Do the work unit characteristics directly or indirectly affect psychological distress in female call-handlers?

PURPOSE: This study aimed to test if work unit characteristics (WUCs) reported by call-center managers were directly related to the psychological distress reported by call-handlers or if these associations were mediated by the psychosocial working conditions (PWC). METHODS: Managers of 105 call-centers were interviewed about their call-center's WUCs by occupational physicians. 2719 female call-handlers from these call-centers completed self-reported questionnaires to evaluate PWC (Karasek, Siegrist, and other specific workplace stressors) and psychological distress (GHQ12 score). A two-level analysis tested the relationships between the 14 WUCs and GHQ12 score, with and without adding PWC as confounders. Unchanged coefficients between WUCs and GHQ12 score were assumed to flag a direct association between WUCs and psychological distress. In the case of changed coefficients, the mediated proportion was estimated using multiple mixed models. RESULTS: Five out of fourteen WUCs were related to GHQ12 score: outbound-call type, call-center size, number of activity parameters displayed on the screen, the existence of a fixed break, and the assigned role of the supervisor being the monitoring/supervision of call-handler activities. After adding PWC, the association remained statistically significant only for outbound calls. For the other WUCs, the proportion of mediation by stressor ranged from 56 to 66%. Mediation was mostly through job demand, lack of reward and ethical conflict dimensions. CONCLUSION: The main results were that (1) associations exist between the WUCs reported by managers and the psychological distress reported by call-handlers, and (2) that most of these associations are mediated by psychosocial working conditions.

Is the effect of work-related psychosocial exposure on depressive and anxiety disorders short-term, lagged or cumulative?

PURPOSE: To determine the short-term, lagged, and cumulative effects of psychosocial factors (PSF) on the incidence of depression and anxiety. METHOD: Major depressive disorders (MDD) and generalized anxiety disorders (GAD) were diagnosed in 2006 and 2010 using the Mini International Neuropsychiatric Interview among 5684 workers from the French SIP cohort. The outcome considered here was diagnosis of MDD and/or GAD (MDD/GAD) in 2010. The frequency of 17 PSF, covering labour intensity and working time, emotional demand, autonomy, social relationships, conflict of values, and job insecurity, was self-reported in 2006 and 2010. For each PSF, four groups (A-D) were considered: exposed neither in 2006 nor in 2010 (A as the reference), exposed in 2010 but not in 2006 (B as a short-term association), exposed in 2006 but not in 2010 (C as a lagged association), exposed in both 2006 and 2010 (D as a cumulative association). RESULTS: In men, short-term and cumulative-and to a lesser extent lagged-associations of four labour-intensity factors with MDD/GAD occurrence were observed (high volume of work, pressure at work, high complexity, and long working hours). In women, the short-term and cumulative associations of five PSF were observed, mostly emotional demand factors, lack of reward and work-family imbalance. Job insecurity had strong, short-term, cumulative and lagged associations in both men and women. CONCLUSION: According to PSF and gender, the results suggest that the relationships between PSF exposure and MDD/GAD were mostly short-term and cumulative rather than lagged.

Relationships between organizational workplace characteristics and perceived workplace strain in call-centers in France.

BACKGROUND: Our objective was to study the associations between organizational workplace characteristics (OC) reported by call-center (CC) managers and workplace stressors reported by call-handlers. METHODS: The managers of 107 CCs were interviewed by their occupational physicians using a questionnaire designed to specifically explore OC in the CCs. Four thousand two call-handlers from these CCs completed a self-report questionnaire including the Karasek and Siegrist work stressor questionnaires and two specific items on other workplace stressors. RESULTS: Around one-third of the OC examined were associated with the demand/control ratio, the perception of demanding work and ethical conflicts, however, far fewer OC were associated with the effort/reward ratio. Most OC were associated with higher levels of job stressors. Some had strong, systematic negative associations with stressors (e.g., highly formatted instructions for the client relationship). CONCLUSIONS: These findings could help in targeting job stressor prevention and health improvement strategies in CCs.

Multi-level modeling of aspects associated with poor mental health in a sample of prehospital emergency professionals.

BACKGROUND: The goal of this paper is to investigate the respective influence of work characteristics, the effort-reward ratio, and overcommitment on the poor mental health of out-of-hospital care providers. METHODS: 333 out-of-hospital care providers answered a questionnaire that included queries on mental health (GHQ-12), demographics, health-related information and work characteristics, questions from the Effort-Reward Imbalance Questionnaire, and items about overcommitment. A two-level multiple regression was performed between mental health (the dependent variable) and the effort-reward ratio, the overcommitment score, weekly number of interventions, percentage of non-prehospital transport of patients out of total missions, gender, and age. Participants were first-level units, and ambulance services were second-level units. We also shadowed ambulance personnel for a total of 416 hr. RESULTS: With cutoff points of 2/3 and 3/4 positive answers on the GHQ-12, the percentages of potential cases with poor mental health were 20% and 15%, respectively. The effort-reward ratio was associated with poor mental health (P < 0.001), irrespective of age or gender. Overcommitment was associated with poor mental health; this association was stronger in women (ß = 0.054) than in men (ß = 0.020). The percentage of prehospital missions out of total missions was only associated with poor mental health at the individual level. CONCLUSIONS: Emergency medical services should pay attention to the way employees perceive their efforts and the rewarding aspects of their work: an imbalance of those aspects is associated with poor mental health. Low perceived esteem appeared particularly associated with poor mental health. This suggests that supervisors of emergency medical services should enhance the value of their employees' work. Employees with overcommitment should also receive appropriate consideration. Preventive measures should target individual perceptions of effort and reward in order to improve mental health in prehospital care providers.

[Effects of shift work on health]. / Effets du travail de nuit sur la santé.

20% of employees in industrialized countries are concerned by shift work. Nevertheless, there is very little information in general medical journals about the effects of shift work on health. Shift work can have several major effects on health such as cardiovascular and digestive disorders among others, as demonstrated by several studies in recent decades. Shift work has attracted considerable attention recently when it was declared probable carcinogen by the International Agency for research on cancer. We review the health disorders that may be generated or aggravated by shift work and illustrate the problem by two case studies of occupational medicine and discuss the appropriate attitude to take.

Evaluation of the French version of EUROQUEST: a questionnaire for neurotoxic symptoms.

BACKGROUND: EUROQUEST was designed to explore various neuropsychiatric symptoms caused by neurotoxic agents in occupational epidemiological studies. This paper was aimed at assessing (i) the internal consistency of the French version of EUROQUEST, (ii) its sensitivity to age, educational level and exposure, (iii) and its convergent validity by examining relationships between declared symptoms and results from psychometric tests on the same mental functions. DESIGN: Data from four cross-sectional studies were selected: 180 workers exposed to toluene, mixed solvents or anaesthetic gas, and 588 non-exposed ones. The internal consistency of the questionnaire was assessed by computing Cronbach's alphas. Sensitivity to age, educational level and exposure were assessed with multiple linear regression models. Relationships between EUROQUEST scores and correspondent neuropsychological tests were assessed with Pearson's correlation coefficients. The relationships between EUROQUEST domain specific scores, age and educational level were evaluated for men and women from the Reference group. Most of the analyses were performed in men and women separately. RESULTS: The results of the Cronbach's alphas computed for each EUROQUEST domain, showed a reasonable internal consistency for the questionnaire. For both women and men, memory problems and sleep disorders increased significantly with age. A significant association between EUROQUEST scores and exposure to neurotoxic agents was found for workers exposed to anaesthetic gas only. In addition, EUROQUEST memory symptoms from the Reference population were found to be correlated with two memory neuropsychological tests, both for men and women. CONCLUSION: Our results showed a high internal consistency and a good convergent validity on assessed domains. Moreover, they showed a significant sensitivity to age, educational level and highlighted sensitivity to anaesthetic gas exposure.

Exposure to job-stress factors in a national survey in France.

OBJECTIVES: Job stress is a growing epidemiologic field in France. The aim of this study was to evaluate the levels of occupational psychosocial risk factors to which the French working population is exposed. It also focused on developing a job-exposure matrix. METHODS: This study used existing French national data on work conditions collected by the French Ministry of Labor in 1991, in which 20 929 workers were interviewed by questionnaire. The items of the questionnaire were retained that represented potential stressors. A principal component analysis was performed to summarize the data in terms of job-stress factors. Four independent variables (gender, age, occupation, and activity) were available, as well as scores for exposure to psychosocial risk factors. The CART (classification and regression tree) segmentation method was used to construct the job-exposure matrix. RESULTS: Fourteen psychosocial factors were identified and interpreted on the basis of the results of the principal component analysis and deepened by experts' judgment. To take into account the well-known difference of distribution in occupations between men and women, a gender-specific matrix was developed. CONCLUSIONS: This study is the first attempt to develop a job-exposure matrix in the area of job-stress factors in France. Thus the results have allowed the assessment of exposure to 14 psychosocial factors for all of the 455 categories of the French occupational classification for men and women separately.

Health effects of occupational exposure in a dairy food industry, with a specific assessment of exposure to airborne lactic acid bacteria.

OBJECTIVE: Lactic acid bacteria (LAB) are used in food industries as probiotic agents. The aim of this study is to assess the potential health effects of airborne exposure to a mix of preblend (LAB and carbohydrate) and milk powder in workers. METHODS: A medical questionnaire, lung function tests, and immunologic tests were carried out on 50 workers. Occupational exposure to inhalable dust and airborne LAB was measured. RESULTS: Workers not using respiratory masks reported more symptoms of irritation than workers using protection. Workers from areas with higher levels of airborne LAB reported the most health symptoms and the immune responses of workers to LAB was higher than the immune responses of a control population. CONCLUSIONS: Measures to reduce exposure to airborne LAB and milk powder in food industries are recommended.

Comparison of potential adjustment variables representing primary intellectual level in epidemiological studies on neurotoxicity.

BACKGROUND: Primary intellectual abilities (PIA) are a confounder in epidemiological studies on neurotoxicity. A good measure of this confounder should be independent of age as PIA is an intrinsic ability. Furthermore, as PIA is related to health endpoints, any measure of PIA should reveal this association. This study is aimed at comparing vocabulary test, diploma and age at end of schooling properties as measures of PIA in a non-exposed population of workers. METHODS: The design was a cross-sectional study of 413 non-exposed workers (203 women and 210 men) selected from a health check-up center. The effect of age on the vocabulary score was assessed using an analysis of covariance adjusted for diploma. Relationships between neuropsychological performances and vocabulary score, diploma and end of schooling age were, respectively, assessed using multiple linear regressions adjusted for age and gender. RESULTS: Vocabulary score increased significantly with age, both for men and women. The increase was 0.14 word per year for women, and 0.18 word per year for men. The explained variance of the models evaluating the relationships between age at end of schooling, diploma, vocabulary test, and neuropsychological performances was quite similar for the three measures of PIA. CONCLUSIONS: Vocabulary score was found to be age-related, even after adjustment for diploma. No difference was found between these three variables in terms of their relationship to neuropsychological endpoints. Moreover, the literature shows that vocabulary test performances are influenced by exposure to neurotoxic agents. These results suggest that vocabulary score could be of interest for participants of similar ages and similar diplomas. Otherwise, the other two variables would be better PIA measures in neurotoxicology studies.

Neurobehavioral disturbances arising from occupational toluene exposure.

BACKGROUND: Neurotoxicity of long-term exposure to toluene is known at higher levels than 50 ppm and is suspected at lower levels. METHODS: A cross-sectional study carried out in two printing plants on 129 blue collar workers explored such a low level exposure of toluene. With 231 samples of ambient air, toluene concentration was estimated from 0 to 18 ppm in Plant A (offset) and from 2 to 27 ppm in Plant B (heliogravure). Outside any period of acute exposure, the workers answered a self-administered questionnaire on neurotoxic symptoms, EUROQUEST, and performed six psychometric tests on a computer-assisted version of battery NES. RESULTS: After adjustment for confounders, we found significant relationships only between present exposure and Digit Span Forwards (DSF) performance (decrement is 1 digit for 40 ppm, P=0.04) and Digit Span Backwards (DSB) performance (decrement is 1 digit for 25 ppm, P=0.01). Neurotoxic symptoms were not significantly correlated with current exposure. No association was found between estimated cumulative exposure and either psychometric performances or neurotoxic symptoms. CONCLUSION: In this study, low present exposure levels to toluene were associated with decrements of memory test performances.