The Relationship between Job Strain and Ischemic Heart Disease Mediated by Endothelial Dysfunction Markers and Imaging.

Background and Objectives: Job strain is a psychological, physical, and behavioral stress that occurs at the workplace. Job strain is associated with more than double the normal risk of coronary artery disease (CAD). The main aim of this study was to determine the association between job strain and the following parameters: high-sensitivity C-reactive protein (hs-CRP), the albumin urine excretion rate (AUER), and secondary-level testing. Materials and Methods: This study was a descriptive cross-sectional study conducted on patients who underwent cardiological assessment between October 2023 and February 2024 at the Promedicanon Cardiology Center. This study comprised 210 participants, with two groups: 105 chronic coronary syndromes (CCS) patients and 105 no-CCS patients. The baseline characteristics collected were age, gender, education, rural/urban environment, traditional CAD risk factors, hs-CRP, and AUER. The secondary-level testing included an electrocardiogram (ECG), echocardiography, and enhanced contrast computed tomography (ECCT). Psychological questionnaires comprised the tertiary-level testing, including the PHQ-9 depression questionnaire, and the satisfaction with work scale (SWWS) for job strain (Likert score). Results: The baseline characteristics were all significantly different between the groups (p < 0.05) except for total cholesterol. The hs-CRP level had a mean value of 0.4837 ± 0.19082 in the CCS group; for the no-CCS group, the hs-CRP mean value was 0.2289 ± 0.11009; p-value < 0.001. The AUER had a mean value of 42.770 ± 12.8658 for the CCS group and 26.432 ± 9.7338 for the no-CCS group; p-value < 0.001. For the associations between secondary-level testing and job strain: p < 0.001 for ST depression, negative T-waves, and q-waves; p = 0.415 for atrial fibrillation (AF); p = 0.018 for wall motion studies; p = 0.005 for ECCT. The association between job strain and AF had no statistical significance. The contractility of left ventricle walls and coronary calcification score were associated with job strain, with statistical significance. The p-value was 0.013 for the relationship between depression and the ECCT; for the association between depression and CCS status, the p-value was 0.021. Depression is usually diagnosed in job strain. The association between depression, and coronary calcification, as well as depression and CCS status had statistical significance. Conclusions: Job strain increased the hs-CRP level and AUER in both the CCS and no-CCS patients. The primary and secondary prevention of CHD could also include interventions to reduce job strain.

Stress and depression among male police officers in Taiwan: Severity, determinants, and coping strategies.

BACKGROUND: Police work, known for its high stress, exhibits elevated depression rates. OBJECTIVE: This study explores stress and depression in male officers, examining personality traits, coping strategies, family, and social support. Aligned with the diathesis-stress hypothesis and job demands-resources model, it aims to illuminate these factors in policing. METHODS: Two hundred and sixty-four male police officers from Yunlin, Taiwan were enrolled in this study. Structured measurements of stress level, depression symptoms, personality traits, family functioning, and social support were made. We used multiple regression analysis to assess predictors of stress level and depression and identified coping strategies used by the police officers. RESULTS: Of the 264 male police officers, 36.4% had clinically significant depression. Occupational stress was mostly related to organizational factors. Multivariate regression analyses showed that age, personality traits, officer's rank, and period of education obtained could predict police officers' occupational stress. Personality traits, social support, occupational stress, and period of education obtained could predict depression. The most frequently used coping strategies were drinking and smoking. CONCLUSIONS: The results of our study support the diathesis-stress hypothesis and the job demands-resources model. Enhancing male police officers' mental well-being requires addressing key factors like social support and occupational stress. Strategic measures, such as mental health education, destigmatization, counseling, and community-building, are vital. Policymakers should collaborate with mental health professionals for tailored interventions, fostering a healthier work environment.

Occupational stress and musculoskeletal disorders in firefighters: the mediating effect of depression and job burnout.

The firefighting profession carries a heightened risk of musculoskeletal disorders. A firefighter's job is physically demanding and includes activities such as running, climbing, dragging, and lifting. Often, these tasks are unpredictable, performed in harsh environments, and have been found to cause psychological stress. The purpose of this study was to investigate the effects of occupational stress on work-related musculoskeletal disorders (WRMSD) in firefighters. In addition, the mediating effects of depression and job burnout on proposed relationships were examined. Data informing this study were collected using a survey questionnaire. The survey questionnaire included the Beck Depression Inventory, the Center for Epidemiological Studies Depression Scale (CES-D), the Maslach Burnout Inventory, the Post Traumatic Stress Disorder Inventory (PCL), and the Nordic Musculoskeletal Questionnaire. Collected data were analyzed using structural equation modeling approach in AMOS. The results of the 2339 responding firefighters suggest that work related stress is positively related to WRMSDs in firefighters and can lead to musculoskeletal symptoms through four paths, being emotional exhaustion, personal accomplishment, CES-D total score, and depersonalization. Through depersonalization, job stress had the most significant impact on musculoskeletal symptoms (coefficient = 0.053). Furthermore, the results showed that post-traumatic stress disorders (PTSD) can affect musculoskeletal symptoms through ten paths, again through depersonalization, PTSD had the most significant impact on musculoskeletal symptoms (coefficient = 0.141). The results of this study suggest that organizations should design interventions and policies to prevent and manage occupational stress, depression, and job burnout to negate its undesired consequences on firefighters' health (i.e. WRMSD).

Relationships between job stress, post-traumatic stress and musculoskeletal symptoms in firefighters and the role of job burnout and depression mediators: a bayesian network model.

INTRODUCTION: Job stress, post-traumatic stress disorder (PTSD), and negative psychological outcomes in firefighters can be caused, or aggravated, by their work. These mental disorders can impart musculoskeletal symptoms. This study aimed to investigate relationships between musculoskeletal and psychological disorders in a population of firefighters using a Bayesian network model. METHODS: This cross-sectional study, conducted in 2022, included 2339 firefighters who completed questionnaires during their rest periods. The questionnaires comprised of demographical information, the Occupational Stress Questionnaire-HSE, the PTSD Checklist, Maslach Burnout Inventory, Center for Epidemiologic Studies - Depression scale (CES-D), and Nordic Musculoskeletal Questionnaire. GeNIe academic software was used to analyze the Bayesian network. RESULTS: High job stress and high PTSD each increased the probability of musculoskeletal symptoms by 34%. When combined, high job stress and high PTSD increased the probability of musculoskeletal symptoms by 37%. Among the mediator's burnout and depression, depression had the highest association with musculoskeletal symptoms. CONCLUSIONS: Job stress and PTSD can increase musculoskeletal symptoms and are influenced by psychological mediators (like burnout and depression). Adopting preventive and therapeutic measures to mitigate job stress and PTSD, mitigate and rehabilitate WMSD, and manage associated mediators are critical for the mental and physical health of firefighters.

Work-related stress is associated with low work ability, but not with poor self-rated health: A cross-sectional study in primary healthcare.

BACKGROUND: People seeking care at primary healthcare centres may be exposed to work-related stress, increasing the risk of future sick leave. Thus, it is important to identify work-related stress, and to explore how stress relates to work ability and health. OBJECTIVE: To investigate the association between work-related stress and a) work ability, and b) self-rated health, among working women and men seeking care for physical or mental health complaints. METHODS: This cross-sectional study analyzed baseline data (n = 232) from a randomized controlled trial investigating the effects of a brief intervention to prevent sick leave. Data regarding work-related stress, work ability and self-rated health were analyzed using binary logistic regression models. RESULTS: In models adjusted for age, gender and education, high work-related stress measured by the Work Stress Questionnaire was significantly associated with low work ability. The highest odds ratio (OR 3.27, 95% CI 1.66-6.42) was found between the domain "interference between work and leisure time" and work ability, suggesting a more than three times higher odds for low work ability when perceiving that work interferes with leisure time. No significant association was found between work-related stress and self-rated health. CONCLUSION: Health professionals should explore patients' work-related stress when they seek care for physical or mental complaints in primary healthcare. Patients' perceived balance between work and leisure time seems particularly important to address. Increased awareness might facilitate timely, relevant strategies to reduce stress and promote work ability.

Job stressors in relation to burnout and compromised sleep among academic physicians in India.

BACKGROUND: Burnout among physicians, especially in the academic setting, is an urgent concern, with adequate sleep one of the key focal points. OBJECTIVE: To identify job stressors contributing to burnout and compromised sleep among academic physicians, using a comprehensive, theory-based instrument, the Occupational Stressor Index (OSI), whose specific form was created 'for physicians by physicians'. METHODS: This parallel mixed-methods cross-sectional investigation was conducted among 109 physicians employed in a public teaching hospital, Jodhpur, India. Work conditions were evaluated by the physician-specific OSI (part I). The Copenhagen Burnout Index and Pittsburgh Sleep Quality Index (PSQI) were the outcome instruments (part II). Seventy-six physicians completed parts I and II. RESULTS: The physicians were from wide-ranging specialties, and 82% of the cohort were residents. Mean total OSI scores were 87.4±8.1, with unit-change yielding adjusted odds-ratios (95% confidence-intervals) for personal (1.10 (1.02-1.18)) and work-related burnout (1.12 (1.04-1.22)), and PSQI (1.09 (1.01-1.17)). Significant multivariable associations with burnout and/or sleep indices included: working 7 days/week, lacking work-free vacation, insufficient rest breaks, interruptions, many patients in intensive-care, no separate time for non-clinical duties, pressure to publish, injury/suicide attempts of colleagues/staff, performing pointless tasks. The latter were described as administrative/clerical. Lacking genuine rest breaks was mainly patient-related, further compromised by emergency work and lacking separate time for non-clinical duties. Long workhours and exhausting schedule were cited as most difficult parts of work, while reducing workhours, improving work schedule, and hiring more staff most frequently recommended. CONCLUSION: Specific working conditions potentially contributory to burnout and compromised sleep among physicians working in academic medicine are identified using a methodologically-rigorous, in-depth approach. These findings inform evidence-based interventions aimed at preserving physician mental health and work capacity.

Speech-language pathologists' professional stress level and factors affecting it in the Republic of Serbia.

BACKGROUND: In the Republic of Serbia, to our knowledge, there has been no research dedicated to the professional stress faced by speech-language pathologists (SLPs). Since speech therapy belongs to the helping professions, SLPs might experience professional stress. OBJECTIVE: To examine the levels of professional stress in SLPs concerning sociodemographic characteristics and terms of the workplace. METHODS: The research was conducted online, using a questionnaire designed to determine professional stress in speech-language pathologists - Speech-Language Pathologist Stress Inventory. The voluntary sample consisted of 185 employed SLPs from the Republic of Serbia. The stress level was observed concerning marital status, years of working experience, age, educational degree, caseload size, job sector, job setting, type of patients' diagnosis, and type of service which SLPs provide. RESULTS: The results showed that SLPs experience mild to moderate levels of professional stress and that there is a statistically significant difference in the stress level concerning years of working experience, age, job sector, and job setting. Applying Generalized Linear Mixed Model revealed that two-way interaction (Years of working experience * Marital status) and three-way interaction (Age * Job Setting * Type of patients' diagnosis) dominated on the model. CONCLUSION: Since it is noted that SLPs are experiencing mild to moderate levels of professional stress, it is important to emphasize the need for adaptation of existing work terms as well as to provide additional support to speech therapists in order to improve their mental health.

Measurement of work-related psychological injury with depressive symptoms.

OBJECTIVE: This study aimed to measure the level of psychological injury caused by work-related stress as well as the severity of depression among workers. METHOD: First, we conducted an online survey and recruited 500 workers diagnosed with depression or adjustment disorder to investigate what type of stress they experienced within six months before onset. Second, we conducted another online survey and recruited 767 participants who experienced some form of work-related stress. All the participants were classified into four groups by whether or not they were diagnosed with depression and whether or not they quit their jobs due to work-related stress. We used the Impact of Event Scale-Revised (IES-R) to measure psychological injury caused by work-related stressful events and the Patient Health Questionnaire (PHQ)-9 to assess the severity of depression. RESULTS: In study 1, 62.4% of workers diagnosed with depression or adjustment disorder experienced work-related stress within six months before onset. In study 2, the IES-R mean scores were 40.7 (SD = 23.1) for Group A (workers with depression and quit their jobs) and 36.67 (SD = 23.4) for Group B (workers with depression but stayed at their jobs), with both exceeding the cut-off point (24/25) of PTSD (Post-Traumatic Stress Disorder), while the mean score of Group C (workers who did not have depression but quit their jobs because of work-related stress) was 20.74 (SD = 21.2), and it was 13.89 (SD = 17.4) for Group D (workers who had work-related stress but stayed at their jobs), with both of them below the cut-off point of PTSD. The total scores of IES-R of Group A and Group B were significantly higher than those of Group C and Group D(p < 0.001). There was a significant positive correlation between the scores of IES-R and PHQ-9 for all four groups (r = 0.708). CONCLUSIONS: This study suggests that it is necessary to measure not only depressive symptoms but also the level of psychological injury resulting from stressful events in the workplace to assess workers with depression.

The mediating role of psychological capital in the relationship between job stress and professional identity in Chinese medical interns.

BACKGROUND: Adaption to clinical work during the internship can induce several stressors among medical students, especially in the context of the coronavirus disease 2019 (COVID-19) pandemic. Particularly, job stress could be linked to the development of psychological traits and the formation of the professional identity of medical interns. OBJECTIVE: This study aimed to explore the relationship between job stress, psychological capital, and professional identity through a mediation analysis of Chinese medical interns. METHODS: A descriptive cross-sectional study was conducted in 30 hospitals and clinics in China from June 2021 to March 2022. A total of 665 medical interns filled out questionnaires related to demographic questions, psychological capital, job stress, and professional identity. Data analysis was executed using the IBM SPSS version 22.0 software and its add-in PROCESS Windows version 4.0. RESULTS: The findings indicated a statistically significant mediating effect of psychological capital between job stress and professional identity. Job stress and job stress combined with psychological capital accounted for 5.3% and 37.9%, respectively, of the variance in professional identity. The bootstrapping method corroborated the significance of the indirect effect of job stress through psychological capital (95% bootstrap CI = -4.7921, -2.4345). CONCLUSION: The current findings underscore the need for increased attention on improving the psychological capital of medical interns.

Social inequalities, stressful work and non-fatal cardiovascular disease: follow-up findings from the CONSTANCES Study.

BACKGROUND: Studies show that a disadvantaged socioeconomic position (SEP) and psychosocial stress at work are both independently associated with an increased risk of cardiovascular disease (CVD). But it is not clear if the effect of stress at work on CVD varies by SEP. METHODS: We used baseline and follow-up data from the French population-based cohort study CONSTANCES, including 48 383 employed women and men aged 30-70 years. Three SEP indicators (education, income, occupation), stressful psychosocial work as measured by effort-reward imbalance, pre-existing CVD and confounders were assessed at baseline, and incident non-fatal CVD events reported during annual follow-up (up to five follow-ups) were used as outcomes. The effect modification hypothesis was both investigated on an additive and multiplicative scale. RESULTS: SEP was inversely associated with CVD risk (eg, for low vs high income, OR 1.28 (95% CI 1.12 to 1.46)), and for all three components of stressful work CVD risks were significantly increased (eg, for effort-reward ratio OR 1.26 (95% CI 1.17 to 1.36)). Employees with a disadvantaged SEP showed moderately increased effect sizes of stressful work on CVD. However, no clear evidence of an effect modification was found. CONCLUSIONS: Disadvantaged SEP and stressful work contribute to higher CVD risk in this cohort. Despite moderately increased effect sizes for disadvantaged SEP groups, no evidence was found to support an effect modification hypothesis.

A cohort study on the association between changing occupational stress, hair cortisol concentration, and hypertension.

OBJECTIVE: To explore the relationship between changing occupational stress levels, hair cortisol concentration (HCC), and hypertension. METHODS: Baseline blood pressure of 2520 workers was measured in 2015. The Occupational Stress Inventory-Revised Edition (OSI-R) was used to assess changes in occupational stress. Occupational stress and blood pressure were followed up annually from January 2016 to December 2017. The final cohort numbered 1784 workers. The mean age of the cohort was 37.77±7.53 years and the percentage male was 46.52%. At baseline, 423 eligible subjects were randomly selected for hair sample collection to determine cortisol levels. RESULTS: Increased occupational stress was a risk factor for hypertension [risk ratio (RR) = 4.200, 95% confidence interval (CI): 1.734-10.172]. The HCC of workers with elevated occupational stress was higher than that of workers with constant occupational stress [(ORQ score ≥70: geometric mean±geometric standard deviation = 5.25±3.59 ng/g hair; 60-90: 5.02±4.00; 40-59: 3.45±3.41; <40: 2.73±3.40) x2 = 5.261]. High HCC increased the risk of hypertension (RR = 5.270, 95% CI: 2.375-11.692) and high HCC was associated with higher rates of elevated diastolic and systolic blood pressure. The mediating effect of HCC was 0.51[(95% CI: 0.23-0.79, odds ratio(OR) = 1.67] and accounted for 36.83% of the total effect. CONCLUSIONS: Increased occupational stress could lead to an increase in hypertension incidence. High HCC could increase the risk of hypertension. HCC acts as a mediator between occupational stress and hypertension.

Examining Race-Based Discrimination, Depression, and Occupational Stress in Black Registered Nurses.

Nursing is a highly stressful and demanding profession that can negatively affect mental health, as shown by nurses' high rate of depression. Furthermore, Black nurses may experience additional stress due to race-based discrimination in the work environment. This research aimed to examine depression, experiences of race-based discrimination at work, and occupational stress among Black nurses. To better understand associations between these factors, we conducted multiple linear regression analyses to assess whether (1) past-year or lifetime experiences of race-based discrimination at work and occupational stress predicted depressive symptoms; and (2) controlling for depressive symptoms, past-year and lifetime experiences of race-based discrimination at work predicted occupational stress in a cohort of Black registered nurses. All analyses controlled for years of nursing experience, primary nursing practice position, work setting, and work shift. The results indicated that both past-year and lifetime experiences of race-based discrimination on the job were significant predictors of occupational stress. However, experiences of race-based discrimination at work and occupational stress were not significant predictors of depression. The results of the research highlighted the predictive effect of race-based discrimination on occupational stress in Black registered nurses. This evidence can inform the development of organizational and leadership strategies to improve the well-being of Black nurses in the workplace.

Four serially mediating mechanisms in the relationship between COVID-19 fear and employee performance.

BACKGROUND: During the COVID-19 pandemic, most workers were forced to work remotely, although having no prior experience, and as a result, they were exposed to new job-related stressors. OBJECTIVES: To examine the mediating role of job stress, work-family conflict and job satisfaction between fear of COVID-19 and job performance. METHODS: An online questionnaire was conducted a survey of remote workers in Turkey. Responses were obtained from 351 subjects. Related scales were used to measure work-life balance, job stress, job satisfaction, and employee performance as well as fear of COVID-19. Because all hypothesis constructs can be analyzed simultaneously, structural equation modeling was used for data analysis. RESULTS: The results showed that fear of COVID-19 affects job stress (p = .001; ß= .264). There was a significant relationship between job stress and job satisfaction (p = .001; ß= .619). Also, work-family conflict was affected employee job stress (p = .001; ß= .516). Job stress had a mediator role fear of COVID-19 on job satisfaction and work-family conflict on job satisfaction. CONCLUSION: The findings of this study provide a useful measurement model that can be used to evaluate and improve job performance and job satisfaction through work stress and work-family conflict in times of crisis such as COVID-19.

Surviving Burnout as an Oncologist.

PURPOSE OF REVIEW: The aim of this review is defining burnout in medical oncologists, analyzing the causes, and evaluating both individual and institutional approaches to overcome burnout. RECENT FINDINGS: Burnout is defined as a reaction to long-term work-related stress, which is a serious condition and has negative consequences at both personal and professional levels. In recent years, there has been a greater emphasis on burnout in medicine in general and specifically in oncology given the complexity of care provided to oncology patients. More research is being done in this field and more coping strategies are evolving to help oncologists reduce the amount of stress and burnout they are experiencing. Oncologists need to recognize and acknowledge burnout and use different strategies to find joy in their work while maintaining their work-life balance. Strategies like individual-directed interventions and organizational-directed interventions, such as providing support and resources to oncologists to relieve their work-related stress may have a positive impact on oncologists' well-being, their patients' care, and satisfaction.

Cross-cultural adaptation and validation of the Job Content Questionnaire (JCQ-22).

BACKGROUND: Although the Job Content Questionnaire (JCQ-22) has been translated into numerous languages and applied in various countries, its cultural applicability in China remains unclear. OBJECTIVE: To adjust the JCQ-22 for cross-cultural use and optimize the scoring method for suitability for Chinese working populations. METHODS: We first used the original JCQ-22 questionnaire to measure occupational stress. Cross-cultural adjustment involved reorganization of scale items (adjusted-I scale) and deletion of inefficient redundant items during reorganization of scale items (adjusted-II scale). Structural validity and the relationship between stress and health outcomes (insomnia and self-conscious symptoms) before and after adjustment were compared. RESULTS: Exploratory factor analysis revealed that the two-factor cumulative variance contribution rate of job demand and control of the adjusted-II scale was 52.47%, compared with 48.44% and 48.44% in the original version and adjusted-I scale, respectively. Among the 16 fitness indicators in confirmatory factor analysis, 9 items of the adjusted-II scale met the standard, compared with 4 items of the original and adjusted-I scales. The Pearson's correlation coefficients between occupational stress and insomnia as well as self-conscious symptoms from the adjusted-II scale were 0.15 and 0.32, respectively, which were higher than those of the original scale (0.10 and 0.20). Receiver operating characteristic analysis revealed that the adjusted-II scale exhibited a better area under the curve and Youden index values than the original scale. CONCLUSION: The adjusted-II scale exhibited superior structural validity with more reasonable health outcome predictions and fewer items, making it more suitable for measuring occupational stress in Chinese populations.

Escape or activate? Pathways of work stress on substance use.

BACKGROUND: Research on the spillover effects of work stress on substance use have mainly focused on the concept of escapist substance. OBJECTIVE: Building on the concept of self-endangering work behavior, we expand this stress-theoretic view with a presenteeism path of work-induced substance use. Contrary to emotion-based disengaging coping strategies associated with escapist use, we argue that high job demands may also promote problem-focused engagement coping, where substances are used for activation. METHODS: A structural equation model was used to analyze both assumed pathways of stress-induced substance use with survey data from a random sample of n = 411 employees. RESULTS: We confirmed that high job demands are directly related to escapist substance use, but indirectly related to activating substance use, mediated by presenteeism behavior. Both types of substance use are reduced in organizations with high psychosocial safety climate, but increase with higher competitive climate. Social support is related to reduced activating substance use. Males show a stronger tendency for the escapist path, whereas the presenteeism path is more prevalent in women. CONCLUSION: Work stress may not only induce substance use as a disengaging emotional coping strategy, but also as an active problem-focused coping strategy, where employees engage in substance use to continue their efforts necessary for work-related goal attainment. A psychosocial safety climate may provide opportunities for intervening on the "cause of causes" of substance use. Moreover, due to the higher prevalence for activating substance use in female workers, previous research may have underestimated women's risks for work-induced substance use.

Gender and Workplace Stress Affect the Association Between Concussion History and Depression Symptoms in Professional Jockeys.

OBJECTIVE: Professional jockeys experience high rates of concussion, workplace stress, and poor mental health. The present cross-sectional study, for the first time, concurrently assessed the potential interplay between concussion history and workplace stress with current depression symptoms. METHOD: Seventy-two professional flat-track jockeys (male = 49, female = 23) were grouped based on self-reported concussion history (CG; n = 56) and those who did not report a concussion history (NCG; total n = 16). Analyses featured both between (CG vs NCG) and within group (CG only) assessment on self-reported measures of workplace stress and depression symptoms (affect, daily functioning). RESULTS: Jockeys in the CG had more symptoms of negative affect than the NCG. This association, however, was nonsignificant after covarying for age, gender, and workplace stress. Higher workplace stress (p = .005) and gender (p = .001) were associated with poorer daily functioning after controlling for concussion history (CG vs. NCG) and age. Gender moderated the association between concussion group and poorer daily functioning (ß = -18.739, t (71) = -2.924, p = .005), with the difference between CG and NCG significant for females, but not males (ß = 33.648, t (71) = 3.420, p = .001). CONCLUSIONS: The findings provide preliminary evidence that previously concussed females may be more likely to report poorer daily functioning than males with a history of concussion, and that workplace stress may reduce the association between a history of concussion and depression symptoms. Prospective studies are required to validate and extend these findings.

The Interaction between Occupational Stress and Smoking, Alcohol Drinking and BMI on Hypertension in Chinese Petrochemical Workers.

BACKGROUND: Hypertension is one of the most vital risk factors for cardiovascular diseases, so we wanted to explore the impact of the interaction between occupational stress and smoking, alcohol drinking and BMI on hypertension in Chinese petrochemical workers. METHODS: A total of 1488 employees participated. Questionnaires included the value of blood pressure, occupational stress (assessed by the effort-reward imbalance scale), demographic factors and work conditions. Multivariable logistic regression was used to explore related factors, and the interactions between occupational stress and smoking, alcohol drinking and BMI on hypertension were analyzed using an additive model. RESULTS: The prevalence of hypertension was 34.3%. Age ≥ 56 (OR = 3.19, 95%CI: 1.841-5.526), male (OR = 1.436, 95%CI: 1.056-1.954), BMI ≥ 25 (OR = 1.86, 95%CI: 1.468-2.346), smoking (OR = 1.52, 95%CI: 1.191-1.951) and alcohol drinking (OR = 1.53, 95%CI: 1.180-1.972), ERI > 1 (OR = 1.50, 95%CI: 1.133-1.960) are risk factors for hypertension, and a higher education level (OR = 0.57, 95%CI: 0.438-0.754) is a protective factor against hypertension. Positive interactions existed between occupational stress and smoking (RERI = 2.134, AP = 0.328, S = 1.635), alcohol drinking (RERI = 2.332, AP = 0.361, S = 1.746) and BMI (RERI = 1.841, AP = 0.340, S = 1.717) on hypertension in petrochemical workers. CONCLUSIONS: Age, gender, educational level, BMI, smoking, alcohol drinking and occupational stress are closely related to the risk of hypertension. There are also positive interactions between occupational stress and alcohol drinking, smoking and BMI, which have a certain impact on hypertension.

[The new Maugeri diagnostic protocol for work-related stress and mobbing (MASD-2)]. / Il nuovo protocollo diagnostico Maugeri per stress lavoro-correlato e mobbing (MaSD-2).

SUMMARY: Occupational stress can exceed the workers' individual capacity to adapt, and cause psychopathological conditions, including adjustment disorder (AD) and post-traumatic stress disorder (PTSD), for which medico-legal reporting is mandatory by law. Since the early 2000s, an interdisciplinary diagnostic protocol has been in use at our Institute to address patients towards an appropriate therapeutic path, in order to promote their psychological well-being and work reintegration. In 2017, the protocol was updated and expanded. The current version (MaSD-2) includes: occupational medicine examination, psychological counselling, psychiatric interview, and psychodiagnostic testing: Short-Negative Acts Questionnaire (S-NAQ), Cognitive Behavioral Assessment 2.0 (CBA-2.0), SCID (Structured Clinical Interview for DSM: Diagnostic and Statistical Manual of Mental Disorders), Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), Maugeri Stress Index - Reduced form (MASI-R). Between 2017 and 2019, we used the MaSD-2 to assess, for suspected psychopathological work-related problems, 198 patients (120 women and 78 men; mean age SD: 47.9 9.0 years). Nine (4.5%), already examined with the original version of the protocol, received diagnostic confirmation (2 cases of paranoid personality disorder, 7 of work-related anxiety-depressive disorder). Of the other 189 subjects, three (1.6%) were not affected by psychiatric disease, 12 (6.3%) had a psychiatric disorder (e.g., anxiety disorder, mood disorder, personality disorder) independent of work, 160 (84.7%) a work-related anxiety and/or depressive disorder. DA was identified in 12 cases (6.3%), and two patients (1.1%) were diagnosed with DA in pre-existent DPTS, for a total of 14 medico-legal reports of occupational disease. Compared to the past, the case record presents a much higher percentage of psychiatric disorders related to occupational stress. This may be due to a greater sensitivity of the new diagnostic protocol, and to a better selection of the patients referred to us. Women and tertiary workers continue to be at greater risk, with significant involvement of health professionals. Diagnoses of DA and DPTS remain rare, confirming the need for a rigorous and cautious interdisciplinary approach, aimed at selecting the cases for which to start medico-legal procedures. Finally, the study calls for adequate preventive measures.

Impact of nurses' emotional labour on job stress and emotional exhaustion amid COVID-19: The role of instrumental support and coaching leadership as moderators.

AIM: This study examines Pakistan nurses' emotional labour and stress in health care emergencies, specifically their emotional exhaustion and availability of support of organization and management to alleviate the effects. BACKGROUND: As COVID-19 pandemic has been declared a global outbreak and many countries have enacted medical emergencies, this has increased job demands and expected desired emotional expressions from frontline workers. Such high levels of job demand contribute to various stress reactions among employees. METHODS: Authors applied a longitudinal design, using an experimental approach, to collect data from 319 nurses serving in 107 government hospitals in Pakistan. The authors surveyed nurses at two time points with the interval of 3 months by using an online questionnaire tool. At one time, they asked nurses to report on emotional labour, stress and exhaustion. In the second phase, after providing supports (during interval phase) at different levels, the authors repeated the same scales from same participants in addition to instrumental support and coaching leadership. Data were processed using SPSS-Amos for elementary analysis and SPSS-process macro software for robustness and hypotheses testing. RESULTS: The findings indicate that job stress fully mediates the relationship between surface acting and emotional exhaustion in controlled phase and partially mediates in intervention phase. Furthermore, in intervention phase, instrumental support moderates and alleviates positive effects of emotional labour on job stress, and coaching leadership moderates and lessens positive effects of job stress on emotional exhaustion. CONCLUSION: This research concludes that health care organizations can alleviate emotional exhaustion caused by emotional labour and job stress amid emergencies by providing support at different levels: organizational and managerial. However, the effectiveness of these supports depends on high to low levels. IMPLICATIONS FOR NURSING MANAGEMENT: This study demonstrates that to handle and support emotional labour and job stress to avoid emotional exhaustion in health care emergencies, organizational supports matter. Support at organizational level can include instrumental support. At managerial level, holding a coaching leadership style can foster external facets of management while uplifting the internal support qualities of confidence and self-awareness that improve the individuals' ability to lead; work with paradox and uncertainty.