A framework for participatory work environment interventions in home care - success factors and some challenges.

BACKGROUND: Home care is beset with work environment issues and high staff turnover, while research concerned with interventions to improve the work environment is sparse. Few of the existing interventions apply a participative approach, despite this being associated with more positive outcomes and sustainable change. This paper presents a framework, rooted in action research and action learning, for participatory work environment interventions in home care, and demonstrates how this framework has been implemented in four Swedish home care organizations. METHODS: The framework has three phases (pre-intervention, intervention planning and intervention implementation) and consists of cycles of action and reflection in three constellations: a group of researchers, a reference group with labour market organization representatives and home care managers, and intervention work groups in the home care organizations. The work was documented and analysed with focus on the realization of the framework and challenges that were met on the way. The interventions were evaluated using a pre-/post-test questionnaire design. RESULTS: Parts of the framework were successfully implemented. The pre-intervention phase and the intervention planning phase, with intervention work groups, worked well. All four groups identified one intervention relevant to their own context. However, only two of the proposed interventions were fully implemented and evaluated. The high staff and management turnover, and the high rate of organizational changes made it impossible to evaluate the interventions statistically. Yet, data from open-ended questions in the post questionnaire showed that the two implemented interventions were perceived as successful. CONCLUSIONS: The participatory framework, presented in this paper, seems promising for work environment interventions in home care. The framework was designed to reduce the risk of known disturbances affecting the process in unstable organizations. Despite this, it proved challenging to execute the framework, and especially the interventions, due to changes happening at high speed. In the two cases where organizational changes were not dominating, the interventions were implemented successfully. While the prerequisites for participation and successful implementation could be improved somewhat, the main issue, the instability of the organizational context, is hard for researchers or the individual home care units to tackle alone.

Prevalence of exhaustion symptoms and associations with school level, length of work experience and gender: a nationwide cross-sectional study of Swedish principals.

BACKGROUND: While poor mental health and psychiatric disorders attributed to stressful work conditions are a public health concern in many countries, the health consequences of the occupational stress experienced by school principals is an understudied issue. Although current data is lacking, some research suggests that principals have a stressful work situation that eventually may lead to burnout and exhaustion disorder, thus negatively affecting the ability of principals to function as leaders. To gauge the situation in Sweden, and as a basis for future preventive actions, we examined to what extent principals displayed signs of exhaustion and whether the prevalence rates of exhaustion differed across school levels, length of work experience as a principal, and gender. METHODS: Principals (N = 2219; mean age 49 years [SD 7 years]; 78% women) working at least 50% in pre-schools, compulsory schools, upper secondary schools or adult education completed a cross-sectional web survey entailing two validated inventories: The Karolinska Exhaustion Disorder Scale (KEDS) and the Lund University Checklist for Incipient Exhaustion (LUCIE). Data was analysed using traditional non-parametric methods. Gender stratification achieved covariate balance when analysing school level and length of work experience. RESULTS: Altogether, 29.0% of the principals met the exhaustion criteria in KEDS. The prevalence rates for the four LUCIE-steps of increasing signs of exhaustion were: no signs of stress, 48.8%; weak signs of stress, 25.6%; clear signs of stress but no exhaustion, 15.4%; possible exhaustion disorder, 10.2%. Compared with male principals, female principals reported more signs of possible exhaustion disorder in both LUCIE and KEDS. School level was not associated with reports of exhaustion symptoms in neither LUCIE nor KEDS. Among male principals, length of work experience was associated with exhaustion symptoms in KEDS. CONCLUSIONS: A large group of Swedish principals working in pre-schools, compulsory schools, upper secondary schools or adult education displayed a symptomatology of signs of exhaustion that if sustained might lead to poor health. This observation suggests that education authorities, or other relevant stakeholders, ought to take some form of preventive action. However, effective combinations of individual, group, organisational, and/or societal preventive activities remain to be identified and tested.

Organizational and social work environment factors, occupational balance and no or negligible stress symptoms among Swedish principals - a cross-sectional study.

BACKGROUND: Few studies have assessed the mental health of principals, or studied associations with both organizational and social work environment factors and occupational balance. The purpose of the present study was therefore to investigate associations between supporting and demanding organizational and social work environment factors, occupational balance and stress symptoms in principals. METHODS: A total of 4309 surveys (2316 from the first round, 1992 from the second round), representing 2781 Swedish principals who had responded to at least one of two surveys, were included in the present study. The surveys include questions about socio-demographic factors, occupational balance, overtime work, and supporting and demanding organizational and social work environment factors, as well as questions about personal stress and exhaustion. Generalized Estimating Equations (GEE) models were used to specify a repeated measures model with a dichotomous outcome (binary logistic regression) and multiple independent factors. Data from two surveys were combined, taking into account dependent observations due to the fact that many study subjects had participated in both surveys. RESULTS: Associations were found between occupational balance (Q1: OR 2.52, 95% CI 2.03-3.15; Q2: OR 4.95, 95% CI 3.86-6.35; Q3: OR 9.29, 95% CI 6.99-12.34), overtime work (Once a week: OR 1.51, 95% CI 1.10-2.08; Sometimes a week: OR 1.31, 95% CI 1.03-1.66), supportive private life (OR 1.50, 95% CI 1.36-1.66), supportive colleagues at the leadership level (OR 1.24, 95% CI 1.14-1.36), supportive management (OR 1.17, 95% CI 1.07-1.28) and no or negligible stress symptoms. In addition, role demands (OR 0.72, 95% CI 0.63-0.83), having a container function (OR 0.72, 95% CI 0.64-0.82), collaboration with employees (OR 0.77, 95% CI 0.66-0.89), role conflicts (OR 0.75, 95% CI 0.66-0.89) and having a buffer function (OR 0.86, 95% CI 0.77-0.97) were associated with lower likelihood to rate no or negligible stress symptoms. CONCLUSIONS: The occupational balance of principals is strongly associated with no or negligible stress symptoms, and thus is a promising venue for promoting well-being. Improvements should be made to several factors in the organizational and social work environments to improve principals' chances of having occupational balance, and therefore better mental health.

Picking low hanging fruit - A scoping review of work environment related interventions in the home care sector.

Home care for elderly people is an important part of the social welfare system. The sector employs many people, especially women, and work environment issues are common. This review explores the scientific literature on organizational interventions that target the home care work environment. Altogether, 16 studies of varying quality met the inclusion criteria. The interventions identified involved organizational change, education and training, digitalization and scheduling. Many interventions were concerned with changing specific behaviors or with introducing new technology rather than tackling complex issues such as sick leave, stress or gender inequality. Employee participation increased the likelihood of success.

Comparison of exhaustion symptoms in patients with stress-related and other psychiatric and somatic diagnoses.

BACKGROUND: Several rating scales assessing stress-related symptoms of exhaustion have emerged in recent years. However, more knowledge is needed about the performance of these rating scales in patients with stress-related disorders as well as in other patient groups. With the recently developed Karolinska Exhaustion Disorder Scale (KEDS), we compared symptoms of exhaustion in different patient groups that were sorted according to diagnosis. METHODS: Patients were sampled consecutively from departments of occupational medicine (DOM) at three Danish hospitals. The total study group comprised 698 care-seeking patients (487 women). Patients with stress-related diagnoses (n = 217; the International Classification of Diseases [ICD]-10 code F43: reaction to severe stress and adjustment disorder) were compared to a diverse group of patients with a range of somatic diagnoses (n = 338) and to patients with other psychiatric diagnoses (n = 143), including subgroups with major depression disorder (n = 34; F32 and F33) and problems related to employment and unemployment (n = 99; Z56). The data were analysed using linear mixed models with the SPSS statistical program. RESULTS: The mean KEDS sum score in patients with stress-related diagnoses (29.3; SD = 8.0) was significantly higher than in patients with other psychiatric diagnoses (25.9; SD = 9.5) and in patients with somatic diagnoses (17.6; SD = 10.8). The subgroup with a major depression disorder had high mean KEDS sum scores (31.4, SD = 8.1), similar to patients with stress-related diagnoses, while the mean KEDS sum score in patients with problems related to employment and unemployment (Z56) was 23.5 (SD = 9.0). Young and old patients scored similarly on KEDS, but in patients with somatic diagnoses, female patients scored significantly higher than male patients. CONCLUSION: The symptoms of exhaustion measured with KEDS were higher in patients with stress-related diagnoses and major depression disorder than in patients with somatic diagnoses. The intermediate level of the symptoms of exhaustion that were associated with problems related to employment and unemployment, (Z56) compared to the lower level of the symptoms with somatic diagnoses, suggests that KEDS might be useful in detecting mild, prodromal states of exhaustion. This needs further investigation.

Burnout among school teachers: quantitative and qualitative results from a follow-up study in southern Sweden.

BACKGROUND: Teachers are at high risk of stress-related disorders. This longitudinal study aimed to (a) identify which occupational, sociodemographic and life-style factors and self-efficacy at baseline that were of importance for burnout, (b) explore associations between changes in the studied factors versus changes in burnout, and (c) by interviews increase the understanding of perceived job demands among teachers. METHODS: A cohort of 310 Swedish teachers in school-years 4-9 responded to a questionnaire of occupational, sociodemographic and life-style factors, self-efficacy and burnout, at baseline and at follow-up (mean 30 months later). A combined measure with four levels of burnout was crafted, based on exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey). Quantitative data were analysed with multiple ordinal regression, and qualitative data were analysed with content analysis of interview responses from a subgroup of the teachers (n = 81). RESULTS: The occurrence of high burnout (level 2 and 3 combined) were similar at baseline and follow-up (14% vs. 15%). However, many teachers fluctuated between the levels of burnout (28% increased and 24% decreased). Burnout at baseline was of importance for change of work or being off duty at follow up. In the multi-exposure model, low self-efficacy [OR 0.42; CI 0.26-0.68] and high job demands [OR 1.97; CI 1.02-3.8] were the strongest explanatory variables. Low self-efficacy remained as the strongest explanatory factor after adjustment for burnout at baseline. Increased job demands during follow-up was associated with an increased level of burnout [OR 3.41; CI 1.73-6.69], whereas increased decision latitude was associated with a decreased level of burnout [OR 0.51; CI 0.30-0.87]. Two major categories of demands emerged in the qualitative analysis; i.e. too high workload and a sense of inadequacy. CONCLUSIONS: A substantial proportion of teachers showed signs of burnout at both occasions. Low self-efficacy and high job demands was of importance for burnout, and changes in burnout was further associated with changes in decision latitude. The results points to the need of actions on individual, organizational and a societal levels.

A role for septin 2 in Drp1-mediated mitochondrial fission.

Mitochondria are essential eukaryotic organelles often forming intricate networks. The overall network morphology is determined by mitochondrial fusion and fission. Among the multiple mechanisms that appear to regulate mitochondrial fission, the ER and actin have recently been shown to play an important role by mediating mitochondrial constriction and promoting the action of a key fission factor, the dynamin-like protein Drp1. Here, we report that the cytoskeletal component septin 2 is involved in Drp1-dependent mitochondrial fission in mammalian cells. Septin 2 localizes to a subset of mitochondrial constrictions and directly binds Drp1, as shown by immunoprecipitation of the endogenous proteins and by pulldown assays with recombinant proteins. Depletion of septin 2 reduces Drp1 recruitment to mitochondria and results in hyperfused mitochondria and delayed FCCP-induced fission. Strikingly, septin depletion also affects mitochondrial morphology in Caenorhabditis elegans, strongly suggesting that the role of septins in mitochondrial dynamics is evolutionarily conserved.

Reasons for using workplace wellness services: Cross-sectional study among 6000 employees.

AIMS: While workplace wellness services are proactively established to improve well-being and reduce sickness absence, knowledge of reasons for using these services remains sparse. This study investigates which factors determine use of an in-house wellness service at a large organization (the Danish Police) with several departments in different geographical locations. METHODS: All potential users of the Wellness service ( n = 15,284) were invited to respond to a cross-sectional questionnaire. Of 6060 eligible respondents, 58% had used the service at least once (any use) and 17% had used the service at least three times (frequent users). Two items assessed the frequency of statements of justifications for using or not using the Wellness service. Associations between 32 demographic and psychosocial variables and use of the Wellness service were evaluated with unadjusted bivariate logistic regression analyses. RESULTS: The two primary justifications for using the Wellness service were: to get a blood pressure assessment (37%) and to rehabilitate injury (26%). The two most common justifications for not using the Wellness service were: no perceived need (44%) and already physically active (34%). Of the 32 demographical and psychosocial variables included, 28 were associated with any use and 24 with frequent use. CONCLUSIONS: Use of the Wellness service appears to be driven by a complex configuration of factors that resist easy translation into practical advice. Non-participation was accounted for in terms of both positive and negative barriers. Use of the service for purposes of primary prevention and health promotion was, relatively speaking, lagging behind.

A cohort study on self-reported role stressors at work and poor sleep: does sense of coherence moderate or mediate the associations?

AIM: The aim of the present study was to examine the bidirectional associations between subjective role ambiguity and role conflicts at work, respectively, and self-reported sleep 2 years later. In addition, we also examine whether sense of coherence (SOC) moderate or mediate the association between role stressors and poor sleep and between poor sleep and role stressors. METHODS: We used questionnaire data collected in 2006 and 2008 from the Workplace Bullying and Harassment cohort. In 2006, 3363 responded to the questionnaire and in 2008 1671 responded. In total, 1569 participants responded in both 2006 and 2008 to the questions on role stressors (in terms of role ambiguity and role conflicts at work) and sleep problems in both 2006 and 2008. Sleep problems were assessed with the awakening index (AWI) and the disturbed sleep index (DSI). Moderation and mediation analyses of the association were estimated using structural equation modelling. RESULTS: We found a prospective association between role stressors and sleep problems [beta values were 0.07 (95% CI 0.03-0.11) and 0.05 (CI 0.01-0.10) for DSI and AWI, respectively] when adjusting for sleep problems at baseline, age, sex, and life style factors (i.e. alcohol, smoking, and leisure time physical activity). SOC moderated the association showing that participants with lower SOC scores who reported higher role ambiguity reported sleep problems to a higher extent than participants with high SOC scores. SOC also mediated the association between role stressors and sleep problems. We also found support for sleep problems at baseline and role stressors 2 years later [DSI 0.04 (CI 0.00-0.08) and 0.15 (CI 0.09-0.21)] for role ambiguity and role conflicts, respectively. Similar results were observed for AWI. CONCLUSION: Subjective role stressors were prospectively associated with sleep problems. Yet, sleep problems could also prospectively predict subjective role stressors (i.e. reverse causation). The analyses also showed that SOC may be regarded as both a mediating and a moderating factor of the association between subjective role conflicts and poor sleep. We found that SOC moderated the prospective association so participants with low SOC report more sleep problems with subjective role conflicts compared to participants with high SOC. Finally, we also found SOC mediated the prospective association between subjective role stressors and sleep problems and the reverse association.

Two Swedish screening instruments for exhaustion disorder: cross-sectional associations with burnout, work stress, private life stress, and personality traits.

AIMS: To examine the relationships of two screening instruments recently developed for assessment of exhaustion disorder (ED) with some other well-known inventories intended to assess ED-related concepts and self-reports of job demands, job control, job support, private life stressors, and personality factors. METHODS: A cross-sectional population sample ( n = 1355) completed: the Karolinska Exhaustion Disorder Scale (KEDS), Self-reported Exhaustion Disorder Scale (s-ED), Shirom-Melamed Burnout Questionnaire (SMBQ), Utrecht Work Engagement Scale (UWES-9), Job Content Questionnaire (JCQ), Big Five Inventory (BFI), and items concerning family-to-work interference and stress in private life. RESULTS: Compared to participants without any indication of ED, participants classified as having ED on KEDS or s-ED had higher scores on all four SMBQ subscales, lower scores on the UWES-9 subscales vigor and dedication, higher JCQ job demands scores, lower JCQ job support scores, higher degrees of family-to-work interference and stress in private life, and higher BFI neuroticism and openness scores. In addition, participants classified as having ED on KEDS had lower scores on the UWES-9 absorption subscale, the JCQ job control scale, and lower BFI extraversion, agreeableness and conscientiousness scores, compared to the subgroup not classified as having ED. CONCLUSIONS: As expected, we observed an overall pattern of associations between the ED screening inventories KEDS and s-ED and measures of burnout, work engagement, job demands-control-support, stress in private life, family-to-work interference, and personality factors. The results suggest that instruments designed to assess burnout, work engagement, and ED share common ground, despite their conceptual differences.

The associations between workplace bullying, salivary cortisol, and long-term sickness absence: a longitudinal study.

BACKGROUND: Workplace stressors, such as bullying, are strongly related to subsequent long-term sickness absence, but little is known of the possible physiological mechanisms linking workplace stressors and sickness absence. The primary aim of this study was to investigate to what extent cortisol levels were associated with subsequent sickness absence and if cortisol mediated the association between workplace bullying and sickness absence. We additionally investigated possible bidirectional associations between bullying, cortisol, and long-term sickness absence. METHODS: Participants came from two Danish cohort studies, the "Psychosocial RIsk factors for Stress and MEntal disease" (PRISME) cohort and the "Workplace Bullying and Harassment" (WBH) cohort (n = 5418). Information about exposure to workplace bullying and morning and evening salivary cortisol was collected at three time points with approximately two years in between. After each data collection, all participants were followed for two years in registers, and cases with long-term sickness absence lasting 30 or more consecutive days were identified. The association between cortisol levels and subsequent sickness absence was assessed by logistic regression, while the extent to which the association between bullying and sickness absence was mediated by cortisol was quantified through natural direct and indirect effects. RESULTS: High evening cortisol was associated with a decreased risk of sickness absence (OR = 0.82, 95% CI = 0.68-0.99), but we did not find that high morning cortisol levels (OR = 0.98, 95% CI = 0.81-1.18) or high morning-to-evening slope (OR = 0.99, 95% CI = 0.82-1.18) were associated with subsequent sickness absence. We also tested for reverse causation and found that long-term sickness absence, but not salivary cortisol, was a strong risk factor for subsequent workplace bullying. There was no indication that cortisol mediated the association between workplace bullying and sickness absence. CONCLUSION: We found no straightforward and simple association between cortisol and long-term sickness absence. Furthermore, the association between workplace bullying and long-term sickness absence was not mediated by cortisol.

Contradictory individualized self-blaming: a cross-sectional study of associations between expectations to managers, coworkers, one-self and risk factors for musculoskeletal disorders among construction workers.

BACKGROUND: Within work sociology, several studies have addressed construction workers' practices of masculinity, class, economy, safety risks and production. However, few studies have investigated room for agency in relation to bodily pain or musculoskeletal disorders and even fewer have made a quantitative approach. Accordingly, by means of a questionnaire, we examined the association between construction workers' room for agency and physical exertion, bodily and mental fatigue, and lower back pain. METHODS: A total of 481 Danish construction workers who responded to a multifaceted questionnaire were included. Drawing on previous studies and a Foucauldian inspired concept of agency, agency was quantified through specially crafted questions and examined in relation to established measures on physical exertion, physical and mental fatigue and pain in the lower back. Associations were tested using analyses of variance (general linear models) and controlled for age, gender, job group, lifestyle and depression. RESULTS: When asked about options for agency reducing the burden of work, few workers believed themselves to be prime agents of such practices. When asking about their view on performing alternative agency implying caring for the body, 39-49% expected negative reactions from management, and 20-33% expected negative reactions from colleagues. In contrast, only 13-18% of the participants stated that they would give a negative reception to such alternative practices. Using the expected reception outcomes (positive, neutral, negative) to alternative practices as predictors, the statistical regression analyses showed that negative expectations to management were associated with higher levels of physical exertion 0.62 (95% CI = 0.14-1.09) (scale 0-11), bodily fatigue 0.63 (95% CI = 0.22-1.04), mental fatigue 0.60 (95% CI = 0.07-1.12), and low back pain 0.79 (95% CI = 0.13-1.46) (scales 0-10). CONCLUSION: In our study, construction workers answered questions about work and MSD. The answers indicated a contradiction between perceived responsibility and room for agency. Based on the study, a number of target areas could fruitfully be addressed in aiming to reduce MSD among construction workers. To change workers' expectances to the reception of lowering work pace if needed to take care of the body, their expectances to the reception of sickness absence as a result of pain, of discussing physical exertion in work and of demanding appropriate technical assistive devices are such examples. Our results emphasize that management plays an important role in this.

The Lund University Checklist for Incipient Exhaustion-a cross-sectional comparison of a new instrument with similar contemporary tools.

BACKGROUND: Stress-related health problems (e.g., work-related exhaustion) are a societal concern in many postindustrial countries. Experience suggests that early detection and intervention are crucial in preventing long-term negative consequences. In the present study, we benchmark a new tool for early identification of work-related exhaustion-the Lund University Checklist for Incipient Exhaustion (LUCIE)-against other contextually relevant inventories and two contemporary Swedish screening scales. METHODS: A cross-sectional population sample (n = 1355) completed: LUCIE, Karolinska Exhaustion Disorder Scale (KEDS), Self-reported Exhaustion Disorder Scale (s-ED), Shirom-Melamed Burnout Questionnaire (SMBQ), Utrecht Work Engagement Scale (UWES-9), Job Content Questionnaire (JCQ), Big Five Inventory (BFI), and items concerning work-family interference and stress in private life. RESULTS: Increasing signs of exhaustion on LUCIE were positively associated with signs of exhaustion on KEDS and s-ED. The prevalence rates were 13.4, 13.8 and 7.8 %, respectively (3.8 % were identified by all three instruments). Increasing signs of exhaustion on LUCIE were also positively associated with reports of burnout, job demands, stress in private life, family-to-work interference and neuroticism as well as negatively associated with reports of job control, job support and work engagement. CONCLUSIONS: LUCIE, which is intended to detect pre-stages of ED, exhibits logical and coherent positive relations with KEDS and s-ED as well as other conceptually similar inventories. The results suggest that LUCIE has the potential to detect mild states of exhaustion (possibly representing pre-stages to ED) that if not brought to the attention of the healthcare system and treated, may develop in to ED. The prospective validity remains to be evaluated.

The Lund University Checklist for Incipient Exhaustion: a prospective validation of the onset of sustained stress and exhaustion warnings.

BACKGROUND: The need for instruments that can assist in detecting the prodromal stages of stress-related exhaustion has been acknowledged. The aim of the present study was to evaluate whether the Lund University Checklist for Incipient Exhaustion (LUCIE) could accurately and prospectively detect the onset of incipient exhaustion and to what extent work stressor exposure and private burdens were associated with increasing LUCIE scores. METHODS: Using surveys, 1355 employees were followed for 11 quarters. Participants with prospectively elevated LUCIE scores were targeted by three algorithms entailing 4 quarters: (1) abrupt onset to a sustained Stress Warning (n = 18), (2) gradual onset to a sustained Stress Warning (n = 42), and (3) sustained Exhaustion Warning (n = 36). The targeted participants' survey reports on changes in work situation and private life during the fulfillment of any algorithm criteria were analyzed, together with the interview data. Participants untargeted by the algorithms constituted a control group (n = 745). RESULTS: Eighty-seven percent of participants fulfilling any LUCIE algorithm criteria (LUCIE indication cases) rated a negative change in their work situation during the 4 quarters, compared to 48 % of controls. Ratings of negative changes in private life were also more common in the LUCIE indication groups than among controls (58 % vs. 29 %), but free-text commentaries revealed that almost half of the ratings in the LUCIE indication groups were due to work-to-family conflicts and health problems caused by excessive workload, assigned more properly to work-related negative changes. When excluding the themes related to work-stress-related private life compromises, negative private life changes in the LUCIE indication groups dropped from 58 to 32 %, while only a negligible drop from 29 to 26 % was observed among controls. In retrospective interviews, 79 % of the LUCIE indication participants confirmed exclusively/predominantly work stressors, while 6 % described a predominance of private life stressors. CONCLUSIONS: Negative changes in the work situation were the most prominent change related to a sustained increase in LUCIE scores. The findings seem to confirm that LUCIE is a potentially useful tool for clinical screening of incipient work-related exhaustion.

Burnout among Swedish school teachers - a cross-sectional analysis.

BACKGROUND: Teachers are at high risk of stress-related disorders. This study aimed to examine the occurrence of burnout in a sample of Swedish school-teachers, to test a combined measure of three burnout dimensions on the individual level, to characterize associations between burnout and factors encountered during work and leisure time, and to explore any differences between the genders. METHODS: A questionnaire of occupational, sociodemographic and life-style factors was answered by 490 teachers in school years 4-9. Outcome measures were (a) the single burnout dimensions of exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey), and (b) a combined measure based on high or low values in the three dimensions. The combined measure was used to stratify the study population into four levels (0-3) of burnout. Multivariable Poisson regression was applied on level 2 + 3 vs. level 0 + 1, for variables that we considered as relevant risk factors for burn out. RESULTS: Half of the teachers reported low values in all three dimensions (level 0), whereas 15 were classified as having high burnout in at least two out of the three dimensions (level 2 + 3), and 4 % in all three dimensions (level 3). Almost all psychosocial factors were incrementally more unfavourably reported through the rising levels of burnout, and so were dissatisfaction with the computer workstation, pain, sleep problems and lack of personal recovery. There was no association between gender and rising levels of overall burnout (p > 0.30). Low self-efficacy, poor leadership, high job demands and teaching in higher grades were the variables most clearly associated with burnout in multivariable Poisson regression. CONCLUSIONS: Even if circa 50 % of the teachers appear do well with respect to burnout, the results points to the need of implementing multifaceted countermeasures that may serve to reduce burnout.

The effects of acoustical refurbishment of classrooms on teachers' perceived noise exposure and noise-related health symptoms.

OBJECTIVES: To investigate whether acoustical refurbishment of classrooms for elementary and lower secondary grade pupils affected teachers' perceived noise exposure during teaching and noise-related health symptoms. METHODS: Two schools (A and B) with a total of 102 teachers were subjected to an acoustical intervention. Accordingly, 36 classrooms (20 and 16 in school A and school B, respectively) were acoustically refurbished and 31 classrooms (16 and 15 in school A and school B, respectively) were not changed. Thirteen classrooms in school A were interim "sham" refurbished. Control measurements of RT and activity sound levels were measured before and after refurbishment. Data on perceived noise exposure, disturbance attributed to different noise sources, voice symptoms, and fatigue after work were collected over a year in a total of six consecutive questionnaires. RESULTS: Refurbished classrooms were associated with lower perceived noise exposure and lower ratings of disturbance attributed to noise from equipment in the class compared with unrefurbished classrooms. No associations between the classroom refurbishment and health symptoms were observed. Before acoustical refurbishment, the mean classroom reverberation time was 0.68 (school A) and 0.57 (school B) and 0.55 s in sham refurbished classrooms. After refurbishment, the RT was approximately 0.4 s in both schools. Activity sound level measurements confirmed that the intervention had reduced the equivalent sound levels during lessons with circa 2 dB(A) in both schools. CONCLUSION: The acoustical refurbishment was associated with a reduction in classroom reverberation time and activity sound levels in both schools. The acoustical refurbishment was associated with a reduction in the teachers' perceived noise exposure, and reports of disturbance from equipment in the classroom decreased. There was no significant effect of the refurbishment on the teachers' voice symptoms or fatigue after work.

Exposure to negative acts and risk of turnover: a study of a register-based outcome among employees in three occupational groups.

PURPOSE: To investigate whether self-reported exposure to negative acts in the workplace (bullying and threats of violence) predicted turnover in three occupational groups (human service and sales workers, office workers and manual workers). METHODS: Survey data on 2766 respondents were combined with data from a national labour force register to assess turnover. Mixed effects logistic regression analysis was used to examine the association between self-reported exposure to negative acts at baseline and risk of turnover after a 1-year follow-up. RESULTS: We found no significant associations between exposure to negative acts (bullying and threats of violence) and risk of turnover. When participants were stratified by occupational group and analyses were adjusted for age, gender, tenure and psychosocial working conditions, we found that exposure to bullying predicted risk of turnover in office workers (OR 2.03, 95 % CI 1.05-3.90), but neither in human service and sales workers, nor in manual workers. The association in office workers lost statistical significance when additionally adjusted for depressive symptoms (OR 1.77, 95 % CI 0.90-3.49). However, in a sensitivity analysis in which we used a 2-year (instead of a 1-year) follow-up period the association between bullying and turnover remained statistically significant in office workers even after adjusting for depressive symptoms (OR 2.10, 95 % CI 1.17-3.76). We found no statistically significant associations between threats of violence and risk of turnover in the stratified analyses. CONCLUSION: Exposure to bullying predicted risk of turnover among office workers but not among human service and sales workers and among manual workers. Threats of violence were not associated with turnover in any occupational group.

Effect of physical exercise on workplace social capital: Cluster randomized controlled trial.

AIMS: While workplace health promotion with group-based physical exercise can improve workers' physical health, less is known about potential carry-over effects to psychosocial factors. This study investigates the effect of physical exercise on social capital at work. METHODS: Altogether, 200 female healthcare workers (nurses and nurse's aides) from 18 departments at three hospitals were randomly allocated at the department level to 10 weeks of (1) group-based physical exercise at work during working hours or (2) physical exercise at home during leisure time. At baseline and follow-up, participants replied to a questionnaire concerning workplace social capital: (1) within teams (bonding); (2) between teams (bridging); (3) between teams and nearest leaders (linking A); (4) between teams and distant leaders (linking B). RESULTS: At baseline, bonding, bridging, linking A and linking B social capital were 74 (SD 17), 61 (SD 19), 72 (SD 22) and 70 (SD 18), respectively, on a scale of 0-100 (where 100 is best). A group by time interaction was found for bonding social capital (P=0.02), where physical exercise at work compared with physical exercise during leisure time increased 5.3 (95% confidence interval 2.3- 8.2)(effect size, Cohen's d = 0.31) from baseline to follow-up. For physical exercise at home during leisure time and exercise at work combined, a time effect (P=0.001) was found for linking A social capital, with a decrease of 4.8 (95% confidence interval 1.9-7.6). CONCLUSIONS: Group-based physical exercise at work contributed to building social capital within teams at the workplace. However, the general decrease of social capital between teams and nearest leaders during the intervention period warrants further research.

Month-to-month variation in sleep among healthy, Scandinavian daytime workers.

BACKGROUND: The overall purpose of the present study was to attain more insight in month-to-month variation of sleep duration and quality in order to improve design and interpretation of, e.g. epidemiological studies using sleep as outcome. METHODS: The study design entailed monthly self-reports from 38 (26 women/12 men) daytime workers, who completed the Karolinska Sleep Diary (KSD) once a month during one year. A subgroup (n = 16) also wore actigraphs on one day every month during a year. Self-reports of bedtime, time of awakening, sleep duration, individual sleep characteristics, disturbed sleep index (DSI, 4 items) and awakening index (AWI, 3 items) were analyzed together with actigraphy-derived measures. Hours of daylight were used to test for circa-annual variation in statistical models adjusted for intake of hypnotics and alcohol, gender, age and within-person variability. RESULTS: Hours of daylight were found to be associated to self-reported bedtime (p = 0.032) and DSI (p = 0.030), thereby indicating a circa-annual variation. Bedtime was delayed by 1.8 min (95% CI: 0.6-2.9 min) per 1 hour increase in length of daylight. Sleep was slightly more disturbed during the winter. CONCLUSION: Only circa-annual variation in self-reports of bedtime and DSI were observed in a healthy daytime working population, and the effects were small. Therefore potential bias due to circa-annuality in the studied parameters appears to be of limited concern in adult daytime working populations.

Workplace bullying and sleep difficulties: a 2-year follow-up study.

PURPOSE: The aims of the present study were to investigate whether being subjected to bullying and witnessing bullying at the workplace was associated with concurrent sleep difficulties, whether frequently bullied/witnesses have more sleep difficulties than occasionally bullied/witnesses, and whether there were associations between being subjected to bullying or witnessing bullying at the workplace and subsequent sleep difficulties. METHODS: A total of 3,382 respondents (67 % women and 33 % men) completed a baseline questionnaire about their psychosocial work environment and health. The overall response rate was 46 %. At follow-up 2 years later, 1671 of those responded to a second questionnaire (49 % of the 3,382 respondents at baseline). Sleep difficulties were measured in terms of disturbed sleep, awakening problems, and poor quality of sleep. RESULTS: Bullied persons and witnesses reported more sleep difficulties than those who were neither bullied nor witnesses to bullying at baseline. Frequently bullied/witnesses reported more sleep difficulties than respondents who were occasionally bullied or witnessing bullying at baseline. Further, odds ratios for subsequent sleep difficulties were increased among the occasionally bullied, but not among witnesses. However, the associations weakened when adjusting for sleep difficulties at baseline. CONCLUSION: Being subjected to occasional bullying at baseline was predictive of subsequent sleep difficulties. Witnessing bullying at baseline did not predict sleep difficulties at follow-up.