are presented and examples are given to illustrate: (1) the present situation in which ergonomics is not part of regular planning and control cycles in organizations to ensure business performance; and (2) the desired situation in which ergonomics is an integrated part of strategy formulation and implementation. In order to realize the desired situation, considerable changes must take place within the ergonomics research, education and practice community by moving from a health ergonomics paradigm to a business ergonomics paradigm, without losing the health and safety goals.

Overstretched and Unreciprocated Commitment: Reviewing Research on the Occupational Health and Safety Effects of Downsizing and Job Insecurity

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.

Perceived job insecurity, job predictability, personality, and health

OBJECTIVE

The present study sought to determine whether job insecurity is associated with personality traits and beliefs. In addition, it was tested whether aspects of personality confounded the relationships between job insecurity and health, or moderated this association.

METHODS

At the first data collection, 5163 persons participated, and at the second data collection, 1946 persons of a random sample participated. Data were obtained from Oslo Health Study.

RESULTS

The job insecurity aspect concerning confidence in having a good job in 2 years was more strongly related to the health variables, and particularly with mental distress, compared with other aspects of job insecurity. Type-A behavior predicted an increase in upper back pain (beta 0.07), while optimism predicted a change in lower back pain (beta -0.07).

CONCLUSIONS

Job insecurity is associated with health; this association is strongest for mental distress and self-reported health, and weaker for back-pain.

Occupational neck and shoulder pain among automobile manufacturing workers in Iran

BACKGROUND

Work-related musculoskeletal disorders (MSDs) of the upper extremities are a major problem globally, though most relevant studies have been reported from high income countries.

AIMS AND METHODS

The prevalence of neck and shoulder pain and its association with work-related physical and psychosocial factors and life style was determined by a cross-sectional survey using the Nordic Musculoskeletal Questionnaire (NMQ) in the largest Iranian car manufacturing company, with more than 18,000 employees.

RESULTS

A total of 14,384 (79.8%) of all employees completed the questionnaire. Depending on the questions used to measure neck and shoulder symptoms, the prevalence varied widely (from 20.5% to 3.9%). In the multiple logistic regression model, limited to employees with at least 1 year of work experience, risk indicators for disabling pain of the neck and/or shoulder that remained for male were: duration of employment, high visual demands, repetitive work, sitting position at work, awkward working position, no regular exercise, monotonous work, lack of encouraging organizational culture, and anxiety concerning change. For female repetitive work, sitting position at work and no support if there is trouble at work were the only remaining factors.

CONCLUSIONS

The study confirms the effects of physical and psychosocial factors on neck and shoulder symptoms among automobile manufacturing workers in a low to middle income country in spite of the relative youth and job insecurity of the population.

JCQ scale reliability and responsiveness to changes in manufacturing process

BACKGROUND

The job content questionnaire (JCQ) was administered to automobile manufacturing workers in two interviews, 5 years apart. Between the two interviews, the company introduced substantial changes in production technology in some production areas. The aims were: (1) to describe the impact of these changes on self-reported psychosocial exposures, and (2) to examine test-retest reliability of the JCQ scales, taking into account changes in job assignment and, for a subset of workers, physical ergonomic exposures as assessed through field observations.

METHODS

The study population included 790 subjects at the first and 519 at the second interview, of whom 387 were present in both. Differences in demand and control scores between interviews were analyzed by Wilcoxon matched-pairs signed-rank test. Test-retest reliability of these scales was evaluated by the intraclass correlation coefficient (ICC) and the Spearman's rho coefficient.

RESULTS

The introduction of more automated technology produced an overall increase in job control but did not decrease psychological demand. The reliability of the control scale was low overall but increased to an acceptable level among workers who had not changed job. The demand scale had high reliability only among workers whose physical ergonomic exposures were similar on both survey occasions.

CONCLUSIONS

These results show that 5-year test-retest reliability of self-reported psychosocial exposures is adequate among workers whose job assignment and ergonomic exposures have remained stable over time.

Time--a key issue for musculoskeletal health and manufacturing

Time is a key issue for both ergonomists and engineers when they engage in production system interventions. While not their primary purpose, the actions of engineers have major effects on biomechanical exposure; possibly of much greater magnitude than many ergonomics interventions. This paper summarises the aims, actions and tools of engineers and ergonomists, emphasising time-related outcomes. Activities of the two groups when attempting to manipulate time aspects of work may be contradictory; engineers wishing to improve production and ergonomists aiming at better health as well as contributing to production. Consequently, tools developed by ergonomists for assessing time aspects of work describe rest patterns, movement velocities or daily duration of exposures, while engineering tools emphasise time-efficient production. The paper identifies measures that could be used to communicate time-relevant information between engineers and ergonomists. Further cooperation between these two stakeholders as well as research on the topic are needed to enable ergonomists to have a larger impact on the design of production systems.

Queixas osteomusculares relacionadas ao trabalho relatadas por mulheres de centro de ressocialização

Considerando as queixas de origem laboral um problema de saúde pública, objetivou-se, com o presente estudo, analisar a freqüência da população que refere queixas osteomusculares e a associação de ocorrência e severidade destas às variáveis antropométricas e de trabalho. Tomou-se 146 mulheres de um centro de ressocialização feminino, que responderam a um questionário validado contendo informações sobre dados antropométricos e queixas osteomusculares relacionadas ao trabalho. O estudo da associação entre e dentro das variáveis foi feito pelo teste de Goodman. Observou-se elevada freqüência de ocorrência de queixas após início de atividade laboral (94,19%). As participantes com necessidade de afastamento apresentaram maiores valores em idade e peso. Queixa acentuada foi mais referida na coluna do tronco. Afastamento foi mais referido para as que trabalhavam há mais tempo. Concluiu-se que é alta a freqüência de queixas relacionadas ao trabalho e que há associação entre maiores valores de peso e de estatura e nível de severidade acentuado; maiores valores de idade e de peso e necessidade de afastamento; níveis acentuados de queixas e região da coluna e entre maior tempo de serviço e necessidade de afastamento.

Barriers against returning to work--as perceived by disability pensioners with back pain: a focus group based qualitative study

PURPOSE

The aim of this study was to explore the issue of perceived barriers for returning to work, based on the experiences and beliefs in a group of disability pensioners with back pain.

METHOD

Focus groups were used to interview 12 women and five men, aged 38 - 56, who participated in a larger project aiming to help disability pensioners back to work.

RESULTS

The barriers appearing were related to earlier negative experiences, poor self-judgement of work ability and low self-esteem, lack of support from social security authorities and unsuitable economic arrangements. The pensioners also suggested alternative solutions for making a possible return to work.

CONCLUSIONS

Our study provides insight into the perceived barriers of returning to work and might be useful in future efforts aiming to help disability pensioners back to work.

Factors associated with a positive attitude towards change among employees during the early phase of a downsizing process

Most research on organizational changes in working life, including downsizing, focuses on the negative attitudes and negative consequences of the change. The aim of this study was to evaluate if the employee's previous learning experience and characteristics of the working environment were associated with positive attitudes towards organizational change. The 467 employees (73.5% males) working in a global oil company in the early phases of a downsizing process were asked to answer a questionnaire with demographic variables, perception of the working environment, and attitude to change (93% response rate). Corporate social responsibility (CSR), involvement and participation, team leadership and team effectiveness were important factors related to positive attitudes towards organizational change. Non-leaders and older employees were positive to change. We conclude that employees' perceptions of their psychosocial working environment, in particular the CSR, were highly related to their attitude to organizational change.

Organisational downsizing and increased use of psychotropic drugs among employees who remain in employment

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.

The relations between psychosocial factors at work and health status among workers in home care organizations

A considerable proportion of sickness absence and disability pension is caused by subjective health complaints, especially low back pain (LBP). In recent years focus has been on psychosocial characteristics of work as potential risk factors. The aim of this study is to examine the relations between psychosocial work aspects and subjective health complaints, LBP, and need for recovery. A total of 779 employees working in home care participated in a cross-sectional study. Higher psychological demands were associated with subjective health complaints and need for recovery. However, decision authority, skill discretion, and the 2 aspects of social support did not seem to be important factors. Higher psychological demands do not seem to be associated with severity of LBP, but does show an association with sick leave.

Prognosis research: why is Dr. Lydgate still waiting?

BACKGROUND

Understanding prognosis--the future risk of adverse outcomes among people with existing disease--plays third fiddle behind clinical research into therapeutic interventions and novel diagnostic technologies.

METHODS AND RESULTS

Diseases show marked variations in a wide range of prognostic outcomes, yet these variations have seldom been the subject of systematic and sustained epidemiologic and multidisciplinary research. This is important to prioritize hypotheses for testing in intervention studies in groups, and to refine tools for prognostication in individuals. Methodologic standards for the design, conduct, analysis and reporting of prognosis research are required. Training is needed for the clinicians, policymakers, and payers who use prognostic information.

CONCLUSION

Here, arguments detracting from the potential scope of prognosis research are rebutted and misconceptions addressed with the aim of stimulating debate on the evolving role of prognosis research.

On the evolution of task-based analysis of manual materials handling, and its applicability in contemporary ergonomics

The industrial revolution significantly changed the way work was organized and analyzed by the introduction and widespread implementation of the division of labor philosophy. This philosophy has continued to dominate work design, and has evolved beyond the factory to include many facets of service industries, and even professional occupations. The analysis of manual work, particularly materials handling tasks, remains an active domain of ergonomics research and practice. Many of the task-analytic tools used for workplace analysis are rooted in the philosophy of dividing work into elements, analyzing the individual elements, and synthesizing the results into conclusions about the entire job, including the risk of contracting musculoskeletal disorders (MSDs). The authors discuss the notion that the nature of modern work, which is characterized by multiple tasks in a complex time pattern, and the complex nature of MSDs, which are influenced by biomechanical as well as psychological, political, and economic factors, may limit the effectiveness of classical task analytic techniques in preventing MSDs.

Organisational downsizing and work stress: testing synergistic health effects in employed men and women

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.

Organisational downsizing as a predictor of disability pension: the 10-town prospective cohort study

OBJECTIVE

To examine whether downsizing, the reduction of personnel in organisations, is a predictor of increased risk of disability retirement among employees who kept their jobs.

DESIGN

Prospective cohort study. Based on reductions of personnel in participants' occupation and workplace, employees were grouped into exposure categories of no downsizing (less than 8% reduction), minor downsizing (reduction between 8% and 18%), and major downsizing (more than 18% reduction). They were followed up for a five year period after downsizing.

SETTING

Four towns in Finland.

PARTICIPANTS

19 273 municipal employees, aged 21-54 years.

MAIN OUTCOME MEASURES

All permanent full disability pensions granted because of medical reasons below 55 years of age between 1 January 1994 and 31 December 1998 from the national registers.

RESULTS

In all, 223 employees were granted a permanent disability pension. The overall rate for disability pensions per 1000 employees was 7.7 after no downsizing, 13.1 after minor downsizing, and 14.9 after major downsizing. Cox proportional hazard models adjusted for age, sex, occupational status, type of employment contract, and town showed 1.81 (95% confidence intervals 1.22 to 2.70) times higher risk of disability retirement after major downsizing than after no downsizing.

CONCLUSIONS

The immediate financial advantages of downsizing need to be considered in relation to increased occupational disability and the resulting extra costs to employers and society.

Work factors and occupational class disparities in sickness absence: findings from the GAZEL cohort study

OBJECTIVES

To estimate the contribution of stress-related and physical work factors to occupational class disparities in sickness absence from work.

METHODS

Our sample consisted of 8847 men and 2886 women participating in the French GAZEL cohort study. Occupational class and medically certified sickness absence data (1995-2001) were obtained from the participants' employer. Work characteristics (physical and stress-related) were self-reported. We calculated rate ratios with Poisson regression models; fractions of sickness absence attributable to work factors were estimated with the Miettinen formula.

RESULTS

Sickness absence was distributed along an occupational gradient. Work characteristics accounted for 19% (women) and 21% (men) of all absences. Physical work conditions accounted for 42% and 13% of absences for musculoskeletal reasons, and work stress accounted for 48% and 40% of psychiatric absences. Overall, about 20% of the occupational class gradient in sickness absence could have been associated with deleterious work conditions.

CONCLUSION

Work conditions contribute to sickness absence, particularly among manual workers and clerks. Policies that decrease ergonomic constraints and work stress also could reduce the burden of ill health and sickness absence among the lowest strata of working populations.

A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain

The aim of the present study was to evaluate the long-term outcome of a behavioural medicine rehabilitation programme and the outcome of its two main components, compared to a 'treatment-as-usual' control group. The study employed a 4 x 5 repeated-measures design with four groups and five assessment periods during a 3-year follow-up. The group studied consisted of blue-collar and service/care workers on sick leave, identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomised to one of the four conditions: behaviour-oriented physiotherapy (PT), cognitive behavioural therapy (CBT), behavioural medicine rehabilitation consisting of PT+CBT (BM) and a 'treatment-as-usual' control group (CG). Outcome variables were sick leave, early retirement and health-related quality of life. A cost-effectiveness analysis, comparing the programmes, was made. The results showed, consistently, the full-time behavioural medicine programme being superior to the three other conditions. The strongest effect was found on females. Regarding sick leave, the mean difference in the per-protocol analysis between the BM programme and the control group was 201 days, thus reducing sick leave by about two-thirds of a working year. Rehabilitating women has a substantial impact on costs for production losses, whereas rehabilitating men seem to be effortless with no significant effect on either health or costs. In conclusion, a full-time behavioural medicine programme is a cost-effective method for improving health and increasing return to work in women working in blue-collar or service/care occupations and suffering from back/neck pain.

The development of a new corporate specific health risk measurement instrument, and its use in investigating the relationship between health and well-being and employee productivity

BACKGROUND

There is a growing body of evidence linking health and well-being to key business issues. Despite this, corporate uptake of workplace health promotion programmes has been slow outside the USA. One possible reason for this is the lack of a generally available health risk measure that is quick and easy to administer and produces data that is rich enough to inform and direct subsequent employee health promotional interventions.

METHODS

We report on the development and validation of the health and well-being (HWB) assessment, a free to use health risk appraisal questionnaire that has been specifically developed for use in the corporate setting. The HWB assessment focuses upon modifiable health issues that directly impact upon business drivers. Development involved interviews with business leaders to ascertain their key areas of focus, scientific and general literature review to find evidence for health status having an impact upon these areas, and end user testing.Three UK-based organisations (insurance, telecommunications and consumer goods sectors) participated in the research. A total of 2224 employees completed the HWB assessment, the short-form 36 (SF-36) and the World Health Organisation Health and Work Performance questionnaire (WHO-HPQ) as part of the validation process.

RESULTS

The HWB assessment is a twenty item questionnaire covering ten areas of health and well-being. Completion of the HWB assessment generates a global health risk score and ten sub-scores corresponding to the ten areas covered. It is easy to use and quick to complete (average completion time was eight minutes) and showed good internal consistency and test-retest reliability. Statistically significant correlations with similar SF-36 variables were observed. A significant negative correlation between HWB score and productivity decrement, as measured by the WHO-HPQ, was observed (r = -0.4). Individuals with HWB scores above the 25th percentile were more likely to achieve workplace productivity standards than those with scores below the 25th percentile (OR 3.62, 95% confidence limits 2.93 - 4.47).

CONCLUSION

The HWB assessment generates reliable business focused health risk data that can be used to direct and target appropriate interventions within corporate populations. It may also be useful in quantifying the financial impact health status issues have upon organisations.

Job insecurity and its association with health among employees in the Taiwanese general population

As employers respond to intensive global competition through the deregulation of labor, job insecurity has become a widespread problem. It has been shown to have significant health impacts in a growing number of workers, but less is known about its social distribution, the mechanisms through which it may act, and the moderating effects of gender, socioeconomic position, and company size. Utilizing data from a national survey of a representative sample of paid employees in Taiwan, we examined the prevalence of job insecurity and its associations with psychosocial work characteristics and health status. A total of 8705 men and 5986 women aged between 25 and 65 years old were studied. Information on perceived job insecurity, industrial and occupational types, psychosocial work characteristics as assessed by the Job Strain model, and various measures of health status were obtained by a self-administered questionnaire. The overall prevalence of job insecurity was high (50%). Job insecurity was more prevalent among employees with lower education attainment, in blue-collar and construction workers, those employed in smaller companies, and in older women. Insecure employees also reported lower job control, higher job demands, and poor workplace social support, as compared with those who held secure positions. Regression analyses showed that job insecurity was strongly associated with poor health, even with adjustment of age, job control, job demands, and work place social support. The deleterious effects of job insecurity appeared to be stronger in men than women, in women who held managerial or professional jobs than women in other employment grades, and in those working in larger companies than smaller ones. The findings of this study suggest that perceived job insecurity is an important source of stress, and it is accompanied with adverse psychosocial work conditions and poor health. High-risk groups were identified for further investigation.

Employment status, employment conditions, and limiting illness: prospective evidence from the British household panel survey 1991-2001

OBJECTIVES

To assess the relation of the incidence of, and recovery from, limiting illness to employment status, occupational social class, and income over time in an initially healthy sample of working age men and women.

METHODS

Cox proportional hazards models.

RESULTS

There were large differences in the risk of limiting illness according to occupational social class, with men and women in the least favourable employment conditions nearly four times more likely to become ill than those in the most favourable. Unemployment and economic inactivity also had a powerful effect on illness incidence. Limiting illness was not a permanent state for most participants in the study. Employment status was also related to recovery.

CONCLUSIONS

Having secure employment in favourable working conditions greatly reduces the risk of healthy people developing limiting illness. Secure employment increases the likelihood of recovery. These findings have considerable implications for both health inequality and economic policies.

Psychosocial factors at work as predictors of hospitalization for back disorders: a 28-year follow-up of industrial employees

STUDY DESIGN

A prospective cohort study.

OBJECTIVES

To study the association of psychosocial factors at work with severe back disorders leading to hospitalization.

SUMMARY OF BACKGROUND DATA

Some psychosocial factors at work have been related to back pain, but little is known about their predictive role in severe back disorders.

METHODS

Psychosocial factors at work were studied by questionnaire and interview in 1973 among a cohort of 902 metal industry employees. Information on hospital admissions for back disorders from the Finnish Hospital Discharge Register in 1973-2000 was linked to the data. Cox proportional hazards regression was used to estimate the time between the assessment of risk factors and the first hospital admission for intervertebral disc disorders (36 cases) and other back disorders (47 cases).

RESULTS

In a model including psychosocial factors and potential confounders, low job control versus high control was associated with a 3.2-fold risk (95% confidence interval, 1.3-7.8) of hospitalization for back disorders other than those of the intervertebral disc. The corresponding rate ratio for low versus high supervisor support was 2.9 (95% confidence interval, 1.3-6.3). Job demands, coworker support, and distress were not independently associated with these disorders. The result did not change when patients with chronic back disorder at baseline were excluded from the analysis. There was no association between psychosocial factors at work and hospitalizations for intervertebral disc disorders.

CONCLUSION

Low job control and low supervisor support seem to increase the risk of hospitalization for back disorders other than intervertebral disc disorders.

Workplace expansion, long-term sickness absence, and hospital admission

BACKGROUND

Downsizing has in previous studies, as well as in public debate, been associated with increased sickness absence. No studies have, however, looked at the long-term relation between workplace expansion and morbidity.

METHODS

We investigated exposure to personnel change during 1991-96 in relation to long-term (90 days or longer) medically certified sickness absence and hospital admission for specified diagnoses during 1997-99 in 24?036 participants with a complete employment record in the biennial national Swedish Work Environment Surveys from 1989 to the end of 1999.

FINDINGS

Accumulated exposure to large expansion (> or =18% per year) was related to an increased risk of long-term sickness absence (odds ratio 1.07 [95% CI 1.01-1.13], p=0.013) and hospital admission (1.09 [1.02-1.16], p=0.017). In this context, odds ratio signifies the change in odds for each additional year of exposure, varying from 0 to 6. Moderate expansion (> or =8% and <18% per year), was associated with a decreased risk of admission (0.91 [0.84-0.98], p=0.012). Moderate downsizing (> or =8% and <18% per year) was associated with an increased risk of sickness absence (1.07 [1.02-1.12], p=0.003). The strongest association between large expansion and sickness absence was in women in the public sector (1.18 [1.08-1.30], p=0.0002), corresponding to an odds ratio of 2.77 [1.62-4.74] between full exposure (all 6 years) and no exposure.

INTERPRETATION

This study confirms earlier findings that downsizing is associated with health risks. It also shows that repeated exposure to rapid personnel expansion, possibly connected with centralisation of functions, statistically predicts long-term sickness absence and hospital admission. Although no conclusions about causal pathways can be drawn from our results, this exposure should be considered in future studies, policy making, and occupational health care practice.

Job characteristics, physical and psychological symptoms, and social support as antecedents of sickness absence among men and women in the private industrial sector

Most longitudinal studies on the relationship between psychosocial health resources and risks, and the employees' subsequent sickness absences have been conducted in the public sector. The purpose of this study was to find out psychosocial antecedents of sickness absenteeism in the private industrial sector. The effects of job characteristics (job autonomy and job complexity), physical and psychological symptoms, and social support (from coworkers and supervisors) on sickness absenteeism were investigated. The number of long (4-21 days) and very long (>21 days) sickness absence episodes of 3895 persons (76% men and 24% women, mean age 44 years) was obtained from the health registers of a multinational forest industry corporation in 1995-1998. A questionnaire survey on the working conditions and health of the workers was carried out in 1996. The follow-up time of the sickness absences was 1-year 9-month. Job autonomy was found to be associated with long and very long episodes in men (rate ratio (RR) in the lowest autonomy group approximately 2 times higher than the highest autonomy group), and with very long episodes of absence in women (2-3 times higher RR between the low vs. the high category). Low job complexity predicted men's very long absences (RR 1.4). Long and very long episodes were associated with physical and psychological symptoms (RR 1.2-1.7) among men and women. Lack of coworkers' support increased the frequency of very long sickness absence among men (RR 1.4), and lack of supervisor's support among women (RR 1.6). Also, some interaction effects of social support variables were observed among both genders. We conclude that the studied psychosocial factors are associated with subsequent sickness absence, and that the associations are partly gender-specific. The results showing which variables are related to employees' sickness absenteeism in the private industrial sector can be applied in human resource management and health service planning.

Human costs of organizational downsizing: comparing health trends between leavers and stayers

We studied health-related selection and consequences of an organizational downsizing among 886 municipal employees. Measurements of health indicators were conducted before any rumor of the downsizing and immediately after the downsizing 3 years later. Results of pre-downsizing health showed that those who did not find employment after the staff reductions were older employees with high preexisting morbidity. Those getting a new job elsewhere were younger and had better health already before the downsizing than the stayers. After the downsizing, deterioration of health was most likely in the stayers working in groups of major staff reductions and among the nonemployed leavers. In the reemployed leavers, the risk of increased health problems was lower than in others including employees working in no or minor downsizing groups.