The independent and interactive effects of changes in overtime and night shifts during the COVID-19 pandemic on burnout among nurses: a longitudinal study.

OBJECTIVES: This study aimed to evaluate the independent and interactive effects of changes in overtime and night shifts on burnout among nurses during the COVID-19 pandemic. METHODS: Nurses working in an Italian university hospital (N=317) completed the Maslach Burnout Inventory in September 2019 and again in December 2020. Based on hospital administrative data, changes in overtime and night shifts in the same years were categorized into three groups each. Linear regressions were used to estimate 2020 burnout differences between exposure groups, controlling for 2019 burnout levels, demographic and work-related characteristics, and to test the interaction between the two exposures. RESULTS: Nurses in the onset of high overtime group had higher emotional exhaustion [4.33, 95% confidence interval (CI) 1.74-6.92], depersonalization (2.10, 95% CI 0.49-3.71), and poor personal accomplishment (2.64, 95% CI 0.55-4.74) compared to stable low overtime nurses. Nurses in the increase in night shifts group had lower emotional exhaustion (-4.49, 95% CI -7.46- -1.52) compared to no night shift nurses. Interaction analyses revealed that this apparently paradoxical effect was limited to stable low overtime nurses only. Moreover, increases in night shifts were associated with higher depersonalization and poor personal accomplishment in nurses in the stable high overtime group. CONCLUSIONS: Increase in overtime is an independent risk factor for burnout among nurses, highlighting the need for specific regulations and actions to address it. Long-standing guidelines for the assignment of night shifts might have contributed to attenuate the impact of their increase on nurses' mental health.

Effects of working from home on lifestyle behaviors and mental health during the COVID-19 pandemic: A survey study.

The COVID-19 outbreak has led to relevant changes in everyday life worldwide. One of these changes has been a rapid transition to and an increasing implementation of working from home (WH) modality. This study aimed to evaluate the impact of mandatory WH during the COVID-19 pandemic on lifestyle behaviors, Mediterranean diet adherence, body weight, and depression. An online cross-sectional survey was conducted in the early 2022 at the National Research Council of Italy using ad hoc questions and validated scales collecting information on physical activity, sedentary behavior, hobbies/pastimes, dietary habits including adherence to the Mediterranean diet, body weight, and depression during WH compared with before WH. 748 respondents were included in the study. An increased sedentary lifetime was reported by 48% of respondents; however, the subsample of workers who previously performed moderate physical activity intensified this activity. Body weight gain during WH was self-reported in 39.9% of respondents. Mediterranean diet adherence increased (p≪0.001) during WH compared with before WH. The average level of mental health did not record an overall variation; however, the proportion of subjects with mild and moderate depression increased (p = 0.006), while workers who reported values indicative of depression before the transition declared an improvement. These findings highlight health-related impact of WH during the COVID-19 pandemic that may inform future strategies and policies to improve employees' health and well-being.

Consequences and coping strategies of nurses and registered nurses perceiving to work in an environment characterized by workplace bullying.

Aim: The aim of this study was to analyze the well-being and coping strategies of nurses working in an organizational setting perceived as characterized by workplace bullying. The innovative aspect of this study is that we considered only those who perceive to work in an organizational environment characterized by workplace bullying, and not those who see themselves as victims and those who perceive they work in an organizational environment not characterized by workplace bullying. Method: A questionnaire with the NAQ-R, PGWBI, Val.Mob. and Brief COPE scales was administered to nurses. To better understand this phenomenon, a comparison was made between 331 nurses and 166 workers in other professions who also work in an organizational environment perceived to be characterized by workplace bullying. Results: In both groups (nurses and workers), the results were approximately the same in terms of personal bullying and workplace bullying episodes and the number of physical and emotive symptoms. The PGWBI score was lower for nurses than for workers in other fields. Among the individual symptoms, nurses and registered nurses were more likely to report gastritis, insomnia and heartburn than workers in other contexts. Workers in other contexts were more likely than nurses to report symptoms of anxiety, fear, feelings of insecurity, inferiority and guilt. In terms of coping strategies, nurses were more likely than other workers to report distraction, substance use, emotional support, disengagement, venting, positive reframing, humor, and religion. Workers in other professional context were more likely than nurses to report active coping, denial, instrumental support, planning, acceptance, and self-blame. Conclusion: Results suggest that the consequences of working in a perceived organizational environment characterized by workplace bullying are similar for both groups of workers, with nonstatistical differences in perceived workplace bullying episodes and sum of physical and emotive symptoms. Implication: Overall, findings suggest that workplace bullying prevention is a fundamental element in training workers in all types of workplaces and should be an integral part of curriculum activities.

The Work Ability Index (WAI) in the Healthcare Sector: A Cross-Sectional/Retrospective Assessment of the Questionnaire.

The Work Ability Index (WAI) is the most widely used questionnaire for the self-assessment of working ability. Because of its different applications, shorter versions, and widespread use in healthcare activities, assessing its characteristics is worthwhile. The WAI was distributed online among the employees of a healthcare company; the results were compared with data contained in the employees' personal health records and with absence registers. A total of 340 out of 575 workers (59.1%) participated; 6.5% of them reported poor work ability. Exploratory factor analysis indicated that the one-factor version best described the characteristics of the WAI. The scores of the complete WAI, the shorter form without the list of diseases, and the minimal one-item version (WAS) had equal distribution and were significantly correlated. The WAI score was inversely related to age and significantly lower in women than in men, but it was higher in night workers than in their day shift counterparts due to the probable effect of selective factors. The WAI score was also correlated with absenteeism, but no differences were found between males and females in the average number of absences, suggesting that cultural or emotional factors influence the self-rating of the WAI. Workers tended to over-report illnesses in the online survey compared to data collected during occupational health checks. Musculoskeletal disorders were the most frequently reported illnesses (53%). Psychiatric illnesses affected 21% of workers and had the greatest impact on work ability. Multilevel ergonomic and human factor intervention seems to be needed to recover the working capacity of healthcare workers.

Assessing Workplace Violence: Methodological Considerations.

The risk of violence is present in all workplaces. It must be accurately assessed to establish prevention and protection measures tailored to the features of each situation. The risk management process requires compliance in a sequential order: 1) risk identification, 2) quantitative risk assessment, and 3) impact assessment. Gathering workers' experiences using lists, focus groups, or participatory ergonomics groups is necessary to identify the phenomenon. For risk assessment, spontaneous reporting of events is often insufficient. It may be complemented with two methods: systematic recording of violent events that occurred in the past year during periodic medical examinations of workers and targeted surveys. The epidemiological analysis of data from individual interviews and surveys provides the phenomenon's prevalence, incidence, and evolution. Moreover, reporting the harm suffered by victims of violence allows constructing impact matrices to allocate resources where they are most needed.

SARS-CoV-2 infection in meat and poultry workers after the "first wave" (Summer 2020): a cross-sectional study on knowledge, attitudes, practices (KAP) of Italian occupational physicians.

BACKGROUND AND AIM: This cross-sectional study assessed knowledge, attitudes and practices (KAP) of Italian Occupational Physicians (OPs) on Coronavirus disease 2019 (COVID-19) among meat/poultry processing plant workers (MPWs) (Summer season 2020). METHODS: Data were collected through an online questionnaire including demographic characteristics, and items about COVID-19-related KAP in MPWs. A logistic regression was modelled in order to characterize explanatory variables of the outcome variable of having any professional experience as OP in meat/poultry processing industry. RESULTS: A total of 424 OPs (mean age 49.0 ± 9.1years; 49.5% males) participated into the survey. Despite a generally good level of knowledge on SARS-CoV-2 pandemic, OPs having professional experience with MPWs failed to recognize any increased risk for COVID-19 (Odds Ratio [OR] 0.162; 95% Confidence intervals [95%CI] 0.039-0.670), and were less likely to recommend periodical tests via nasal swabs (OR 0.168, 95%CI 0.047-0.605). On the contrary, they identified socioeconomic status of MPWs as a risk factor (OR 5.686, 95%CI 1.413-22.881), recommending cleaning interventions on changing rooms and canteens (OR 16.090, 95%CI 1.099-259.244). CONCLUSIONS: In conclusion, we reported a diffuse underestimation of the risk for COVID-19, that was alarmingly higher among professionals who should be more familiar with the specific requirements of MPWs. Some significant knowledge gaps were also clearly identified, stressing the opportunity for tailored educative interventions (www.actabiomedica.it).

Feasibility of a Stop Smoking Program for Healthcare Workers in an Italian Hospital: Econometric Analysis in a Total Worker Health® Approach.

Background: Over 20% of healthcare workers (HCWs) are active smokers. Smoking is a targeted issue for workplace health promotion (WHP) programs. Objective: Our study aims to evaluate the effectiveness of the Stop Smoking Promotion (SSP) intervention, a 6-hour training course for HCWs, which took place from May 2018 to July 2019. Methods: We compared HCWs who successfully quit smoking (n = 15) to those who did not (n = 25) in terms of Sickness Absence Days (SADs). Moreover, we conducted an econometric analysis by calculating the return on investment and implementing a break-even analysis. Findings: Among the 40 enrolled workers, a success rate of 37.5% was observed after a span of over two years from the SSP intervention (with nurses and physicians showed the best success rate). Overall, participants showed a noticeable absenteeism reduction after the SSP intervention, with a reduction rate of 85.0% in a one-year period. The estimated ROI for the hospital was 1.90, and the break-even point was 7.85. In other words, the organization nearly doubled its profit from the investment, and the success of at least eight participants balanced costs and profits. Conclusion: Our pilot study confirms that WHP programs are simple and cost-saving tools which may help improve control over the smoking pandemic in healthcare settings.

Supporting Return to Work after Breast Cancer: A Mixed Method Study.

Breast cancer (BC) is the most common invasive cancer in the world. Most BC survivors (BCSs) continue working while dealing with cancer-related disabilities. BCSs' return-to-work (RTW) after cancer treatment is an important stage of their recovery and is associated with a higher survival rate. In this study, we addressed the RTW of BCSs with the intention of facilitating this process through direct action in the workplace. Thirty-two women who requested assistance from January to December 2022 were enrolled in the study. Semi-structured interviews and medical examinations were conducted by a team of three physicians. Interviews were analyzed using Thematic Analysis. Moreover, a quantitative cross-sectional study was conducted to compare the health status of BCSs with that of a control group of 160 working women, using standardized questionnaires on work ability, fatigue, sleep problems, anxiety, depression, and happiness. BCSs were also asked to rate the level of organizational justice they perceived at work prior to their illness. From the qualitative analysis emerged three facilitating/hindering themes: (1) person-related factors, (2) company-related factors, and (3) society-related factors. In the quantitative analysis, BCSs had significantly higher scores for anxiety, depression, sleep problems and fatigue, and lower levels of happiness than controls. The RTW of BCSs entails adapting working conditions and providing adequate support. The work-related analysis of each case made it possible to highlight the measures that need to be taken in the workplace to promote RTW. The treatment of cancer should be paired with advice on the best way to regain the ability to work.

Resilience and Extrinsic Motivation as Mediators in the Relationship between Fear of Failure and Burnout.

Athletes with fear of failure are at risk of developing the symptoms of a wide range of psychological problems, including burnout. Understanding the risks and protective factors of athletes' psychological health is an essential step in tailoring strategies and interventions to promote athletes' psychological and mental health. This study examined the mediating roles of resilience and extrinsic motivation in the relationship between fear of failure and burnout among Turkish athletes. The study included 335 young athletes (93.4% males) whose ages ranged from 18 to 55 years (M = 24.95, SD = 8.22). Participants completed the self-reported measures of fear of failure, resilience, extrinsic motivation, and burnout. The analysis revealed that fear of failure had significant predictive effects on resilience, extrinsic motivation, and burnout. Resilience and extrinsic motivation also had significant predictive effects on burnout. The mediation analysis results showed that both resilience and extrinsic motivation partially mediated the effect of fear of failure on athlete burnout. The findings of the study provide a better insight into the underlying mechanisms between fear of failure and athlete burnout by considering resilience and extrinsic motivation as mediators. These results suggest that the adverse impact of fear of failure on athlete burnout can be mitigated by cultivating resilience and hindering extrinsic motivation.

Post-COVID Symptoms in Occupational Cohorts: Effects on Health and Work Ability.

Post-acute COVID-19 syndrome is frequently observed in workers and has a substantial impact on work ability. We conducted a health promotion program to identify cases of post-COVID syndrome, analyze the distribution of symptoms and their association with work ability. Of the 1422 workers who underwent routine medical examination in 2021, 1378 agreed to participate. Among the latter, 164 had contracted SARS-CoV-2 and 115 (70% of those who were infected) had persistent symptoms. A cluster analysis showed that most of the post-COVID syndrome cases were characterized by sensory disturbances (anosmia and dysgeusia) and fatigue (weakness, fatigability, tiredness). In one-fifth of these cases, additional symptoms included dyspnea, tachycardia, headache, sleep disturbances, anxiety, and muscle aches. Workers with post-COVID were found to have poorer quality sleep, increased fatigue, anxiety, depression, and decreased work ability compared with workers whose symptoms had rapidly disappeared. It is important for the occupational physician to diagnose post-COVID syndrome in the workplace since this condition may require a temporary reduction in work tasks and supportive treatment.

Coping with burnout and the impact of the COVID-19 pandemic on workers' mental health: A systematic review.

Introduction: The COVID-19 pandemic had a negative impact on the psychological wellbeing of workers worldwide. Certain coping styles may increase burnout risk. To investigate the relationship between burnout and coping styles, a systematic review was performed. Methods: Following the PRISMA statements, three databases were screened up until October 2022, including research articles written in English language and investigating the relationship between burnout and coping strategies in workers. The quality of articles was assessed by the Newcastle-Ottawa Scale. Results: The initial search resulted in 3,413 records, 15 of which were included in this review. Most studies were performed on healthcare workers (n = 13, 86.6%) and included a majority of female workers (n = 13, 86.7%). The most used burnout assessment questionnaire was the Maslach Burnout Inventory (n = 8, 53.3%), and the most used coping assessment tool was the Brief-COPE (n = 6, 40.0%). Task-related coping was a protective factor for burnout in all four studies investigating its correlation with burnout dimensions. Two of the four studies investigating emotion-oriented coping found that it was protective while the other two found that it was predictive of burnout. All five studies investigating avoidance-oriented coping and burnout dimensions found that this coping style was predictive of burnout. Discussion: Task-oriented and adaptive coping were protective for burnout, avoidance-oriented, and maladaptive coping were predictive factors of burnout. Mixed results were highlighted concerning emotion-oriented coping, suggesting that different outcomes of this coping style may depend on gender, with women relying more on it than men. In conclusion, further research is needed to investigate the effect of coping styles in individuals, and how these correlates with their unique characteristics. Training workers about appropriate coping styles to adopt may be essential to enact prevention strategies to reduce burnout incidence in workers.

Workplace Health Promotion Embedded in Medical Surveillance: The Italian Way to Total Worker Health Program.

In 2011, NIOSH launched the Total Worker Health (TWH) strategy based on integrating prevention and health promotion in the workplace. For several years now, in Italy, this integration has led to the creation of workplace health promotion embedded in medical surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. Results collected over the past 12 years from more than 20,000 participants demonstrate that WHPEMS projects are economical, sustainable, and effective. The creation of a network of occupational physicians who are involved in WHPEMS projects could help to improve the work culture, health, and safety of workers.

Sleep in Residents: A Comparison between Anesthesiology and Occupational Medicine Interns.

Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less (p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.

The state of general surgery residents in Italy after COVID-19 outbreak: a nationwide cross-sectional study.

INTRODUCTION: A significant reorganization of working activities including those of teaching hospitals occurred after COVID-19 outbreak, leading to the need to re-assess the current status of training after the pandemic. This study aimed to investigate the state of general surgery (GS) residency in Italy. The impact of COVID-19 on GS residents was also assessed. METHODS: Between October and November 2020, an anonymous online survey was distributed to GS residents across Italy. Email addresses were provided by the Regional Committees of the Italian Polyspecialistic Society of Young Surgeons. The residents completed a set of questions regarding their training schedule and three standardized questionnaires to measure burnout and psychological distress. RESULTS: Overall, 1709 residents were contacted and 648 completed the survey. Almost two-thirds of the residents (68.4%, n = 443) reported to not reach the minimum annual operative case volume. According to ordinal logistic regression analysis, two of the most perceived effects of COVID-19 by trainees on training were reduction of surgical activities (OR = 2.21, p < 0.001) and increased concerns about future employment (OR = 1.14, p = 0.025). Loss of training opportunities was also associated with a significant increase of distress (OR = 1.26, p = 0.003) but not with burnout. CONCLUSIONS: This study provided a snapshot of the situation of GS residents in Italy after COVID-19 outbreak. Reduction of activities due to pandemic highlighted the need to improve the level of surgical education in our country by implementing all the new available tools for training and ensuring at the same time the well-being of the residents.

Fitness to Drive: It is Time for Evidence-Based Consensus and Italian Guidelines for Medical Driving Assessment.

European Union (EU) and non-EU countries have adopted different medical procedures for the issuance and renewal of a driver's license showing relevant matters of concern. In Europe, EU directives have been only partially supplemented with national laws, and there is a paucity of evidence-based criteria and methods for fitness-to-drive assessment. For instance, there is no agreement on standards for establishing which is the competent authority charged with the medical examination. Furthermore, license conditions, restrictions, or vehicle modifications, which appear as "limited use" codes on the driver's license are not regulated. This may generate confusion and deformity when it comes to the medico-legal evaluation, with potential ethical implications due to lack of transparency and equity and legal disputes between citizens and competent authorities. In this article, Italian experts on fitness-to-drive medical assessment highlight some major issues concerning the medical driving assessment activity in the EU. The Italian experience is shown as a case study, which is representative of other EU member states, for launching a call for evidence-based consensus documents and scientific guidelines on this topic, which may be helpful to international regulators and medico-legal stakeholders.

Headache in Workers: A Matched Case-Control Study.

A case−control study including 446 workers reporting headaches (cases; 136 males and 310 females, mean age 46.71 ± 10.84 years) and 446 age- and sex-matched colleagues without headaches (controls; mean age 45.44 ± 10.13) was conducted in the second half of 2020 in a sample drawn from socio health and commercial services companies to investigate the association of headache with lifestyle, metabolic, and work-related factors. Workers suffering from headache reported higher body weight (OR: 1.92, 95% CI: 1.46−2.53, p < 0.001), higher blood cholesterol (OR: 2.01, 95% CI: 1.46−2.77, p < 0.001), triglyceride (OR: 2.01, 95% CI: 1.20−3.35, p < 0.01), blood glucose (OR: 1.91, 95% CI: 1.16−3.24, p < 0.01), and blood pressure levels (OR: 1.76, 95% CI: 1.23−2.52, p < 0.01). In the year preceding the survey, cases had experienced a higher frequency of workplace violence (OR: 2.29, 95% CI: 1.25−4.20, p < 0.01 for physical aggression, OR: 2.22, 95% CI: 1.45−3.41, p < 0.001 for threat, OR: 2.74, 95% CI: 1.72−4.38, p < 0.001 for harassment) and were more frequently distressed (effort/reward ratio > 1) (OR: 1.82, 95% CI: 1.39−2.40, p < 0.001) than the controls. Compared to the controls, cases also had higher scores on anxiety and depression scales, lower scores on happiness, and lower levels of sleep quality (p < 0.001). The association of headaches with metabolic and mental health problems suggests that monitoring headaches in the workplace could help to identify workers at risk of impairment.

The Impact of Workplace Violence on Headache and Sleep Problems in Nurses.

Workplace violence (WV) is a significant occupational hazard for nurses. Previous studies have shown that WV has a reciprocal relationship with occupational stress. Headaches and sleep problems are early neuropsychological signs of distress. This cross-sectional study aims to ascertain the frequency of physical or verbal assaults on nurses and to study the association of WV with headaches and sleep problems. During their regular medical examination in the workplace, 550 nurses and nursing assistants (105 males, 19.1%; mean age 48.02 ± 9.98 years) were asked to fill in a standardized questionnaire containing the Violent Incident Form (VIF) concerning the episodes of violence experienced, the Headache Impact Test (HIT-6) regarding headaches, and the Pittsburgh Sleep Quality Inventory (PSQI) on sleep quality. Occupational stress was measured using the Effort/Reward Imbalance questionnaire (ERI). Physical and non-physical violence experienced in the previous year was reported by 7.5% and 17.5% of workers, respectively. In the univariate logistic regression models, the workers who experienced violence had an increased risk of headaches and sleep problems. After adjusting for sex, age, job type, and ERI, the relationship between physical violence and headaches remained significant (adjusted odds ratio aOR = 2.25; confidence interval CI95% = 1.11; 4.57). All forms of WV were significantly associated with poor sleep in a multivariate logistic regression model adjusted for sex, age, job type, and ERI (aOR = 2.35 CI95% = 1.44; 3.85). WV was also associated with the impact of headaches and with sleep quality. WV prevention may reduce the frequency of lasting psychoneurological symptoms, such as headaches and poor sleep quality, that interfere with the ability to work.

The Impact of Quality of Work Organization on Distress and Absenteeism among Healthcare Workers.

The quality of work organization may be responsible not only for reduced productivity but also for an increased risk of mental and physical disorders. This study was aimed at testing this hypothesis. Workers of a local health unit in Italy were asked to fill out the Work Organization Assessment Questionnaire (WOAQ) during their periodic medical examinations in the second half of 2018. On the same occasion, they also completed the Demand/Control/Support (DCS) measure of job strain, the Effort/Reward Imbalance (ERI) questionnaire, and the General Health Questionnaire (GHQ12) to assess psychological health. A total of 345 workers (85.8%) completed the survey. Linear regression analysis showed that the quality of work organization was inversely proportional to psychological health problems (p < 0.001). Occupational stress, measured both by job strain and ERI, was a moderating factor in this relationship. The relationship between the WOAQ and psychological health, moderated by job strain or ERI, remained highly significant even after adjustment for sex, age, social support, and overcommitment. Regression models explained over 40% of the shared variance of the association between quality of work organization and psychological health. The quality of work organization significantly predicted the risk of sickness absence for musculoskeletal disorders (OR = 0.984, CI95% 0.972-0.996) and for other health problems (OR = 0.977, CI95% 0.967-0.988). A continuous improvement of work organization must consider not only the clients' or production needs but also the well-being of workers.

Development and Validation of a New Measure of Work Annoyance Using a Psychometric Network Approach.

Existing measures of the impact of job characteristics on workers' well-being do not directly assess the extent to which such characteristics (e.g., opportunity to learn new skills) are perceived as positive or negative. We developed a measure, the Work Annoyance Scale (WAS), of the level of annoyance that workers feel about certain aspects of the job and evaluated its psychometric properties. Using archival data from two cohorts (n = 2226 and 655) of workers that had undergone an annual medical examination for occupational hazard, we show the usefulness of the network psychometric approach to scale validation and its similarities and differences from a traditional factor analytic approach. The results revealed a two-dimensional structure (working conditions and cognitive demands) that was replicable across cohorts and bootstrapped samples. The two dimensions had adequate structural consistency and discriminant validity with respect to other questionnaires commonly used in organizational assessment, and showed a consistent pattern of association with relevant background variables. Despite the need for more extensive tests of its content and construct validity in light of the organizational changes due to the COVID-19 pandemic and of an evaluation of the generalizability of the results to cultural contexts different from the Italian one, the WAS appears as a psychometrically sound tool for assessment and research in organizational contexts.

Organizational Justice and Health: A Survey in Hospital Workers.

In complex systems such as hospitals, work organization can influence the level of occupational stress and, consequently, the physical and mental health of workers. Hospital healthcare workers were asked to complete a questionnaire during their regular occupational health examination, in order to assess the perceived level of organizational justice, and to verify whether it was associated with occupational stress, mental health, and absenteeism. The questionnaire included the Colquitt Organizational Justice (OJ) Scale, the Karasek/Theorell demand-control-support (DCS) questionnaire for occupational stress, and the General Health Questionnaire (GHQ12) for mental health. Workers were also required to indicate whether they had been absent because of back pain in the past year. Organizational justice was a significant predictor of occupational stress. Stress was a mediator in the relationship between justice and mental health. Occupational stress was more closely related to perceptions of lack of distributive justice than to perceptions of procedural, informational, and interpersonal justice. Physicians perceived significantly less distributive justice than other workers. In adjusted univariate logistic regression models, the perceptions of organizational justice were associated with a significant reduction in the risk of sick leave for back pain (OR 0.96; CI95% 0.94−0.99; p < 0.001), whereas occupational stress was associated with an increased risk of sick leave (OR 6.73; CI95% 2.02−22.40; p < 0.002). Work organization is a strong predictor of occupational stress and of mental and physical health among hospital employees.