Examining the fatigue-quality relationship in manufacturing

A recent systematic review identified 73 empirical studies that linked human factors (HF) with manufacturing quality. Human fatigue was noted as a frequent (n = 26) issue in the HF-quality relationship - a finding that warrants closer examination. We extend this review by investigating the relationship between fatigue and manufacturing quality by identifying how fatigue has been conceptualized and measured, and we attempted to quantify their relationship. From the original database, 12 of 26 relevant studies (46%) indicated that physical fatigue was the primary contributor to observed quality deficits. There was a positive relationship between fatigue and quality deficits, with fatigue accounting up to 42% of the variance. More studies are needed to improve the resolution, specificity, and power of these analyses. This study sheds light on the role of HF and human fatigue effects on manufacturing quality with macroergonomic implications for embedding HF aspects into design and quality assurance processes.

Cognitive, relational and task crafting: Spanish adaptation and analysis of psychometric properties of the Job Crafting Questionnaire

Even though classic job design theories have evolved over the years and become more focused on employees' ability to autonomously change their job characteristics, tools to assess job crafting are still limited. The purpose of this study was to analyze the psychometric properties of the Spanish version of the Job Crafting Questionnaire (JCQ), taking into account the valuable contribution made by Wrzesniewski and Dutton's model to the understanding of the job crafting concept. The total sample consisted of 768 employees (participants' mean age was 41.63 and 49.7% of them were women). The sample was randomly divided into two halves in order to conduct two factor analyses (Exploratory Factor Analysis and Confirmatory Factor Analysis). Concurrent and convergent validity was assessed by computing correlations with validated questionnaires for measuring job crafting (Job Crafting Scale, JCS), engagement (Utrecht Work Engagement Scale, UWES-9) and job burnout (Maslach Burnout Inventory-General Survey, MBI-GS). The results indicated a high level of internal consistency (Cronbach's alpha = .880) which was similar to the original scale, and provided a good fit to the three-dimensional model tested. Appropriate evidence of construct validity was also shown (r = .45 with total JCS; r = .52 with total UWES-9 and r-values between -.33 and .45 with MBI dimensions). The results confirmed that the Spanish translation of the JCQ is a suitable tool for measuring job crafting and enabling practitioners and researchers to further expand the existing knowledge of this concept.

Using evidence to support the design of submarine control console workstations

PURPOSE

This paper outlines an approach to develop practical guidelines to support the design of submarine control console workstations.

METHOD

Guideline development was undertaken for 13 physical design criteria, provided to the research team. Data was gathered from four sources: a systematic literature review, relevant standards, population specific anthropometric data, and user focus groups. The systematic review included risk of bias, quality assessment and evidence synthesis.

RESULTS & CONCLUSION

The systematic review retrieved 43 relevant articles in relation to seven of the 13 design criteria. Very few high-quality studies were identified. The combined evidence available from each of the four data sources was collated and used to provide a set of guidelines for each of the 13 criteria, highlighting the importance of the use of multiple data sources. This approach has applicability beyond this study where the need exists to collate evidence sources beyond the scientific literature.

The prevalence of binge eating disorder and its relationship to work and classroom productivity and activity impairment

OBJECTIVE

The study aimed to determine the prevalence of binge eating disorder on university campus, its associations with health risk factors, and its associations with work and classroom productivity and activity impairment, adjusted for health risk factors.

PARTICIPANTS

The study was conducted at a public midwestern university in the United States and involved 1,165 students.

METHODS

Data were collected online, using preestablished instruments. Descriptive, chi-square, correlation, and robust multiple regression tests were used.

RESULTS

About 7.8% of the participants were assessed as having binge eating disorder. Binge eating disorder was more common among obese students than nonobese students. Associations were found between moderate binge eating disorder and classroom productivity and daily activity impairment; however, sleep duration and physical activity were the strongest predictors.

CONCLUSIONS

University students are at risk of binge eating disorder. Interventions with this population should include education, screening, and clinical consultation when warranted.

An Experimental Study of Team Size and Performance on a Complex Task

The relationship between team size and productivity is a question of broad relevance across economics, psychology, and management science. For complex tasks, however, where both the potential benefits and costs of coordinated work increase with the number of workers, neither theoretical arguments nor empirical evidence consistently favor larger vs. smaller teams. Experimental findings, meanwhile, have relied on small groups and highly stylized tasks, hence are hard to generalize to realistic settings. Here we narrow the gap between real-world task complexity and experimental control, reporting results from an online experiment in which 47 teams of size ranging from n = 1 to 32 collaborated on a realistic crisis mapping task. We find that individuals in teams exerted lower overall effort than independent workers, in part by allocating their effort to less demanding (and less productive) sub-tasks; however, we also find that individuals in teams collaborated more with increasing team size. Directly comparing these competing effects, we find that the largest teams outperformed an equivalent number of independent workers, suggesting that gains to collaboration dominated losses to effort. Importantly, these teams also performed comparably to a field deployment of crisis mappers, suggesting that experiments of the type described here can help solve practical problems as well as advancing the science of collective intelligence.

Quantitative evaluation of the impact of night shifts and alcohol consumption on construction tiling quality

The adverse effects of night-shift work and alcohol consumption on performance have received considerable attention. However, how night shifts and alcohol affect productivity in workers has not been quantified. This paper describes the experiments featuring multiple tiling tasks and patterns. The tiling quality performed by the graduate student participants in four different statuses was objectively evaluated by an edge-detection computer program. The results indicate that both night shift and alcohol significantly reduce the quality in general, and the effects of the factors on position and alignment-angle qualities were dissimilar in distinct areas due to tile patterns and size. Both night-shift and alcohol conditions affected the basic (-34.01% and -25.79%) and advanced tiling abilities (-40.14% and -26.16%), and night shift had a larger impact than alcohol. These results provide jobsite managers with usable information regarding how night shifts and alcohol affect workers' abilities to execute basic and advanced tasks.

Measuring Work Functioning: Validity of a Weighted Composite Work Functioning Approach

PURPOSE

To examine the construct validity of a weighted composite work functioning measurement approach.

METHODS

Workers (health-impaired/healthy) (n = 117) completed a composite measure survey that recorded four central work functioning aspects with existing scales: capacity to work, quality of work performance, quantity of work, and recovery from work. Previous derived weights reflecting the relative importance of these aspects of work functioning were used to calculate the composite weighted work functioning score of the workers. Work role functioning, productivity, and quality of life were used for validation. Correlations were calculated and norms applied to examine convergent and divergent construct validity. A t test was conducted and a norm applied to examine discriminative construct validity.

RESULTS

Overall the weighted composite work functioning measure demonstrated construct validity. As predicted, the weighted composite score correlated (p < .001) strongly (r > .60) with work role functioning and productivity (convergent construct validity), and moderately (.30 < r < .60) with physical quality of life and less strongly than work role functioning and productivity with mental quality of life (divergent validity). Further, the weighted composite measure detected that health-impaired workers show with a large effect size (Cohen's d > .80) significantly worse work functioning than healthy workers (discriminative validity).

CONCLUSION

The weighted composite work functioning measurement approach takes into account the relative importance of the different work functioning aspects and demonstrated good convergent, fair divergent, and good discriminative construct validity.

Using theory and formative research to design interventions to improve community health worker motivation, retention and performance in Mozambique and Uganda

BACKGROUND

Community health workers (CHWs) are increasingly being used in low-income countries to address human resources shortages, yet there remain few effective, evidence-based strategies for addressing the enduring programmatic constraints of worker motivation, retention and performance. This paper describes how two interventions were designed by the Innovations at Scale for Community Access and Lasting Effects (inSCALE) project to address these constraints in Uganda and Mozambique drawing on behavioural theory and formative research results.

METHODS

A review of the work motivation and CHW motivation literature--incorporating influences on retention and performance--was conducted on articles sourced through electronic web searches. Formative research with a focus on the barriers and facilitators to CHW motivation, retention and performance was conducted with community health workers and key stakeholders in Uganda and Mozambique. An analytical induction approach to the thematic analysis of transcripts from 98 in-depth interviews and 26 focus group discussions was adopted across the country settings.

RESULTS

From the theoretical review, it was determined that the interventions should promote CHWs as members of a collective by highlighting a sense of shared experience, focus on alignment between worker and programme goals, and emphasise the actions that lead to good performance. The Social Identity Approach was selected as the theory most likely to lead to the development of effective, scalable and sustainable interventions by addressing the identified gap in the literature of the influence of CHW working context. The formative research indicated that CHWs value feedback and feeling connected to the health system and their community, are motivated by status and community standing, and want to be provided with the necessary tools to perform. Two interventions based on these results were developed: a participatory, local community approach and an information communication technology (ICT) approach.

CONCLUSIONS

Drawing on contextual data and theory that is sensitive to context can potentially lead to the development of appropriate and effective interventions when aiming to improve the motivation, retention and performance of CHWs in Uganda and Mozambique and other comparable settings. Evaluation of the developed interventions is crucial to assess this potential.

Different views about work-hour limitations in medicine: a qualitative content analysis of surgeons', lawyers', and pilots' positive and negative arguments

Background

Whereas work-hour regulations have been taken for granted since 1940 in other occupational settings, such as commercial aviation, they have been implemented only recently in medical professions, where they lead to a lively debate. The aim of the present study was to evaluate arguments in favour of and against work-hour limitations in medicine given by Swiss surgeons, lawyers, and pilots.

Methods

An electronic questionnaire survey with four free-response items addressing the question of what arguments speak in favour of or against work-hour limitations in general and in medicine was sent to a random sample of board-certified surgeons, lawyers in labour law, and pilots from SWISS International Airlines Ltd.

Results

In all, 279/497 (56%) of the respondents answered the survey: 67/117 surgeons, 92/226 lawyers, and 120/154 pilots. Support for work-hour limitations in general and in medicine was present and higher among lawyers and pilots than it was in surgeons (p<0.001). The latter agreed more with work-hour limitations in general than in medicine (p<0.001). The most often cited arguments in favour of work-hour limitations were “quality and patient safety,” “health and fitness,” and “leisure and work-family balance,” whereas the lack of “flexibility” was the most important argument against. Surgeons expected more often that their “education” and the “quality of their work” would be threatened (p<0.001).

Conclusions

Work-hour limitations should be supported in medicine also, but a way must be found to reduce problems resulting from discontinuity in patient care and to minimise the work in medicine, which has no education value.

Mapping the relationships between work and sustainability and the opportunities for ergonomic action

A map was drawn up of the relationships between work (in its multiple interpretations) and sustainability (sustainable development and corporate sustainability) based on a bibliographic analysis of articles that discuss these themes jointly in the current academic literature. The position of the discipline of ergonomics focused on work was identified from this map and, based on its specific academic literature, it was possible to identify where this discipline could contribute so that work and workers can be included in the discourse of sustainable development and considered in corporate sustainability policies. Ergonomics can be actively influential within the organization on issues relating to work improvements; it may boost integrated increases in the organization's performance and in workers' well-being; it can provide support for changes and new (environmental) sustainability-related work requirements to be considered; and it can contribute to the definition of the concept of work in a context of sustainable development.

Demand-specific work ability, poor health and working conditions in middle-aged full-time employees

We investigated the prevalence of reduced demand-specific work ability, its association with age, gender, education, poor health, and working conditions, and the interaction between poor health and working conditions regarding reduced demand-specific work ability. We used cross-sectional questionnaire data from 3381 full-time employees responding to questions about vocational education, job demands and social support (working conditions), musculoskeletal pain (MSP) and major depression (MD) (poor health) and seven questions about difficulty managing different job demands (reduced demand-specific work ability). Reduced demand-specific work ability varied from 9% to 19% among the 46-year old and from 11% to 21% among the 56-year old. Age was associated with two, gender with four, and education with all measures of reduced demand-specific work ability. MSP was associated with four and MD was associated with six measures of reduced demand-specific work ability. We found no interaction between working conditions and poor health regarding reduced demand-specific work ability.

[A review of measures taken to improve organizational wellbeing in Italy]

INTRODUCTION

The Italian Decree Law D. Lgs. no. 81 dated 9 April 2008, dealing with the implementation of Article 1 of Law No. 123 dated 3 August 2007, on the topic of health and safety in the workplace, indicated that work-related stress (art. 28, section 1) was to be assessed in accordance with the European Agreement of 8 October 2004. It recalled the employer's legal obligation to safeguard workers' health and safety, and included psychosocial risk, in order to improve their wellbeing at work. The Decree Law specified that when risks had been assessed the employer could take all necessary measures, with reference to the "good practice", defined in the Law as organizational or procedural solutions coherent with current regulations and good technical rules, adopted voluntarily with the aim of promoting safety and health in the workplace by reducing risk and improving working conditions [...]" (art. 2, section 1 v); the practical solutions identified were to aim at eliminating, or at least reducing, psychosocial risk in the enterprise.

METHOD

On the basis of the studies most widely accepted in Europe and the indications issued by the European Agency for Safety and Health at Work, we identified the good practice measures adopted by companies in Italy and other countries. The aim was to make known some of the practical solutions regarding psychosocial risk that companies can put in place with a view to improving their workers' health and wellbeing.

RESULTS

We examined measures related to the content and context of work. Measures affecting the work content mainly involved the workplace itself and equipment, work planning and working hours. For the work context the measures centered mostly on organizational function and culture, career progress, and home/work interface.

CONCLUSIONS

In accordance with good safety practice, the practical measures taken by the enterprises examined cantered on some potentially stressful features of work, indicating the growing attention being paid to workers' wellbeing. However, organizational wellbeing is a multifaceted concept and the European Agency points out that measures taken must cover all the aspects of the work that appear particularly critical in risk assessment; from the primary prevention viewpoint, this means all the organizational aspects that might affect a person's wellbeing. As we become increasingly aware of the problems, and of the measures that have proved successful, it is to be hoped that further solutions will be identified and developed in organizations.

[Mobbing, organizational dysfunction and bio-psycho-social effects: an integrated assessment. Preliminary data for the validation of the Questionnaire in the Neapoletan dialect on Distress at Work(Qn-DL)]

The aim of this study is to produce preliminary data about the validation of the "Naples-Questionnaire of Distress at Work" (nQ.DW). This inventory is a new assessment tool in order to evaluate the distress perceived in the working environment by means of the differentiation of the conditions linked to the mobbing from which related to organizational disfunction. The nQ-DW also measures the bio-psycho-social global effects of these two phenomena. The questionnaire has been administered to workers suffering of a psychopathological disturbance related to work distress and to a control group matched for the sociodemographic and working variables. The statistical analysis demonstrated a significant validity and reliability. The degree of internal coherence was satisfactory. The ROC curves allow the determination of a threshold value which allows to separate the workers subjected to mobbing and/or organizational stress from control-workers with an optimal reliability degree. The values of the area under the ROC curves show that the inventory has a high discriminating capacity. Future studies, based on a greater sample size, will be oriented to the analysis of the questionnaire by means of multivariate techniques like the factorial analysis.

Chronic pain and reduced work effectiveness: The hidden cost to Australian employers

Cost estimates of the impact of chronic pain on work have largely focussed on absenteeism, excluding the hidden contribution of reduced work effectiveness to lost productivity. This paper aims to estimate the cost of lost productivity due to chronic pain in Australia, not only in terms of absenteeism but also reduced work effectiveness. Data on chronic pain in Australia and its impact on work were obtained from the 1997 New South Wales Health Survey (n=17,543) and the Northern Sydney Area Pain Study (n=2,092), both of which were population-based and used random-digit dialing sampling methods. This was combined with relevant Australian population and labour force data obtained from the Australian Bureau of Statistics. From this we estimated annual lost productivity costs arising from both chronic pain-related days absent and 'reduced-effectiveness workdays'. There were estimated to be 9.9 million workdays absent due to chronic pain annually in Australia, equating to a cost of AUD 1.4 billion per annum. Under the assumption that reduced-effectiveness workdays affect productivity costs in the same way as lost work days, the total number of lost workday equivalents was 36.5 million, with the total annual cost of lost productivity due to chronic pain estimated as AUD 5.1 billion per annum. In conclusion, while the impact of reduced work effectiveness on days worked with pain on productivity is uncertain, it has the potential to account for the majority of lost productivity costs associated with chronic pain. Interventions which target working despite pain have the potential to significantly reduce lost productivity costs due to chronic pain.

Improvement of force health protection through preventive medicine oversight of contractor support

Unprecedented numbers of contractors are used throughout the Iraq theater of operations to alleviate military manpower shortages. At virtually every major forward operating base, US-based contractors perform the preponderance of essential life support services. At more remote sites, local national contractors are increasingly relied upon to maintain chemical latrines, remove trash, deliver bulk water, and execute other janitorial functions. Vigorous oversight of contractor performance is essential to ensure services are delivered according to specified standards. Poor oversight can increase the risk of criminal activities, permit substandard performance, elevate disease and nonbattle injury rates, degrade morale, and diminish Soldier readiness. As the principal force health protection proponents in the Department of Defense, preventive medicine units must be tightly integrated into the oversight processes. This article defines the force health protection implications associated with service contracts and provide recommendations for strengthening preventive medicine's oversight role.

A screening questionnaire to predict no return to work within 3 months for low back pain claimants

The objective of the present study was to develop a short prediction questionnaire for estimating the risk of no return to work (RTW) within 3 months of sick leave to facilitate triage and management of a patient population of subacute low-back pain (LBP) sufferers. We conducted a prospective study with a 3-month follow-up on 186 patients with LBP introducing a claim for sickness benefits to the largest sickness fund in Belgium. Patients completed a screening questionnaire within 2 weeks after claim submission. All patients were invited for clinical assessment, at 6-8 weeks of sick leave, by the medical adviser. Patients' work status was recorded by the sickness fund. About 20% of the patients did not resume work at 3 months' sick leave. They were more likely to experience pain below the knee, to have an own previous prediction of a 100% no RTW and to have a severe interference of pain on daily activities. The screening tool based on these three items correctly classified 73.7% of the non-resumers and 78.4% of the resumers at a cut-off score of 0.22. The findings of this study provide evidence of the utility of a short screening questionnaire for future use in intervention studies in a social security setting.

[Work conditions and professional profiles of nutritionists who graduated from the Ouro Preto Federal University, Minas Gerais State, Brazil: 1994 - 2001]

The study presents the professional profiles and work conditions of nutritionists who graduated from the Ouro Preto Federal University, Minas Gerais State, Brazil, in their various spheres of action. A quanti-qualitative approach was adopted through questionnaires completed by all professionals graduating from this University between 1994 and 2001 (N=356), in addition to semi-structured interviews with fourteen professionals selected from the universe of the respondents (n=90). An analysis of these questionnaires showed that 67% of them work with Clinical Nutrition, 44% with Collective Nutrition, 14% with Education Programs and 11% with Social Nutrition. Most (57%) of the respondents expressed the desire to remain in the field where they were working. Among those wishing to move into a different area, 44.5% work with Collective Nutrition. Despite clearly precarious employment links, Clinical Nutrition is the field with the largest number of professionals satisfied with their work conditions. The findings of this study explore the work conditions of a group of nutritionists for whom job stability is not always the main factor for professional satisfaction.

Therapeutic alliance and improvements in work performance over time in patients with schizophrenia

While therapeutic alliance (TA) in schizophrenia has been linked with treatment adherence and outcome, less is known about its relationship to rehabilitation outcome. To examine this issue, we classified persons who had been enrolled in a rehabilitation study as having higher or lower levels of TA based on an observer assessment midway through treatment and compared their work performance at weeks 1, 11, and 23. Repeated measures analysis of variance found group effects for Work Quality and Personal Presentation with the higher TA group having better overall performance on both. Time effects were found for Work Quality and Personal Presentation with the sample overall showing improvement over the course of rehabilitation. Interactions were found for Cooperativeness and Work Quality with the higher TA group showing steady increases, whereas the lower TA group showed initial improvement followed by a decline. Results suggest that forming a strong TA may enhance rehabilitation among persons with schizophrenia.

Work performance among Australians with depression and anxiety disorders: a population level second order analysis

At a population level, little is known about how anxiety and depression impact on work performance. We investigated the first and second order correlates of work accomplishment and care taken at work among people with International Statistical Classification of Diseases and Related Health Problems, 10th Revision, affective and anxiety disorders in comparison to healthy community residents. Australian Bureau of Statistics multistage sampling strategies obtained a household sample of 37,580 working age individuals. A secondary analysis was conducted using multiple binary logistic regression. The first order correlates of work performance were the extent of employment restrictions, mental health status, age, sex, and whether or not treatment was received. At the second order level, the effects of mental health status on work performance depended on age, sex, and receiving treatment. The effect of employment restrictions on work performance depended on age and sex only.

Participative management strategy for occupational health, safety and well-being risks

The article discusses the principles that underlie a coherent and efficient prevention program for occupational health, safety and well-being: the need of a global approach of these problems not only at the workplace but for the whole of the living conditions at work; a clear understanding of the complementarity between the different partners of this prevention; the role of actor of the workers and therefore the absolute necessity of a participative approach; the real usefulness of measurements and of risk quantification in general; the differences between risk assessment and risk management and the specificities of small and medium size enterprises. On the basis of these principles, the various steps and levels of intervention are defined. The SOBANE prevention strategy is introduced and its 4 levels (Screening, Observation, Analysis and Expertise) are described as well as the consultation guide Déparis for the Screening level. The strategy proved to make it possible to approach the work situations progressively in small as well as in large companies, to coordinate the cooperation between the workers, the technical staff and the occupational health practitioners and to prevent the problems more rapidly, more efficiently and more economically. The paper describes the role of a 'facilitator' to introduce the philosophy and the tools of the SOBANE strategy in the company, to monitor its application and insure the continuity and the efficiency of the participatory approach.

Opportunities and challenges for collaboration in research and practice in injury prevention across work and other settings

Even though injuries at work and in other settings (homes, roads, etc) commonly involve similar mechanisms, research and prevention are usually specific to each setting. The potential benefits of addressing common features of injury prevention are noted across setting, while some unique features of the work environment are acknowledged. Further integration is recommended using the following approaches: (i) organization of research questions by injury mechanisms and (ii) support of comparative research across settings by funding agencies.

[Life and working conditions among physicians at a university hospital]

This paper evaluated the life and working conditions of physicians who worked in a university hospital. Two questionnaires, one for occupational data and the Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) were applied. 91 surgeons and 96 physicians, mainly of the masculine sex, participated in the inquiry. The average age among surgeons was 44.5 and among physicians, 46. The average of weekly working hours was 51.8 hours among the surgeons and 44.1 among the physicians. 87.9% of the surgeons and 51.6% physicians also mentioned working in other hospitals. Only in Physical Aspects there was a significant statistical difference between the groups, with lower rates among physicians.

A prospective study of acceptance of pain and patient functioning with chronic pain

Acceptance of chronic pain is emerging as an important concept in understanding ways that chronic pain sufferers can remain engaged with valued aspects of life. Recent studies have relied heavily on cross-sectional investigations at a single time point. The present study sought to prospectively investigate relations between acceptance of chronic pain and patient functioning. A sample of adults referred for interdisciplinary treatment of severe and disabling chronic pain was assessed twice, an average of 3.9 months apart. Results showed that pain and acceptance were largely unrelated. Pain at Time 2 was weakly related to measures of functioning at Time 2. On the other hand, acceptance at Time 1 was consistently related to patient functioning at Time 2. Those patients who reported greater acceptance at Time 1 reported better emotional, social, and physical functioning, less medication consumption, and better work status at Time 2. These data suggest that willingness to have pain, and to engage in activity regardless of pain, can lead to healthy functioning for patients with chronic pain. Treatment outcome and process studies may demonstrate the potential for acceptance-based clinical methods for chronic pain management.

[Assessment of working conditions in health care workers]

OBJECTIVE

Validation and first use of a self-completed questionnaire to assess opinion on working conditions in health professionals.

METHODS

The questionnaire consisted of 40 items. It was developed via review of the literature and two focus groups. A reliability test-retest study was performed on 45 health professionals with different roles. Factorial validity and internal consistency of each derived subscale were evaluated on a wide sample of 514 professionals. In addition, the opinion of the health care professionals was evaluated and possible relationships were tested between total and subscale scores and the following variables: age, sex, professional role and years in the job.

RESULTS

Weighted kappa was higher than 0.60 for 95% of the items, higher than 0.70 for 43% and higher than 0.80 for 20%. Factor analysis revealed that six factors--work content and organisation, physical fatigue, relationships, mental stress, hours of work, and physical environment--explained 57% of total variance. Cronbach's alpha coefficient of the subscales ranged from 0.70 to 0.91. Low levels of satisfaction in dfferent job aspects were found among general hospital staff. They were particularly dissatisfied with personal growth and development, fairness in incentives, dissemination of information, environment, support of new ideas and skills, career opportunities. In particular, satisfaction differed among the various professional roles.

DISCUSSION

The questionnaire was found reliable and had a coherent factor structure, with six factors or subscales that showed good internal consistency. This questionnaire may be useful to assess satisfaction with work in health care staff. The preliminary results of its use suggest that satisfaction with different aspects of work is low.

Nursing ethics and conceptualizations of nursing: profession, practice and work

BACKGROUND

Nursing has been understood as a calling, vocation, profession, and most recently, a practice. Each of these conceptualizations has associated with it an ethics that has emphasized particular aspects of nursing reflecting the social position of nursing in a given historical period. The ethics associated with current understandings of nursing as a profession and a practice are, we believe, no longer adequate to address the social realities and moral challenges of health care work.

AIM

The aim of this paper is to discuss the limitations of the ethics associated with profession and practice and to show why the concept of work can contribute to a nursing ethics.

DISCUSSION

The characteristics that have socially defined professionals, among them the possession of a unique body of knowledge, provision of an altruistic service to society, and autonomy in the sense of control over their work and work conditions, only partially reflect the realities of contemporary health care work. This is true even for physicians, an exemplar of a professional group. The ethics associated with the professions has tended to limit what counts as a moral concern and who is authorized to label them as such. More recently, the idea of a practice has been used to argue for an ethics in which professional activities of a certain kind and understood in a specific way are inherently moral. However, this approach is limited for similar reasons. Because morality cannot be separated from the social organization of health care, we argue that considering nursing primarily as work, in contrast to a profession or a practice, offers the possibility of an ethics that more completely reflects the complexity of contemporary health care.

CONCLUSION

Beyond the obvious conclusion that nursing is work, conceptualizing nursing as work points to changing social realities that are raising significant ethical issues. As a concept, work inherently conveys value, connects intellectual and manual labour, and recognizes social divisions of labour. At the moment an ethics of work is merely an idea, but we believe that such an ethics would lead nurses to ask different questions and propose different answers to the moral challenges of the present and near future.

Construction work practices and conditions improved after 2-years' participation in the HomeSafe pilot program

This study reevaluated changes in job-site safety audit scores for a cohort of residential construction workers that had protracted exposure to the HomeSafe pilot program for 2(1/2) years. The investigation was a repeated measure of a cohort study underway in the six-county metro area of Denver, Colo. The larger study was a longitudinal, quasi-experimental design with a cohort of residential construction workers within the HomeSafe strategic partnership between Occupational Safety and Health Administration Region VIII and the Home Builders Association of Metropolitan Denver (HBA). Audits were conducted on residential construction sites. Study subjects were construction workers employed by partner or control companies within the study. Repeated measures of 41 companies showed significant improvement (p=.01) in audit scores, increasing from 71.8 to 76.8 after 2(1/2) years in the program. HomeSafe companies out-performed controls (p=.01) for both the retest group and previously unaudited HomeSafe companies. Prolonged exposure in the HomeSafe pilot program resulted in improved audit scores for companies within the program for at least 2 years.

High-quality work, job satisfaction, and occupational injuries

The authors investigated whether and how 1 element of a high-performance work system, namely high-quality jobs (composed of extensive training, variety, and autonomy), affects occupational injuries. On the basis of data from the Australian WIRS95 database (N = 16,466; Department of Workplace Relations and Small Business, 1997), high-quality jobs exerted a direct effect on injuries and an indirect effect through the mediating influence of job satisfaction. Conceptual, methodological, and practical issues are discussed.

Improving the working lives of cancer clinicians

Cancer clinicians have to deal with particular difficulties in their work, including emotionally demanding interactions with patients and a high proportion of patients in whom curative treatment is ineffective. Perhaps, surprisingly, cancer clinicians are at no greater risk of poor mental health than other specialists, although levels among senior doctors are higher than among the employed general population. Being young, being single, feeling inadequately trained in communication and management skills and experiencing high levels of stress at work increase the risk of poor mental health for cancer clinicians and other senior doctors alike. Job satisfaction is important in that it appears to protect the mental health of cancer clinicians. Further work is required using a longitudinal approach to clarify risk factors. There is also a need to examine factors such as stress outside work that are likely to confer risk. We also need to understand how symptoms of poor mental health impair work performance. Having identified the risk factors, we need to begin to formulate interventions to improve the working lives of cancer clinicians through, for example, initiatives to improve communication and management skills, provide support to new consultants and facilitate teamwork.

[The century of work]

The new Series of papers on Occupational Hygiene, now that the hygienists have been qualified also as "competent physicians", intends to make a comparison between the present and the past conditions of the human work. The present work is characterized by high specialization, more sophisticated technologies and continuous evolution, although in Italy we have consider a drop of the general occupational rate. According to such a situation, Italy must make alliance with the other countries, because, due to the globalization, the occupational problem has overcome the domestic borders.

[Safety problems of occupational activity during alcoholic intoxication]

It has been established that work efficiency of persons occupied by machine operating duties degrades markedly under the action of an acute alcoholic intoxication--less on real machines and more on simulators and when operating simple technical devices. Work efficiency degradation is manifested by the task execution time increase (to a lesser degree) and by erroneous action quantity increase after taking alcohol, i.e. by work reliability decease. Most heavily it is manifested during the first 0.7-1.5 hr. After taking alcohol. And direct work efficiency index is usually improved 12-16 hr. after taking alcohol. Increase of erroneous action quantity is caused probably by a series of physiological, psychophysiological and psychological changes in the condition of a man under the action of alcohol. Time of the day when the activity takes place after taking that dose of alcohol is practically non valid for changing work efficiency index.

Integrated job analysis: a technique to document job activities and to identify occupational risk factors and modes of remediation and accommodation

Integrated job analysis is a form of job evaluation that considers cognitive, physical, and environmental factors related to occupational performance, assessment, and rehabilitation. First, the analysis describes cognitive factors that determine worker interactions with data, people, and things and educational and training requirements. A task description is provided and tools used are identified, along with job physical requirements, environmental conditions, and personal protective equipment needs. Supplementary information is elicited to describe the environment, task requirements, workstations, and work areas. Based on this information, preliminary recommendations are made for abating occupational hazards, and accommodations for alternatively-challenged individuals are identified. The value of this approach is in the detailed documentation of all occupational components regarding a specific job classification, which can then guide the development of meaningful preplacement and periodic medical examinations, physical agility tests, training criteria, rehabilitation, and return-to-work regimens.

Depressive symptoms, satisfaction with health care, and 2-year work outcomes in an employed population

OBJECTIVE

The relationship of depressive symptoms, satisfaction with health care, and 2-year work outcomes was examined in a national cohort of employees.

METHOD

A total of 6,239 employees of three corporations completed surveys on health and satisfaction with health care in 1993 and 1995. This study used bivariate and multivariate analyses to examine the relationships of depressive symptoms (a score below 43 on the Medical Outcomes Study Short-Form Health Survey mental component summary), satisfaction with a variety of dimensions of health care in 1993, and work outcomes (sick days and decreased effectiveness in the workplace) in 1995.

RESULTS

The odds of missed work due to health problems in 1995 were twice as high for employees with depressive symptoms in both 1993 and 1995 as for those without depressive symptoms in either year. The odds of decreased effectiveness at work in 1995 was seven times as high. Among individuals with depressive symptoms in 1993, a report of one or more problems with clinical care in 1993 predicted a 34% increase in the odds of persistent depressive symptoms and a 66% increased odds of decreased effectiveness at work in 1995. There was a weaker association between problems with plan administration and outcomes.

CONCLUSIONS

Depressive disorders in the workplace persist over time and have a major effect on work performance, most notably on "presenteeism," or reduced effectiveness in the workplace. The study's findings suggest a potentially important link between consumers' perceptions of clinical care and work outcomes in this population.

[Evolution of work duties in manufacturing activities]

The present work deals with duties' evolution according to the aspect of the investment's increase in facilities and equipment for employ, of industry-wide agreement, of cost accounting, of added value, of plant lay-out, of job competence and of production technologies. The mutual relation between duties and risk of cumulative trauma disorders is studied in qualitative and quantitative way making use of active and waiting labour time allotment during the labour cycle, rest and fatigue factor, labour losses, collective and individual breaks, high repeated work and worked items' variability. In conclusion the paper presents elements and examples about investments in automation and organisation with relay-out.

[Shift work and health]

Shiftwork, in particular night work, causes disruption of biological rhythms, perturbation of social and family life, with a negative influence on performance efficiency, health and social well-being. Deterioration of health can manifest in the short-term as sleep disorders, jet-lag syndrome and accidents; in the long term there is an increased risk of gastrointestinal, psychoneurotic and cardiovascular diseases, and impairment of the female reproductive function. The evaluation of a worker's fitness for shift and night work should be strictly connected with a careful job analysis, as the primary requisite is to arrange shift schedules according to ergonomic principles and to assure suitable compensative measures. Occupational health physicians should advise shiftworkers about proper coping strategies and carefully evaluate health disorders with absolute or relative contraindications. Health checks should be aimed at detecting early signs of intolerance and their frequency should be set in relation to specific working conditions, individual characteristics, and social factors known to influence tolerance to shift work.

How the Japanese work

The Japanese do not work harder or even use different approaches so much as they aim for a different result--one that balances process and results and extends the definition of quality beyond the product itself to include cost and convenience to the customer as well. Ten methods of the Japanese kaizen culture of work are presented with applications and contrasts to American dentistry.

Some thoughts about the past and future of pathology workforce

Comprehensive information on pathology workforce is currently not available. Prudent planning for pathology Graduate Medical Education (GME) requires more timely data than presently exist. In addition, we lack understanding of workforce kinetics in academic pathology which often serves as a buffer in times of surplus. Although the heads of community hospital and private laboratory groups control the majority of decisions regarding pathology workforce, a database of these decision-makers does not exist. However, information from the most recent published sources strongly suggests that a significant surplus already exists. Furthermore, this position is supported by earlier unpublished work from the 1994-1995 Conjoint Committee on Pathology Enhancement (CCOPE) surveys.

[Hygienic aspects of application of the resolution, "Certification of workplaces according to work conditions"]

The authors summarize experience of using "Act on procedure of working environment assessment at workplace". The authors analyze drawbacks of main documents used in assessment of working environment at workplace.

[Recommendations and notes for Manual RP 2.2.-013-94, "Hygienic criteria in the evaluation of work conditions according to indicators of harmfulness and risks of industrial environment factors and hardness and intensity of the work process"]

Some modifications need to be set in Classification of work conditions, adopted in Manual R rho 2.2.013-94 "Hygienic criteria to evaluate work conditions through occupational hazards and jeopardy, work hardness and intensity". We suggest to modify maximal allowable levels of general vibration, local vibration and infrasound. A recommended formula characterizes total vibration dose received through exposure to several factors, calculates work duration in accordance with all acting hazards.

[Quality of work and absenteeism: lower or higher in elderly workers?]

Data of the Quality of Life Surveys 1990-1993 (n = 9969) were used to examine if and to what extent elderly workers differ from younger workers with regard to perceptions of the quality of work, especially the workload, and to the percentage absence due to sickness. Adjusted for occupational level, educational level and sex, persons aged 60-64 were characterised by either a substantially lower or a similarly perceived workload as compared to those aged 55-59. Subsequently, adjusted for the occupational level, educational level, sex and perceived workload, a substantial lower rate of absenteeism was found for persons aged 60-64. To a certain extent comparable results were found in the comparison of persons aged 55-59 with those aged 45-54. Based on the low grade of job participation of the elderly, it is proposed that these favourable figures support the notion of an age-related healthy-worker selection in the Netherlands.

Work performance of Chinese cycle haulers: controlled field experiments in normal work conditions

Forty-five male Chinese cycle haulers performed a controlled field experiment under mild winter conditions. The objective was to gain insight into factors that affect work performance. Each man hauled the same 481-kg load around a Beijing street course of 14.18 km. The experiment was a measured sample of the same work they do routinely, on the same roads, using similar human powered hauling cycles (modified only enough to carry observers and instruments). The course was completed at a mean speed of 10.4 kph and mean time of 84.2 min. While there was considerable variation in individual pace and in pace change during work, the haulers performed at relatively high output in reference to their capacities. Mean heart rate was 156.8 +/- 16.1 bpm, 83.9% of maximum. The men had average body build and were average in size for the general Chinese population (X stature = 169.7 cm) although they showed relatively high aerobic capacity (determined in laboratory tests). Performance levels during experiments appear to match habitual work patterns, and self-pacing emerged as a major behavioral finding of this research. Speed, a primary index of job performance, showed significant correlation to heart rate, VO2max, variation in windchill, self-reported health and other variables, with a multiple regression coefficient of 0.811. Similar patterns were seen for heart rate relative to speed, except that physical size, education, and other behavioral variables were also predictors.

Women, work, and well-being: the importance of work conditions

This study investigates the role of work conditions in mediating the effect of employment status on married women's psychological well-being. Employed wives and full-time homemakers are compared on characteristics of their daily work activities and the consequences of these work conditions for psychological well-being. Using data from a national survey of employed wives and homemakers, I find that full-time housework involves more autonomy, more interruptions, greater physical effort, more routine, fewer time pressures, and less responsibility for matters outside one's control than paid work. Differences in work activities between employed wives and homemakers also have direct implications for well-being. Two of the dimensions examined--the extent to which the worker is responsible for things outside her control, and the amount of routine entailed--are associated with greater depressive symptoms among women, regardless of work status. It appears that, as compared to employed wives, full-time homemakers benefit from having less responsibility for things outside their control. Employed wives appear to benefit from having less routinized work than homemakers. As a result of the different configurations of their work characteristics, employed wives and homemakers experience on average similar levels of depressive symptoms.

The design of shift systems

All shift systems have advantages and drawbacks. There is no single 'optimum shift system' which can be used in industry or commerce at all work places. However, there are shift systems which are more favourable, and others which are less favourable, in the context of physiological, psychological, and social recommendations for the design of shift systems. This article discusses the following recommendations: (1) Nightwork should be reduced as much as possible. If this is not possible, quickly rotating shift systems are preferable to slowly rotating ones. Permanent nightwork does not seem to be advisable for the majority of shiftworkers. (2) Extended workdays (9-12 h) should only be contemplated, if the nature of work and the workload are suitable; the shift system is designed to minimize the accumulation of fatigue; there are adequate arrangements for cover of absentees; overtime will not be added; toxic exposure is limited; and if it is likely that a complete recovery after work and a high acceptance of the working time arrangement are possible. (3) An early start for the morning shift should be avoided. In all shiftsystems flexible working time arrangements are realizable. The highest flexibility is possible in 'time autonomous groups'. (4) Quick changeovers (e.g., from night to afternoon shift at the same day or from afternoon to morning shift) must be avoided. The number of consecutive working days should be limited to 5-7 days. Every shift system should include some free weekends with at least two successive full days off. (5) The forward rotation of shifts (phase delay, clockwise rotation) would seem to be recommendable at least in continuous shift systems. Besides the design of a shift system, implementation strategy is of particular importance for the acceptance of the shift system.