Occupational health and safety regulatory interventions to improve the work environment: An evidence and gap map of effectiveness studies.

Background: Unsafe and unhealthy working conditions lead to injuries and financial losses across the globe, resulting in a need for research into effective work environment interventions. Objectives: The objective of this evidence and gap map (EGM) is to provide an overview of existing systematic reviews and primary studies examining the effects of occupational health and safety regulatory interventions. Search Methods: Relevant studies are identified through searches in published and unpublished literature performed up to January 2023. Selection Criteria: The population for this EGM is workers above the age of 15 and their workplaces within the OECD. We include randomised controlled trials, non-randomised studies with a comparison of two or more groups of participants, and systematic reviews of effects. Data Collection and Analysis: The map has been populated based on information about interventions and outcomes, study design, OECD country, and publication status. We have performed critical appraisal of included systematic reviews using an adjusted version of the AMSTAR-2 tool. Main Results: The included studies for this report consist of six systematic reviews, 28 primary effect studies, and three on-going studies. The interactive map shows that the largest cluster of studies is located in the inspection activity domain, while the sickness absence outcome domain and the intervention categories for training initiatives and formulation of regulatory standards are only scarcely populated. Additionally, the AMSTAR-appraisal suggests a lack of rigorous systematic reviews and meta-analyses. Authors' Conclusions: More research in the form of primary studies and rigorous systematic reviews is needed to provide stakeholders with better guidance as to what constitutes the most efficient regulatory approaches to improve the work environment.

Literacy and risk of occupational injury.

OBJECTIVE: We examined whether low literacy skills are a risk factor for occupational injury during a 5.3-year follow-up period. METHODS: The study population was taken from the Danish participants in the Programme for the International Assessment of Adult Competencies (PIAAC) in 2011/2012. Literacy skills were based on the PIAAC survey. Data on occupational injuries were obtained from national registers. We included the 5997 employees aged 16-65 who worked during the follow-up period. We used Cox regression to estimate the risk of occupational injury as a function of literacy skills. We adjusted the analysis for gender, age, nationality at birth, educational level, occupation, weekly work hours and month of survey completion. RESULTS: Literacy skills were divided into four categories based on the six levels of skills in PIAAC. With the highest level of literacy skills as the reference (level 4/5), the hazard ratios for occupational injury were estimated at 1.58 (95% CI 0.80-3.15) for literacy level 3, 2.04 (95% CI 0.99-4.19) for literacy level 2 and 2.29 (95% CI 1.08-4.86) for literacy level 0/1. CONCLUSION: Employees with a low level of literacy skills are at a higher risk of occupational injury than employees with a high level of literacy skills.

Full evaluation of the psychometric properties of COPSOQ II. One-year longitudinal study on Polish human service staff.

PURPOSE: The aim of the study was the full evaluation of the psychometric properties of the COPSOQ II in one-year longitudinal study on human service staff in Poland. Data were collected from 599 employees representing three occupational groups related to human service work. METHODS: CFA was conducted in the structure proposed by the author of the original tool, based on one model, which included 119 observable variables forming 33 latent variables (single item subscales were excluded from analysis). To our knowledge, this was the first complete validation of the entire model using CFA. Reliability analysis was performed using two methods: internal consistency analysis and test-retest analysis. Predictive validity was assessed by correlating COPSOQ II variables with ten criterion variables related to job demands, job resources, work-family conflicts, mental health and well-being. RESULTS: According to the results, CFA supported the original structure of the COPSOQ II. Most of the 33 subscales were characterized by good or very good psychometric parameters. The obtained results confirmed also the fairly high reliability, as well as high convergence validity of all subscales of COPSOQ II. CONCLUSION: The final conclusion is that COPSOQ II is characterised by satisfactory psychometric properties and could be successfully used to fulfil the demand for reliable and comprehensive assessment methods also in Polish job market settings.

The effect of monetary incentive on survey response for vulnerable children and youths: A randomized controlled trial.

AIM: In surveys non-responders may introduce bias and lower the validity of the studies. Ways to increase response rates are therefore important. The purpose of the study was to investigate if an unconditional monetary incentive can increase the response rate for vulnerable children and youths in a postal questionnaire survey. METHODS: The study was designed as a randomized controlled trial. The study population consisted of 262 children and youth who participated in an established intervention study aimed at creating networks for different groups of vulnerable children and youths. The mean age of the participants was 16.7 years (range 11-28) and 67.9% were female. The questionnaire was adapted to three different age groups and covered different aspects of the participants' life situation, including the dimensions from the Strengths and Difficulties Questionnaire (SDQ). In the follow-up survey, participants were randomly allocated to two groups that either received a €15 voucher for a supermarket together with the questionnaire or only received the questionnaire. We used Poisson regression to estimate the differences in response rate (Rate Ratio RR) between the intervention group and the control group. RESULTS: The response rate was 75.5% in the intervention group and 42.9% in the control group. The response rate in the intervention group was significantly higher than in the control group when adjusting for age and gender (Rate Ratio, RR 1.73; 95% CI 1.38-2.17). We did not find any significant differences in scales scores between the two groups for the five scales of the SDQ. In stratified analyses, we found the effect of the incentive to be higher for males (RR 2.81; 95% CI 1.61-4.91) than for females (1.43; 95% CI 1.12-1.84). CONCLUSIONS: Monetary incentives can increase the response rate for vulnerable children and youths in surveys. TRIAL REGISTRATION: The trial was retrospectively registered at ClinicalTrials.gov Identifier: NCT01741675.

Feedback-informed treatment: A systematic review and meta-analysis of the partners for change outcome management system.

The Partners for Change Outcome System (PCOMS) is a feedback system that has been developed as part of psychotherapeutic treatment. The aim of this systematic review was to evaluate the effect of the PCOMS. We searched the literature and included studies that used a randomized controlled trial (RCT) design. We calculated a combined effect size across studies for outcomes related to the number of sessions attended. We also calculated a combined effect size for outcomes related to the participants' well-being. However, in the analysis of the effect on well-being, we excluded studies that included only the Outcome Rating Scale as a measure of effect because this scale is part of the PCOMS. In the calculation of the combined effect size, we used random effect models with inverse weighted variance. In the systematic literature search we identified 14 RCT studies that evaluated the effect of the PCOMS. Based on 12 studies, we found a rather small effect size for the number of sessions attended favoring the PCOMS intervention (Hedges's g = 0.13; 95% confidence interval [CI: 0.001, 0.26]). The effect size corresponded to a difference of less than 1 session. Six studies included a well-being scale that was independent of the PCOMS intervention as the outcome. The effect size for the 6 studies was insignificant (Hedges's g = 0.03; 95% Cl [-0.18, 0.23]). We found no evidence that the PCOMS feedback system has an effect on the number of sessions attended by clients or that the PCOMS improves the well-being of clients. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Construct validity of a global scale for Workplace Social Capital based on COPSOQ III.

BACKGROUND AND AIM: Workplace Social Capital has been suggested as a useful concept when addressing organizational and social factors of the work environment. The overall aim of the present study is to establish and evaluate the construct validity of a measure of Workplace Social Capital based on the operationalization suggested in the third version of the Copenhagen Psychosocial questionnaire. METHODS: The present study is based on data collected as part of a validation and development project for the use of the Swedish version of COPSOQ at workplaces and includes responses from 1316 human service workers answering a workplace survey. Six items from scales for organizational justice, vertical trust and horizontal trust in COPSOQ III were included in the analyses. Rasch Analysis was used for scale validation. RESULTS: The analyses showed that the psychometric properties of the suggested COPSOQ scale for Workplace Social Capital were satisfactory after accommodation for local dependency. Each individual item worked as intended, the scale was unidimensional and functioned invariantly for women and men, and for younger and older employees. The scale was furthermore found to be valid for use for distinguishing groups, not individuals. CONCLUSION: We have established that the scale for Workplace Social Capital measured by COPSOQ III is valid for distinguishing groups, e.g. work teams. The scale exhibits good construct validity as it satisfies the measurement criteria defined by the Rasch model.

Long working hours and stroke among employees in the general workforce of Denmark.

AIMS: A systematic review and meta-analysis have found that long working hours were prospectively associated with an increased risk of overall stroke. The primary aim of the present study was to test if this finding could be reproduced in a sample that has been randomly selected from the general workforce of Denmark. A secondary aim was to estimate the association for haemorrhagic and ischaemic stroke separately. METHODS: Individual participant data on 20- to 64-year-old employees were drawn from the Danish Labour Force Survey, 1999-2013, and linked to data on socio-economic status (SES), migrations, hospitalisations and deaths from national registers. The participants were followed from the time of the interview until the end of 2014. Poisson regression was used to estimate age-, sex- and SES-adjusted rate ratios for stroke as a function of weekly working hours. RESULTS: With 35-40 working hours per week as reference, the estimated rate ratios for overall stroke were 0.97 (95% confidence interval (CI) 0.83-1.13) for 41-48 working hours, 1.10 (95% CI 0.86-1.39) for 49-54 working hours and 0.89 (95% CI 0.69-1.16) for ≥55 working hours. The estimated rate ratios per one category increase in working hours were 0.99 (95% CI 0.93-1.06) for overall stroke, 0.96 (95% CI 0.88-1.05) for ischaemic stroke and 1.15 (95% CI 1.02-1.31) for haemorrhagic stroke. CONCLUSIONS: Our analysis does not support the hypothesis that long working hours are associated with increased rates of overall stroke. It suggests, however, that long working hours might be associated with increased rates of haemorrhagic stroke.

Workplace social capital and risk of long-term sickness absence. Are associations modified by occupational grade?

BACKGROUND: Workplace social capital (WSC) is an emerging topic among both work environment professionals and researchers. We examined (i) whether high WSC protected against risk of long-term sickness absence (LTSA) in a random sample of the Danish workforce during a 1-year follow-up and (ii) whether the association of WSC with sickness absence was modified by occupational grade. METHODS: We measured WSC by self-report in a cohort of 3075 employees and linked responses to a national register of sickness absence. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of onset of LTSA (≥21 days), adjusted for covariates. We stratified analyses by occupational grade and examined if there was an interaction effect of WSC and occupational grade. RESULTS: A one standard deviation higher WSC score predicted a reduced risk of sickness absence after adjustment for sociodemographic variables, prevalent health problems and health behaviours (HR = 0.85, 95% CI = 0.74-0.99). The HR was attenuated and lost statistical significance after further adjustment for occupational grade (HR = 0.90, 95% CI = 0.78-1.04). When stratified by occupational grade, high WSC predicted a decreased risk of sickness absence among higher grade workers (HR = 0.61, 95% CI = 0.44-0.84) but not among lower grade workers (HR = 0.98, 95% CI = 0.83-1.15). The interaction effect of WSC and occupational grade was statistically significant (HR = 0.97, 95% CI = 0.95-0.99). CONCLUSION: High WSC might reduce risk of LTSA. However, the protective effect appears to be limited to workers of higher occupational grade.

Update on work-related psychosocial factors and the development of ischemic heart disease: a systematic review.

The present review deals with the relationship between occupational psychosocial factors and the incidence of ischemic heart disease (IHD) with special regard to the statistical power of the findings. This review with 4 inclusion criteria is an update of a 2009 review of which the first 3 criteria were included in the original review: (1) STUDY: a prospective or case-control study if exposure was not self-reported (prognostic studies excluded); (2) OUTCOME: definite IHD determined externally; (3) EXPOSURE: psychosocial factors at work (excluding shift work, trauma, violence or accidents, and social capital); and (4) Statistical power: acceptable to detect a 20% increased risk in IHD. Eleven new papers met the inclusion criteria 1-3; a total of 44 papers were evaluated regarding inclusion criteria 4. Of 169 statistical analyses, only 10 analyses in 2 papers had acceptable statistical power. The results of the 2 papers pointed in the same direction, namely that only the control dimension of job strain explained the excess risk for myocardial infarction for job strain. The large number of underpowered studies and the focus on psychosocial models, such as the job strain models, make it difficult to determine to what extent psychosocial factors at work are risk factors of IHD. There is a need for considering statistical power when planning studies.

Exposure to disturbing noise and risk of long-term sickness absence among office workers: a prospective analysis of register-based outcomes.

PURPOSE: To investigate the association between self-reported exposure to disturbing noise and risk of long-term sickness absence (LTSA) for more than two consecutive weeks among office workers. METHODS: LTSA was measured using register data that were linked to survey data from 2,883 office workers aged 18-59 who were surveyed in 2005 on exposure to disturbing noise. The risk of LTSA was investigated using Cox proportional hazards model. RESULTS: Of the study population, 4.4 % had LTSA in the 1-year follow-up period. Compared to office workers who were 'rarely or never' exposed to disturbing noise at work, office workers who reported being 'frequently' exposed to disturbing noise had a significantly increased estimated risk of LTSA when adjusting for age, gender, smoking status, and managerial position (HR = 1.90; 95 % CI, 1.12-3.22). After additional adjustment for psychosocial work conditions, the estimated risk of LTSA for office workers who were frequently exposed to disturbing noise became marginally insignificant (HR = 1.73; 95 % CI, 0.99-3.01). A subgroup analysis showed that women who reported being frequently exposed to disturbing noise had a significantly increased estimated risk of LTSA (HR = 1.94; 95 % CI, 1.04-3.64), whereas the corresponding risk for men was insignificant (HR = 1.28; 95 % CI, 0.37-4.41). CONCLUSIONS: This study indicates that frequent self-reported exposure to disturbing noise at work is associated with increased risk of LTSA among office workers and that this association may be stronger for women than for men.

Psychosocial risk assessment: French validation of the Copenhagen Psychosocial Questionnaire (COPSOQ).

AIMS: This study presents a French version of the Copenhagen Psychosocial Questionnaire (COPSOQ) and analyses its psychometric properties for the purpose of validation. The questionnaire assesses psychosocial risk factors at work. The French questionnaire (derived from the Danish short version) is composed of 32 items grouped into 17 scales measuring five domains and eight additional questions assessing aggressive behaviour at work. METHOD: The questionnaire was administered to 935 employees of a large firm in the Parisian area. RESULTS: All psychometric analyses performed (internal consistency of the scales, exploratory factor analysis, concurrent validity analysis) gave satisfactory results and demonstrated the validity of the French COPSOQ. CONCLUSIONS: A new questionnaire is now available in French. A large body of data is currently being gathered in view of comparing occupations and types of firms using this new instrument.

Collegial Support and Community with Trust in Swedish and Danish dentistry.

OBJECTIVES: The aim of the study was to better understand the associations between work factors and professional support among dentists (Collegial Support) as well as the sense of being part of a work community characterized by trust (Community with Trust). METHODS: A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models. RESULTS: A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust. CONCLUSION: A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists.

Measurement of social support, community and trust in dentistry.

BACKGROUND AND AIM: Relationships among people at work have previously been found to contribute to the perception of having a good work. The aim of the present paper was to develop scales measuring aspects of social support, trust, and community among dentists, and to evaluate psychometric properties of the scales. MATERIAL AND METHODS: In 2008, a questionnaire was sent to 1,835 general dental practitioners randomly selected from the dental associations in Sweden and Denmark. The response rate was 68% after two reminders. Principal Component Analysis was applied to 14 items and scales were established based on the resulting factors. Internal consistency was evaluated by Cronbach's alpha. Differential Item Functioning (DIF) with respect to gender, nationality and employment sector was analysed using ordinal logistic regression methods. Construct validity was assessed in relation to self-rated health and a range of work satisfaction outcomes. RESULTS: The percentage of missing values on the items was low (range 0.7%-3.8%). Two scales (range 0-100) were established to measure 'Community with Trust'(nine items, mean = 79.2 [SD = 13.4], Cronbach's alpha = 0.89) and 'Collegial Support'(five items, mean = 70.4 [SD = 20.8], Cronbach's alpha = 0.89). DIF of only minor importance was found which supported cultural equivalence. The two scales were weakly positively correlated with each other. 'Community with Trust' was in general more strongly correlated with work satisfaction variables than 'Collegial Support' was. CONCLUSIONS: Stability and internal consistency of the scales were considered as satisfactory. Content validity and construct validity were considered as good. Further validation in other populations is recommended.

The second version of the Copenhagen Psychosocial Questionnaire.

AIMS: The aim of the present paper is to present the development of the second version of the Copenhagen Psychosocial Questionnaire (COPSOQ II). METHODS: The development of COPSOQ II took place in five main steps: (1) We considered practical experience from the use of COPSOQ I, in particular feedback from workplace studies where the questionnaire had been used; (2) All scales concerning workplace factors in COPSOQ I were analyzed for differential item functioning (DIF) with regard to gender, age and occupational status; (3) A test version of COPSOQ II including new scales and items was developed and tested in a representative sample of working Danes between 20 and 59 years of age. In all, 3,517 Danish employees participated in the study. The overall response rate was 60.4%; (4) Based on psychometric analyses, the final questionnaire was developed; and (5) Criteria-related validity of the new scales was tested. RESULTS: The development of COPSOQ II resulted in a questionnaire with 41 scales and 127 items. New scales on values at the workplace were introduced including scales on Trust, Justice and Social inclusiveness. Scales on Variation, Work pace, Recognition, Work-family conflicts and items on offensive behaviour were also added. New scales regarding health symptoms included: Burnout, Stress, Sleeping troubles and Depressive symptoms. In general, the new scales showed good criteria validity. All in all, 57% of the items of COPSOQ I were retained in COPSOQ II. CONCLUSIONS: The COPSOQ I concept has been further developed and new validated scales have been included.

Determining minimally important score differences in scales of the Copenhagen Psychosocial Questionnaire.

AIM: To determine minimally important differences (MIDs) for scales in the first version of the Copenhagen Psychosocial Questionnaire (COPSOQ). METHODS: Data were taken from two separate studies: a national population survey (N = 1062), and an intervention study at 14 workplaces (N = 1505). On the basis of the population survey, the MID for each COPSOQ scale was calculated as one-half of a standard deviation (0.5 SD). For the core COPSOQ scales on ''Quantitative demands'', ''Influence at work'', ''Predictability'', ''Social support (from colleagues and supervisors, respectively)'', and ''Job satisfaction'', the MIDs were evaluated in the intervention study, where score differences for the scales were linked to the respondents' global self-evaluation of the impact of the interventions. The scales were scored from 0 to 100 in both studies. RESULTS: The MIDs calculated as 0.5 SD were, on average, 9.2 (range 6.8-14.9) for the long version scales, and 10.8 (range 7.6-14.9) for the medium-length version scales. The analysis of the self-evaluated changes on the scale scores for the core COPSOQ scales showed that the anchor-based estimates of MID were generally lower than 0.5 SD. CONCLUSIONS: We recommend the following MID values for the COPSOQ scales: ''Quantitative demands'', 0.3 SD; ''Influence'', 0.2 SD; ''Predictability'', 0.3 SD; ''Social support from colleagues'', 0.3 SD; ''Social support from supervisor'', 0.7 SD; and ''Job satisfaction'', 0.4 SD. For all other COPSOQ scales, where we do not have anchor-based results, we recommend the conventional MID value of 0.5 SD.

Do psychosocial work environment factors measured with scales from the Copenhagen Psychosocial Questionnaire predict register-based sickness absence of 3 weeks or more in Denmark?

AIMS: To analyse the predictive validity of 18 psychosocial work environment scales from the Copenhagen Psychosocial Questionnaire version II (COPSOQ II) with regard to risk of sickness absence. METHODS: The study population consisted of 3188 wage earners (52% women) from a representative sample of Danish residents. Participants received the long version of the COPSOQ II in autumn and winter 2004-2005, including 18 psychosocial work environment scales from the domains ''Demands at work'', ''Work organization and job contents'', and ''Interpersonal relations and leadership''. The study endpoint was register-based sickness absence of 3 weeks or more in the 1-year period following completion of the COPSOQ II. Associations between COPSOQ scales at baseline and sickness absence at follow-up were analysed with Cox proportional hazards models, adjusted for age, gender, prevalence of a health problem at baseline, and occupational grade. RESULTS: Sickness absence during follow-up was predicted by a one standard deviation increase on the scales of cognitive demands (hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.00-1.37), emotional demands (HR 1.28, 95% CI 1.10-1.50), and role conflicts (HR 1.32, 95% CI 1.15-1.52). After applying adjustment for multiple testing, the effect of emotional demands and of role conflict remained statistically significant, but not the effect of cognitive demands. CONCLUSIONS: Selected psychosocial work environment factors from the COPSOQ predict register-based sickness absence in the Danish workforce.

Evaluating construct validity of the second version of the Copenhagen Psychosocial Questionnaire through analysis of differential item functioning and differential item effect.

AIMS: To evaluate the construct validity of the Copenhagen Psychosocial Questionnaire II (COPSOQ II) by means of tests for differential item functioning (DIF) and differential item effect (DIE). METHODS: We used a Danish general population postal survey (n = 4,732 with 3,517 wage earners) with a one-year register based follow up for long-term sickness absence. DIF was evaluated against age, gender, education, social class, public/private sector employment, and job type using ordinal logistic regression. DIE was evaluated against job satisfaction and self-rated health (using ordinal logistic regression), against depressive symptoms, burnout, and stress (using multiple linear regression), and against long-term sick leave (using a proportional hazards model). We used a cross-validation approach to counter the risk of significant results due to multiple testing. RESULTS: Out of 1,052 tests, we found 599 significant instances of DIF/DIE, 69 of which showed both practical and statistical significance across two independent samples. Most DIF occurred for job type (in 20 cases), while we found little DIF for age, gender, education, social class and sector. DIE seemed to pertain to particular items, which showed DIE in the same direction for several outcome variables. DISCUSSION: The results allowed a preliminary identification of items that have a positive impact on construct validity and items that have negative impact on construct validity. These results can be used to develop better shortform measures and to improve the conceptual framework, items and scales of the COPSOQ II. CONCLUSIONS: We conclude that tests of DIF and DIE are useful for evaluating construct validity.

Psychosocial work environment and its association with socioeconomic status. A comparison of Spain and Denmark.

AIMS: The purpose of this study was to describe psychosocial work environment inequalities among wage earners in Spain and Denmark. METHODS: Data came from the Spanish COPSOQ (ISTAS 21) and the Danish COPSOQ II surveys both performed in 2004-05 and based on national representative samples of employees with a 60% response rate. Study population was 3,359 Danish and 6,685 Spanish women and men. Only identical items from both surveys were included to construct 18 psychosocial scales. Socioeconomic status was categorized according to the European Socioeconomic Classification System. Analysis included ordinal logistic regression and multiple correspondence analysis after categorizing all scales. RESULTS: A relationship between socioeconomic status and psychosocial work environment in both Denmark and Spain was observed, with wider social inequalities in Spain for many scales, describing a strong interaction effect between socioeconomic status and country. CONCLUSIONS: Socioeconomic status is related to psychosocial work environment and some adverse psychosocial conditions tend to cluster in lower socioeconomic status groups in both Spain and Denmark. This effect could be modified by a country's characteristics, such as economic and labour market structures, normative regulations and industrial relations including work organization. Hence, preventive strategies to reduce social inequalities in working conditions should consider the combination of actions at the macro and micro levels.

Good Work for dentists - a qualitative analysis.

OBJECTIVE: This study explores dentists' perceptions of Good Work in the meaning of positive and rewarding aspects in their work in contrast to a traditional problem-centred focus on work life. METHODS: Nine informants were selected among Danish and Swedish general dental practitioners to obtain variation as to country of origin, gender, age and clinical work experience. Semi-structured, in-depth interviews were audio-recorded and transcribed verbatim in the original language. Statements concerning positive aspects of work were used for systematic text condensation according to the principles of Giorgi's phenomenological analysis, as modified by Malterud, generalizing descriptions reflecting aspects of Good Work. Selection of participants continued until saturation of the emerging categories was achieved. RESULTS: The core of Good Work emanates from the clinical encounter: from the relation with the patient and from the opportunity to carry out high quality odontological handicraft. Social relations at the workplace, as well as organizational values and conditions were perceived as influencing the opportunities to achieve the rewarding aspects from the clinical encounter. CONCLUSIONS: The results implicate a need for developing a work-environmental model with intrinsic as well as extrinsic rewards when dealing with human service organizations. At policy level it is necessary to address the professional culture.

Prevalence of workplace bullying and risk groups: a representative population study.

OBJECTIVES: To estimate the prevalence of bullying and to identify risk groups in a representative population sample. METHODS: The data for this study was taken from the second Danish Psychosocial Work Environment Study (DPWES). The sample consisted of 3,429 employees between 20 and 59-years. The response rate for the study was 60.4%. RESULTS: The study showed that 8.3% of the respondents had been bullied within the past year, 1.6% of the sample reported daily to weekly bullying. Co-workers (71.5%) and managers/supervisors (32.4%) were most often reported as perpetrators of bullying, but bullying from subordinates (6%) was also reported. We found significant differences in the prevalence of bullying for both occupational status and work process, a variable characterizing the employees main task in their job. Unskilled workers reported the highest prevalence of bullying, while managers/supervisors the lowest prevalence. People working with things (male-dominated occupations) and people working with clients/patients (female-dominated occupations) reported higher prevalence of bullying than people working with symbols or customers. No significant gender or age differences were found. CONCLUSIONS: These findings suggest that types of work and gender ratio are risk factors in the onset of workplace bullying. Future studies should take into account the type of work and the gender ratio of the organization.