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Structural and Intermediary Determinants of Social Inequalities in the Subjective Well-being of the European Working Population. A
Relational Approach
Deborah De Moortel, Christophe Vanroelen Vrije Universiteit Brussel
Background: No consensus exists about the socioeconomic patterning of subjective well‐being (SWB) in the European working population: Some studies report a worse well‐being in lower socioeconomic positions, while others report signs of reverse associations or insignificant results. Reasons for
contradictory findings might be the lack of conceptual foundation of the socioeconomic measures and the limited adequacy of a gradient‐approach in social inequality research of SWB.
Aim: Relational social class indicators will be used to examine social inequalities in SWB, because of their capacity to uncover a set of structural mechanisms that are associated with health inequalities. In addition, we investigate whether the psychosocial work environment, employment conditions and relations act as intermediary determinants of social inequalities in SWB.
Method: Data from the European Social Survey Round 2 and 5 is analysed. SWB is assessed by the WHO Well‐being Index. Social class position was measured with the indicators of E.O. Wright.
Models were generated for men and women separately using three‐level multilevel modelling.
Results: We found social class inequalities in the SWB of the European population for both men and women: Managers reported better SWB than supervisors and workers. Supervisors reported a worse SWB than managers, but not than workers. Non‐supervisory non‐managerial workers reported the worse SWB. An unfavourable psychosocial work environment and low quality employment
conditions mediated the relation between social class and SWB. However, the strength of the relation between social class and SWB is only substantially weakened if the effect of employment relations on SWB is being controlled in the male sample.
Conclusion: Relational indicators of social class are related to the SWB of European employees, and provide a complementary approach to stratification indicators in social epidemiology. From a policy perspective better employee SWB could be achieved by a shift in power and social relations among social classes. Furthermore, our results also underscore the importance of the psychosocial work environment, employment conditions and relations if we want to improve the SWB of the European employees.
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Does stress at work comply with pregnancy?
Ann Dyreborg Larsen1, Harald Hannerz1, Carsten Obel2, Vivi Schlünssen3, Mette Juhl4, Ane Marie Thulstrup3, Berit Hvass Christensen3, Jens Peter Bonde5, Karin Sørig Hougaard1
1The National Research Centre for the Working Environment, Copenhagen, Denmark, 2Department of General Medicine, Institute of Public Health, University of Aarhus, Denmark, 3Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark, 4The Research Unit Women's and Children's Health, Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark, 5Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
Introduction: The discussion of occupational stress as a potential determinant of ill health rarely extends to the pregnant woman and her child. Denmark boasts the second highest employment rate for women in Europe and at the same time a high proportion of Danish women reports difficulties in completing their work tasks. Studies of bereavement and anxiety in pregnancy and studies in animals indicate that stress may affect fetal development, but few studies have been devoted to the
occupational setting. The present study was initiated to shed some light on the effects of maternal psychosocial job strain for pregnancy and the child.
Methods: The analyses took advantage of the Danish National Birth Cohort (DNBC), including more than 100,000 pregnancies during 1996‐2001. Mothers participated in interviews during and after pregnancy. Exposure to work‐related strain was assessed early in pregnancy from two questions on job control and demand as proxy for the two dimensions in Karasek’s job‐strain model, placing the women into one of the four job strain categories: high strain, low strain, active, and passive. Outcome information was extracted from the Danish Medical Birth Register, apart from asthma and atopic dermatitis variables which were based on maternal self‐reports when the children were 18 months and 7 years of age. Data were analyzed by multinomial and ordinary logistic regression.
Results: Maternal high strain at work was not associated with preterm birth, small for gestational age, congenital malformations or childhood asthma, as compared to women exposed to low strain.
Children of high strain mothers had lower odds for being large for gestational age at birth and a 15 % increase in the odds of ever having atopic dermatitis at the age of seven.
Conclusion: The findings suggest that occupational strain during pregnancy may influence fetal growth and immune development. At present, Danish regulations for working pregnant women hardly mention stress. The issue of occupational stress as a potential player in fetal programming ought to be explored to ensure that women may attend work in pregnancy without compromising the wellbeing of their child.
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Level and Predictors of chronic Stress in nursing students:
Depression, physical symptoms and pathological eating
Christoph Augner
IGGMB - Health Research Institute, University Clinics of the Paracelsus Medical University, Salzburg, Austria
This study aimed to assess level and predictors of chronic stress (CS) in nursing students. In this cross sectional design 131 students of an Austrian nursing school, aged 17 to 48 years (M=21.15; SD=4.89) completed an self‐administered questionnaire that included chronic stress, depression, physical symptoms, pathological eating and other psychological variables. The sample had a high stress score
(M=23.14, SD=9.37). High frequency of physical symptoms (OR=7.27, 95 % CI:2.45‐21.58) and high depression score (OR=5.54, 95 % CI:1.94‐15.79) were significant predictors for chronic stress in students. Pathological eating and working hours were associated with chronic stress but remained insignificant in regression analysis. Results indicate high chronic stress of nursing students and its association with psychological and physical well‐being. Workplace health promotion has to address these issues and to start during education.
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Who cares about physiotherapists, psychologists or social workers?
Well-being scores of non-medical/non-nursing hospital staff and the interplay of satisfaction with different dimensions of the psychosocial work environment and working conditions
Birgit Susanne Lehner, Holger Pfaff, Lena Ansmann, Christoph Kowalski
Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Germany
In both health care and occupational health research, insufficient attention is being paid to non‐
medical/non‐nursing hospital staff. The present investigation examines the subjective well‐being of physiotherapists, psychologists, and social workers working in breast cancer centers. Furthermore, the investigation looks in detail at how psychosocial factors, i.e. specific job demands and job satisfaction are related with well‐being within these three professional groups.
An employee survey was conducted in 2010/11 in certified breast cancer centers in the state of North‐
Rhine‐Westphalia, Germany. Data were collected using a standardized written questionnaire. In total, 49 hospitals participated (response rate: 51 %). In the heterogeneous sample of the non‐medical/non‐
nursing hospital staff (n = 316), physiotherapists (n = 42), psychologists and psychotherapists (n = 31), and social educators/social workers (n = 39) were the largest vocational groups. First, subgroup analyses and descriptive statistics were performed. Second, relationships between well‐being scores, job demands and satisfaction for the three subgroups were analyzed using intercorrelations.
The mean well‐being score of physiotherapists was 3.34 (SD = 0.77; range 0‐5). The mean of job satisfaction was 5.13 (SD = 0.89; range 1‐7). The correlation analysis showed that neither general satisfaction with working conditions nor job demands were significantly correlated with well‐being in this subgroup.
In the group of psychologists and psychotherapists, mean well‐being score was 3.54 (SD = 0.70; range 0‐5). The mean of job satisfaction was 5.74 (SD = 0.70; range 1‐7). The correlation analysis showed a significant intercorrelation between job satisfaction and well‐being (r = .56, p < .01), and between job demands, specifically workload and time pressure, and well‐being (r.‐.45, p < .05).
Mean well‐being score of social workers was 2.79 (SD = 1.30; range 0‐5). The mean of job satisfaction was M = 4.63 (SD = 1.05; range 1‐7). There was a significant intercorrelation between job satisfaction and well‐being (r = .49, p < .05).The mean scores of perceived well‐being are significantly different between the three subgroups (F = 5.43, p < .01).
When compared, the results of the three groups showed a difference in their well‐being scores. Job satisfaction may not play a decisive role for well‐being in all subgroups, as well as specific kinds of job demands. These results provide preliminary information. Further analyses with larger sample sizes
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are needed in order to allow additional conclusions about the differences in well‐being between non‐
medical/non‐nursing professional subgroups.
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What influences job satisfaction for staff supporting patients using insulin pumps in the community?
Lin Perry1,2, Janet S Dunbabin1, Katherine S Steinbeck3, Julia M Lowe4, Helen Phelan5
1University of Newcastle, Australia, 2University of Technology Sydney, Australia, 3Paediatrics & Child Health, Children's Hospital, Westmead, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Australia, 4Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 5Hunter New England Health, NSW Ministry of Health, Australia
Background: Approximately 10 % of people with Type 1 Diabetes in Australia use ‘insulin pumps’, with numbers rising and almost half under 25 years of age [AIHW 2012]. Insulin pumps allow greater lifestyle flexibility and diabetes control, but at a cost. For the healthcare practitioner, this is in terms of level of education, training and expertise required, and time to deliver complex care. For effective long term use, consumers need to be well supported and maintain links with a multi‐disciplinary diabetes team. However, in this specialist field and particularly in non‐metropolitan areas,
practitioners are thinly spread, making staff continuing engagement and job satisfaction a challenge.
Aims: This study explored factors supporting and deterring the job satisfaction of diabetes healthcare practitioners working in the specialist field of patients using insulin pumps.
Methods: This qualitative study used telephone interviews. Participants were multi‐disciplinary healthcare practitioners of one public Diabetes Service in northern New South Wales. Recruited by snowball sampling, participants worked in a city, country towns and rural settings. A semi‐structured interview schedule was developed and piloted; interviews audio‐recorded, transcribed verbatim, and analysed using Framework Analysis (Ritchie & Spencer 1994). Recruitment continued to data
saturation.
Results: We interviewed 9 specialist physicians/ endocrinologists, 4 General Practitioners, 10 nurses, 3 dietitians and 1 manager. 17 were female; 15 city‐based.
Positive factors included keeping in touch, and seeing patients do well.
Collegiality was crucial: sharing the space with private practitioners, commercial and charitable organisations to share the load. They stressed education and updating for themselves, in this fast‐
moving field, and appreciation of shared expertise. Mentoring was essential, benefiting both mentors and mentees.
Negative features were the frustrations and hassles of administration ‐ the healthcare bureaucracy, subsidy and private healthcare regulations. Managers poorly recognised the time commitment of this relatively small but increasing patient group; the enduring ‘mystique’ (and non‐specialist staff
ignorance) of pumps made communication outside their specialty difficult. The ‘theory‐practice gap’
between ideal and real services was evident.
Conclusions: New service models are required, addressing issues of this study to support expert clinician wellbeing and enable them to continue to provide care to this growing caseload.
Australian Institute of Health and Welfare 2012. Insulin pump use in Australia. Diabetes series no.18.
Cat. no. CVD 58. Canberra: AIHW.
Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In Analyzing Qualitative Data. Bryman A, Burgess RG (Eds). London: Routledge; 1994.
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The interrelationships between individual, contextual and processual constructs and stress and wellbeing among psychologists
Ingrid Schéle, Esther Hauer, Stefan Holmström, Erik Lundkvist, Andreas Stenling, Daniel Eriksson Sörman, Susanne Tafvelin
Umeå University, Sweden
In Sweden, sick‐leave >14 days due to maladaptive stress reactions is considerably more common among psychologists (18.3/1000) than among the employed population as a whole (10/1000). Some of those psychologists are new to the profession, which indicates the need to research the individual, contextual and processual factors that precede their professional career besides their current workplace.
We propose a project consisting of an initial alumni survey followed by a longitudinal study following several cohorts of students over their five year education to at least three years after graduation. The ultimate aim is to design interventions and curricular changes that over time will contribute to the reduction of sick‐leave among psychologists. Among our overarching research questions are: What stories do these individuals tell about the onset of their stress? Do individual factors related to high achievement, perfectionist strivings or self‐efficacy issues make this group of students/professionals vulnerable to stress? To what extent do psychological needs, satisfaction, motivation, recovery and physical activity prevent stress‐related health issues and promote
wellbeing? How do positive/negative experiences of the psychosocial work environment and stress as a student influence subsequent experiences of the psychosocial work environment and stress‐related issues as a professional psychologist? What is the relation between how prepared the students perceive themselves to be for their professional role and their self‐reported stress, general health and well‐being? What are the longitudinal effects of perceived stress on both objective and subjective measures of cognitive functioning? We intend an approach combining interview and longitudinal self‐reported data with repeated cognitive testing. The interviews will focus on how and when what levels of stress are established and/or normalized among the students along with their anticipations and possible apprehensions regarding their career as psychologists and their perceived preparedness for said career. The longitudinal surveys will focus on establishing baseline as well as changes over time in individual factors, perceived psychosocial environment, stress, health and wellbeing. The proposed study will render insight into the interrelatedness between individual, contextual and processual factors and wellbeing, extended knowledge of the transition from student to psychologist and a base for interventions aimed at reduced stress and increased wellbeing among students as well as professional psychologists.
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The influence of local company measures on employees’ work ability and work engagement to support older workers to continue working
Laudry van der Meer TNO, Netherlands
Objectives: To investigate the relation between work ability and work engagement and the use of local company measures that aim to support older workers to continue working, and to study the influence of these measures on work ability and work engagement.
Methods: In total 6.922 employees aged 45‐64 years who participated in the first three waves of the Study on Transitions in Employment, Ability and Motivation (STREAM) were included. Participants yearly filled out an online questionnaire. Local company measures included ‘reduced number of hours of work per week’ because of age and ‘exemption of evening or night work’ because of age.
Logistic regression analyses were applied to study the relation between work ability and work engagement with the use of local company measures, and linear regression analyses to study the influence of these measures on work ability and work engagement.
Results: A higher work ability at baseline predicted a lower likelihood to start using the local
company measure ‘reduced number of hours per week’ after one year of follow‐up (OR 0.91 (95 % CI 0.83‐0.98)). Work engagement was not significantly related with the use of local company measures. In turn, employees who started using the local company measure ‘reduced number of hours of work per week’ between baseline and one year of follow‐up reported a significantly lower work ability after two years of follow‐up (B ‐0.28 (‐0.47‐ ‐0.08)), whereas employees who started using the company measure ‘exemption of evening and night work’ experienced a higher work engagement (B 0.23 (0.07‐
0.39)).
Conclusion: The use of policy measures that aim to support a prolonged working life in older employees may not (always) be related to their work ability or work engagement. The influence of these measures on work ability and work engagement might to depend on the specific measure used.
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Assessing stakeholders' views and practices on the prevention and management of sexual harassment against migrant domestic
workers: The case of Greece
Maria Papadakaki, Lina Pelekidou, Nikoleta Ratsika, Maria Papanikolaou, Joannes Chliaoutakis
Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Greece
Background: Migrant domestic workers are more vulnerable than local people to abusive situations due to the lack of local language skills, the low awareness of the local laws and customs, the
inadequate access to appropriate jobs and the limited knowledge of their rights.
Aim: The current study is part of a European project funded by the DAPHNE_III programme (JUST/2011/DAP/AG/3272) and is carried out in five European countries (Greece, Cyprus, Austria, Sweden and Slovenia) with the involvement of experts from the Netherlands. The current
presentation reports on the Greek study aiming to identify key national priorities through exploring
the stakeholders’ views, activities and suggestions about the problem of sexual victimization of migrant domestic workers.
Method: A mapping process using a snowball technique was employed to identify stakeholders active in the area of prevention and management of violence against migrant domestic workers. A sample of 17 stakeholders was selected using a maximum variation sampling based on the following criteria: a) the stakeholders’ mission, b) the target group, c) the type of organization and d) the population coverage. A semi‐structured interview guide was used for the data collection, which involved 8 thematic areas and explored issues such as the organization’s involvement in the prevention and management of sexual violence against migrant domestic workers, response
strategies, best practices, barriers, challenges and recommendations for an improved response. Data were analyzed using thematic analysis.
Results: The Greek sample consisted of stakeholders with the following characteristics: 5
governmental and 12 non‐governmental organizations, 2 operating at national level, 8 at regional level and 7 at local level. Several barriers were identified by the stakeholders affecting the prevention and management of the problem such as: a) migrants’ vulnerability, b) gaps in legislation, c) lack of specialized services, d) low awareness, e) low capacity, f) financial restrictions.
Conclusion: Policy makers should consider introducing recording tools, guidelines and education for professionals, developing free services for migrant domestic workers, improving the legislative framework for victimized domestic workers as well as increasing the funding of the supporting agencies.
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Meta-analysis of risk factors for secondary traumatic stress disorder in exposed professionals
Jennifer M. Hensel1, Carlos Ruiz2, Caitlin Finney1, Carolyn S. Dewa3
1University of Toronto, Ontario, Canada, 2Centre for Research on Employment and Workplace Health, Toronto, Ontario, Canada, 3Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
Background: Secondary traumatic stress (STS), a syndrome that parallels post‐traumatic stress disorder (PTSD) in response to indirect or secondary exposure to traumatic material, has been somewhat critiqued in the literature. However, a growing evidence base supports its existence and the impact it has on services delivered, workplace function and personal well‐being. Of note, in the most recent revisions to the Diagnostic and Statistical Manual (DSM), secondary exposure among professionals has been highlighted as a criterion stressor for the diagnosis of PTSD. Many studies have examined STS risk factors, however the empirical literature is diverse and often studies consist of small samples limiting the conclusions that can be drawn.
Aim: The aim of this study was to review the literature on risk factors for STS (published and unpublished) and conduct a meta‐analysis of findings.
Method: Thirty‐four published articles and 34 dissertations were included in the meta‐analysis, allowing for evaluation of 13 risk factors. Random effect sizes were calculated for each risk factor. Moderation was evaluated with mixed effects models for 4 moderators: publication type, outcome measure, year published and percentage of females in sample.
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Results: Younger age, less experience, higher trauma caseload, personal history of trauma, a personal history of trauma the same as the clients, being in personal therapy, lower self‐efficacy, low quality supervision, low social support and low work support all significantly predicted higher STS, however mean effect sizes were small ranging from ‐0.06 (experience) to ‐0.23 (quality of supervision). The largest effect size was observed for emotional involvement (0.31), however it was not significant due to a small number of studies and a large amount of between study heterogeneity. Moderator analyses yielded no significant findings.
Conclusions: Risk factors for STS are similar to risk factors for PTSD, with overall small effect sizes. Inadequate support, high caseloads, personal trauma experiences and emotional involvement are important factors to monitor in high risk professional groups.
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Are Electronic Medical Records Affecting Worker Wellbeing in our Medical Residents?
Lisle Hites
The University of Alabama at Birmingham School of Public Health, United States
The use of Electronic Medical Records (EMR) continues to grow at an accelerated rate. While the utility and potential benefits of EMR have been well explored, there is also a dark side that has appeared as the systems are put into practice. In teaching hospitals across the world where EMRs are instituted, the task of entering data during clinical rounds (when physicians are seeing patients) has become the responsibility of recently graduated medical students who are still in their residency phase of their education. Given the immense time drain that comes from high throughput clinical patient rounds (a single physician or attending physician may see 50 or more patients in a given day) the workload of inputting data into EMRs becomes the responsibility of the residents. This practice detracts from their education, adds an undue burden onto those young doctors, and in the minds of many, manifests as workplace bullying and aggression, strongly degrading worker wellbeing. The proposed poster will highlight a study conducted at the University of Alabama at Birmingham School of Medicine by the School of Medicine and School of Public Health Faculty. This study consisted of a survey assessment delivered to teaching Faculty (attending physicians) and medical residents in various stages of their residency programs, as well as a series of focus groups with residents and physicians. The data finds that there is much evidence that not only are residents being unfairly treated, but that there is a cost‐benefit case to be made for employing medical scribes to take the place of the residents in performing EMR duties.
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Psychological and social work factors as predictors of mental distress and positive affect: a prospective study
Live Bakke Finne1,2, Jan Olav Christensen1, Stein Knardahl1
1Department of work psychology and physiology, National Institute of Occupational Health, Oslo, Norway
2Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
The research on work‐related mental health has traditionally focused on determinants for ill‐health like depression, anxiety, mental distress and burnout. In the recent years the health‐promoting