[Preventive withdrawal from work, psychosocial work demands and major depressive symptoms]. / Retrait préventif du travail, exposition aux contraintes psychosociales au travail et symptômes dépressifs majeurs.

AIM: Our study objectives were as follows: assess exposure to psychosocial work demands among working pregnant women and women on preventive withdrawal from work; and measure the association between psychosocial work demands and major depressive symptoms, according to time of withdrawal from work. METHODOLOGY: Karasek's abbreviated scale was used to measure psychosocial work demands (Job strain and "Iso-strain") and CES-D scale (Center for Epidemiological Studies Depression Scale) was used to measure major depressive symptoms (CES-D score≥23), at 24-26 weeks of pregnancy, among 3043 pregnant women in Montreal (Quebec) who worked at paid jobs at least 15 h/week and at least four consecutive weeks since the beginning of their pregnancy. Multivariate logistic regression models were built. RESULTS: At 24-26 weeks of pregnancy, 31.4% (956/3043) of pregnant women were on preventive withdrawal from work. They were more in "high-strain" (31.1% vs. 21.1%) and "Iso-strain" groups (21.0% vs. 14.2%) than those who continued to work (P<0.0001). The prevalence of major depressive symptoms was higher in women on preventive withdrawal from work (10.8%; CI 95%: 8.9 to 12.9) compared to working women (7.1%; CI 95%: 6.1-8.3). After adjustment for personal and professional risk factors, "Iso-strain" remained significantly associated with major depressive symptoms in working women (adjusted OR=1.75; CI 95%: [1.05 to 2.92]) and women on preventive withdrawal from work, regardless of duration of activity before withdrawal: 4 to 12 weeks (adjusted OR=2.72; CI 95%: [1.19-6.12]), 13 to 20 weeks (adjusted OR=3.51; CI 95%: [1.54-7.97]), and ≥21 weeks (adjusted OR=2.39; CI 95%: [1.10-5.20]). CONCLUSION: Psychosocial work demands are an important risk factor for the mental health of pregnant workers and require that preventive actions be put forward.

Effort--reward imbalance and medically certified absence for mental health problems: a prospective study of white-collar workers.

OBJECTIVE: Little is known about the effects of psychosocial work factors on objectively assessed mental health problems leading to medically certified absence. Only one study has evaluated the prospective effects of effort-reward imbalance (ERI) at work with regards to this outcome. The present study aimed to evaluate the effects of ERI on the incidence of medically certified absence for mental health problems. METHODS: The study included 2086 white-collar workers (63.3% women) employed in public organisations in Quebec city. Participants were followed over a 9-year period. Medical absences from work were collected from employers' files and psychosocial factors were measured using the ERI questionnaire. Cox regression models were used to estimate the incidence of certified sickness absence due to mental health problems that lasted 5 workdays or more, while controlling for confounders. RESULTS: Workers exposed to ERI had a higher risk of a first spell of medically certified absence for mental health problems (HR=1.38, 95% CI 1.08 to 1.76) compared with unexposed workers. Low reward was significantly associated with a high risk among men (HR=2.80, 95% CI 1.34 to 5.89) but not in women. (HR=1.24, 95% CI 0.90 to 1.73). Effort at work had no effect on certified absence. All these effects were adjusted for potential confounders. CONCLUSIONS: ERI and low reward at work were prospectively associated with medically certified absence for mental health problems. These effects seem to differ by gender. Primary prevention that is aimed at reducing these stressors should be considered to help reduce the incidence of such severe mental health problems.

Repeated exposure to effort-reward imbalance, increased blood pressure, and hypertension incidence among white-collar workers: effort-reward imbalance and blood pressure.

OBJECTIVES: To determine whether men and women with repeated ERI exposure have increased BP means or higher hypertension incidence over a 3-year follow-up. To examine the potential modifying effect of age and overcommitment. METHODS: The study cohort was composed of 1,595 white-collar workers (629 men and 966 women) assessed at baseline and 3-year follow-up. Ambulatory BP measures were taken every 15 min during a working day. ERI at work was self-reported using validated scales. BP means at follow-up and cumulative incidence of hypertension were respectively modeled with analyses of covariance (ANCOVA) and log-binomial regression. RESULTS: Among men, no association was observed between repeated ERI exposure and BP. Among women, age had a modifying effect. Women <45 years old exposed to ERI at both times had significantly higher BP means at follow-up (122.2/78.9 mmHg) than those unexposed (120.4/77.4 mmHg). In women ≥45 years old, the cumulative incidence of hypertension was 2.78 (95% CI: 1.26-6.10) times higher among those exposed to ERI at both times. Men and women in the higher tertile of overcommitment had higher BP means (men: 128.9/82.2 mmHg, women: 121.9/78.0 mmHg) than those in the lower tertile (men: 127.2/81.3 mmHg, women: 120.6/77.0 mmHg). CONCLUSION: This prospective study showed that, among women, repeated ERI exposure led to a significant age-specific increase in BP means and a major age-specific increase in hypertension incidence. These results suggest that primary intervention aimed at reducing ERI may contribute to lower BP and prevent hypertension in women.

Relationship between psychosocial factors at work and incidence of perceived health problems in the GERICOTS cohort.

BACKGROUND: The objective of this study was to investigate the relationship between the incidence of health problems and the psychosocial work environment in a French occupational cohort. METHODS: Among the 2062 employees in the North of France who participated in the GERICOTS survey between 1999 and 2004, 1154 subjects who kept the same full-time shift in the same firm during the study period (797 men and 357 women) were included. Job strain was assessed using Karasek's model--the strain profile (high psychological demand and low decision latitude) and the iso-strain profile (strain profile and low social support)--and Siegrist's model, Effort-Reward Imbalance (ERI) (high effort and low rewards). Perceived health status was assessed using the four dimensions of the Nottingham Health Profile (emotional reactions, sleep, social isolation, pain). The results are given by the odds ratio adjusted for age, occupational category, and size of firm. RESULTS: At baseline, higher prevalence of health problems was found in workers with job strain, e.g., between emotional reactions and iso-strain for men, OR=3.50 (2.19-5.60) and for women, 2.64 (1.39-5.04) or between sleep disorders and ERI for men, OR=2.41 (1.71-3.40) and for women, OR=2.41 (1.39-4.20). Longitudinal analysis showed a significant relationship between incidence of health problems and level of job strain in 1999, e.g., between sleep disorder incidence and strain profile, OR=1.89 (1.16-3.06) and ERI, OR=2.20 (1.43-3.38). CONCLUSION: These results show a significant relationship between perceived health and job stress in 1999 but also between incidence of health problems between 1999 and 2004 and job strain in 1999.

Assessment of the pharmacological effects of inotropic drugs on left ventricular pressure and contractility: an evaluation of the QA interval as an indirect indicator of cardiac inotropism.

INTRODUCTION: The ICH S7A and S7B guidelines require that effects of test substances on the cardiovascular system be assessed with respect to blood pressure, heart rate and electrocardiogram intervals. Where adverse effects are identified additional supplemental studies, including ventricular contractility, should be conducted as deemed appropriate. However, there is an absence of definitive guidance regarding when to pursue supplementary studies, in part due to ill-defined criteria of what constitutes an adverse effect and to surgical/technical monitoring limitations of study designs. However with advances in technology it is now feasible to develop models for assessing LVP and contractility in conjunction with standard assessments. The objectives of this study were to 1) develop a model for chronic evaluation of LVP and contractility, 2) illustrate changes in LV contractility without concurrent proportional changes in heart rate and/or systemic blood pressure and 3) determine if the QA interval, the time between the Q on the ECG and the beginning of the upstroke on the arterial blood pressure, can be used as a indicator of altered LV contractility. METHODS: Dogs (N=4) were implanted with a telemetry transmitter. LVP, contractility, ECG and BP were assessed prior to and up to 24 h following administration of Atenolol (10 mg/kg) and Pimobendan (0.45 mg/kg). RESULTS: Atenolol caused an approximately 30% decrease in HR, followed by a sustained decrease in maximum left ventricular contractility (+dP/dt mmHg/s). No effects were noted on blood pressure. Pimobendan caused a 100% increase in contractility (+dP/dt mmHg/s) which remained elevated for approximately 4 h. No effects were noted on blood pressure. Heart rate was highly variable initial decreasing, followed by a highly variable increase until 4 h postdose. Following administration of both compounds changes in maximum left ventricular contractility correlated with reverse changes in QA interval duration. DISCUSSION: This model demonstrates that evaluation of LV contractility complements measurements of heart rate and blood pressure as part of a more complete cardiovascular safety assessment strategy. Furthermore, we demonstrate an apparent correlation between dP/dt and QA interval and concluded that QA interval can be utilized as an indicator of a potential inotropic effect. However further confirmation should be assessed through additional in-vivo measurements of LVP and contractility.

Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital.

OBJECTIVES: To describe the development and implementation phases of a participative intervention aimed at reducing four theory grounded and empirically supported adverse psychosocial work factors (high psychological demands, low decision latitude, low social support, and low reward), and their mental health effects. METHODS: The intervention was realised among 500 care providers in an acute care hospital. A prior risk evaluation was performed, using a quantitative approach, to determine the prevalence of adverse psychosocial work factors and of psychological distress in the hospital compared to an appropriate reference population. In addition, a qualitative approach included observation in the care units, interviews with key informants, and collaborative work with an intervention team (IT) including all stakeholders. RESULTS: The prior risk evaluation showed a high prevalence of adverse psychosocial factors and psychological distress among care providers compared to a representative sample of workers from the general population. Psychosocial variables at work associated with psychological distress in the prior risk evaluation were high psychological demands (prevalence ratio (PR) = 2.27), low social support from supervisors and co-workers (PR = 1.35), low reward (PR = 2.92), and effort-reward imbalance (PR = 2.65). These results showed the empirical relevance of an intervention on the four selected adverse psychosocial factors among care providers. Qualitative methods permitted the identification of 56 adverse conditions and of their solutions. Targets of intervention were related to team work and team spirit, staffing processes, work organisation, training, communication, and ergonomy. CONCLUSION: This study adds to the scarce literature describing the development and implementation of preventive intervention aimed at reducing psychosocial factors at work and their health effects. Even if adverse conditions in the psychosocial environment and solutions identified in this study may be specific to the healthcare sector, the intervention process used (participative problem solving) appears highly exportable to other work organisations.

Effectiveness of a participative intervention on psychosocial work factors to prevent mental health problems in a hospital setting.

OBJECTIVES: To assess the effectiveness of a workplace intervention aimed at reducing adverse psychosocial work factors (psychological demands, decision latitude, social support, and effort-reward imbalance) and mental health problems among care providers. METHODS: A quasi-experimental design with a control group was used. Pre-intervention (71% response rate), and one-year post-intervention measures (69% response rate) were collected by telephone interviews. RESULTS: One year after the intervention, there was a reduction of several adverse psychosocial factors in the experimental group, whereas no such reduction was found in the control group. However, there was a significant deterioration of decision latitude and social support from supervisors in both experimental and control groups. There was also a significant reduction in sleeping problems and work related burnout in the experimental hospital, whereas only sleeping problems decreased in the control group while both client related and personal burnout increased in this hospital. The comparison between the experimental and control groups, after adjusting for pre-intervention measures, showed a significant difference in the means of all psychosocial factors except decision latitude. All other factors were better in the experimental group. CONCLUSION: Results suggest positive effects of the intervention, even though only 12 months have passed since the beginning of the intervention. Follow up at 36 months is necessary to evaluate whether observed effects are maintained over time. In light of these results, we believe that continuing the participative process in the experimental hospital will foster the achievement of a more important reduction of adverse psychosocial factors at work. It is expected that the intensity of the intervention will be directly related to its beneficial effects. Long term effects will however depend on the willingness of management and of staff to appropriate the process of identifying what contributes to adverse psychosocial factors at work and to adopt means to reduce them.

[Work characteristics and health of correctional officers]. / Les caractéristiques du travail et la santé des agents en services de détention.

BACKGROUND: The association between the psychosocial work environment and mental health problems has been well documented over the past years. Karasek and Theorell's job strain model and Siegrist's effort/reward imbalance model have been associated to several physical and mental health problems. Moreover, in the last decade, the Quebec correctional services sector has known an important increase in sickness benefit claims for mental health problems. This study aimed to describe the psychosocial work characteristics and health of Quebec correctional officers and to determine the occupational risk factors associated to psychological distress among them. METHODS: This cross-sectional study was realized among 1034 correctional officers from 18 prisons in the province of Quebec, 668 men and 366 women. The response rate was 76%. Psychological demands, decision latitude, social support at work, reward, and psychological distress have been documented by telephone interviews during spring 2000. RESULTS: Correctional officers were more exposed to adverse psychosocial factors at work than a comparable sample of Quebec workers and they reported more health problems. Results showed that the same sources of psychological distress affected men and women, but sometimes at different degrees. High psychological demands combined with low or high decision latitude, and effort/reward imbalance were associated to psychological distress independently of potential confounding factors. Among other work factors associated to the report of high psychological distress among correctional officers were low social support at work, and conflicts with colleagues and superiors. CONCLUSION: Many adverse psychosocial factors at work were in excess among correctional officers compared to workers from the general population. These factors, also related to high levels of psychological distress, could be addressed with the goal of primary prevention of mental health problems at work.

Differentiating temporal electromyographic waveforms between those with chronic low back pain and healthy controls.

OBJECTIVES: Temporal activation patterns from abdominal and lumbar muscles were compared between healthy control subjects and those with chronic low back pain. STUDY DESIGN: A cross-sectional comparative study. BACKGROUND: Synergist and antagonist coactivity has been considered an important neuromuscular control strategy to maintain spinal stability. Differences in onset times and amplitudes have been reported from trunk muscle EMG recordings between healthy subjects and those with low back pain;however, evaluating temporal EMG waveforms should demonstrate whether differences exist in the ability of those with and those without low back pain to respond to changing perturbations. METHODS: The Karhunen-Loève expansion was applied to the ensemble-average EMG profiles recorded from four abdominal and three trunk extensor muscle sites while subjects performed a leg-lifting task aimed at challenging lumbar spine stability. The principal patterns were derived and the weighting coefficients for each pattern were the main dependent variables in a series of two-factor (group and muscle) mixed ANOVA models. RESULTS: Three principal patterns explained 96% of the variance in the temporal EMG profiles. The ANOVAs revealed statistically significant group and muscle main effects (P<0.05) for the principal pattern and significant group by muscle interactions (P<0.05) for patterns two and three. Post hoc analysis showed that patterns were not different among all muscle sites for the healthy controls, but differences were significant for the low back pain group. CONCLUSIONS: The healthy group coactivated all seven sites with the same temporal pattern of activation. The low back pain group used different activation patterns indicative of a lack of synergistic coactivitation among the muscle sites examined. RELEVANCE: These results provide a foundation for developing a diagnostic classifier of neuromuscular impairment associated with low back pain, that could be used to evaluate the effectiveness of therapeutic interventions to improve muscle coactivation.

Muscle activation during exercises to improve trunk stability in men with low back pain.

OBJECTIVES: To evaluate the relative activation amplitudes from 3 abdominal and 2 trunk extensor muscle sites of persons with low back pain (LBP) performing the pelvic-tilt, the abdominal-hollowing, and level 1 of the trunk stability test (TST) exercises and to compare the activation amplitudes among muscle sites and exercises. DESIGN: A prospective, comparative, repeated-measures design. SETTING: Motion analysis research laboratory. PARTICIPANTS: Fourteen men with LBP (mean duration, 8y; mean age +/- standard deviation, 39+/-5y). INTERVENTIONS: Subjects performed 3 exercises in random order while surface electromyograms were recorded from 5 muscle sites: lower and upper rectus abdominus, external oblique, erector spinae, and multifidus. The exercises were divided into 2 phases: a movement phase and a stabilization phase. The root-mean-square (RMS) electromyographic amplitude for each phase was calculated and normalized to the highest RMS amplitude from a series of 4 exercises, which attempted to elicit maximal voluntary isometric contractions (MVICs) for each muscle. A 2-factor, repeated-measures analysis of variance (ANOVA) tested the muscle by exercise interaction and the 2 main effects for each phase separately. MAIN OUTCOME MEASURES: Normalized RMS amplitude was the main dependent variable. The ensemble-average profiles for each muscle were calculated to examine the phasing of activation throughout the exercises. RESULTS: The ANOVA revealed a statistically significant muscle-by-exercise interaction (P<.05) for both phases, which showed that the 3 exercises; recruited the 5 muscle sites using different patterns of relative amplitudes. The external oblique muscle site was activated to higher amplitudes than the other 4 muscle sites for all 3 exercises; the highest normalized RMS activity occurred at the external oblique during the pelvic tilt (32% MVIC). The phasic patterns among the 5 muscle sites were not consistent for the TST but were consistent among the 5 sites for the other 2 exercises. CONCLUSIONS: None of the exercises recruited the abdominal muscles to intensities deemed adequate for strengthening. The TST challenges the coordination of muscle activity during the leg-loading task (stabilization phase) as evidenced by changes in amplitudes over the total exercise time for the external oblique site, but not the other 4 sites. All 3 exercises could be used as initial exercises in a dynamic stability progression when low-recruitment amplitudes of specific muscles were the objective but not for strengthening.

Muscle activation in therapeutic exercises to improve trunk stability.

OBJECTIVE: To evaluate the relative activation amplitudes from 3 abdominal and 2 trunk extensor muscle sites in healthy subjects performing the pelvic tilt, abdominal hollowing, and level 1 of the trunk stability test (TST level 1) exercises and to compare the activation amplitudes among muscle sites and exercises. DESIGN: Prospective comparative study. SETTING: Motion Analysis Research Center, Dalhousie University, Canada. PARTICIPANTS: Twenty-four healthy men (mean age, 30 +/- 8.1 yr [SD]) without low back pain. INTERVENTIONS: Subjects performed 3 exercises in a balanced order, repeating each exercise 5 times while surface electromyography (EMG) was recorded from the 5 muscle sites. Exercises were divided into 2 phases: movement and stabilization. The root-mean-square amplitude of the EMG for each phase was calculated and normalized to the maximal voluntary isometric contraction (MVIC) amplitude for each muscle. A 2-factor repeated-measures analysis of variance (ANOVA) tested the muscle by exercise interaction and the main effects for each phase separately. MAIN OUTCOME MEASURES: Normalized activation amplitude was the main dependent variable. Ensemble-average curves were calculated to examine the phasing of activation. RESULTS: ANOVA showed a statistically significant interaction (p < .05) for both phases, indicating the 3 exercises recruited the 5 muscle sites using different patterns of relative activation. The external oblique (EO) muscle site was activated to higher amplitudes than the other 4 sites in all 3 exercises for both phases. The highest activity was recorded from the EO during the pelvic tilt, just more than 25% of MVIC. The only exercise to recruit the erector spinae to significantly higher amplitudes than the multifidus site was the TST level 1. CONCLUSIONS: Study exercises were not interchangeable for the patterns of trunk muscle activation amplitudes. The exercises did not recruit the abdominal muscles to adequate levels for strengthening for this healthy sample; however, all 5 muscle sites were activated, forming the basis of a stabilizing exercise approach.

Psychosocial factors at work, smoking, sedentary behavior, and body mass index: a prevalence study among 6995 white collar workers.

This cross-sectional study examined whether psychosocial factors at work were associated with smoking, sedentary behavior, and body mass index. The study population was composed of 3531 men and 3464 women employed as white collar workers in 21 organizations. Data were collected at worksites. Psychological demands and decision latitude at work were measured with the Karasek 18-item questionnaire. Smoking, sedentary behavior, and mean body mass index were compared by quartiles of decision latitude and psychological demands and by job strain categories. Prevalence of smoking, mean number of cigarettes smoked per day, prevalence of sedentary behavior, and mean body mass index were not consistently associated with decision latitude, psychological demands, or high job strain. However, prevalence of smoking was elevated in women belonging to the highest quartile of psychological demands (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0 to 1.6) and in the active job strain groups in both men (OR, 1.6; 95% CI, 1.2 to 2.1) and women (OR, 1.4; 95% CI, 1.0 to 2.0). Prevalence of sedentary behavior was elevated in men in the lowest quartile of decision latitude (OR, 1.3; 95% CI, 1.0 to 1.7), in the passive group (OR, 1.3; 95% CI, 1.0 to 1.5), and in the high strain group (OR, 1.2; 95% CI, 1.0 to 1.6). In women, this prevalence was elevated in the third quartile of psychological demand (OR, 1.3; 95% CI, 1.1 to 1.6). These results provide only partial support for an association between some psychosocial factors at work and the prevalence of smoking and sedentary behavior.

Prognostic value of the proliferative index determined by Ki-67 immunostaining in superficial bladder tumors.

The biological behavior of urothelial carcinomas remains unpredictable. The objective of this study was to determine the prognostic value of Ki-67 index in superficial papillary bladder tumors and to correlate it with the S-phase fraction (SPF) measured by flow cytometry. Three hundred nineteen patients with newly diagnosed superficial (pTa, pT1) bladder tumors were included between September 1990 and April 1992. Patients with bladder carcinoma in situ alone were excluded. We observed 255 pTa tumors and 64 pT1 tumors, whereas 111 lesions were classified as grade G1 and 208 as grade G2-G3. Ki-67 immunostaining was performed on paraffin-embedded material using a 3-step immunoperoxidase procedure with the murine monoclonal antibody MiB1. The relation between Ki-67 expression and prognostic variables (stage, grade, tumor size, multifocality, age, and sex) was investigated by the chi-square test. Cox regression was used to describe the association between Ki-67 and tumor recurrence in 308 patients with follow-up while adjusting for potentially confounding prognostic variables. The frequency of high Ki-67 expression (> or =10%) increased with stage (P = .005) and grade (P = .001), but not with tumor size or multifocality. Two hundred one patients experienced tumor recurrence in a median follow-up of 68 months. Stage, grade, tumor size, and multifocality were all independent predictors of recurrence. Ki-67 index greater than 10% was found to be an independent predictor of tumor recurrence among patients with tumors larger than 3 cm in diameter (HR = 2.05, CI = 1.18-3.55), but not those with smaller size tumors. With regards to the DNA index, a significant but weak correlation was observed between Ki-67 expression and the SPF (Spearman's correlation coefficient = 0.23, P = .004). In addition, aneuploid tumors had significantly higher expression of Ki-67 (22.5%) than diploid tumors (10.1%) (P = .0006). Moreover, patients with DNA aneuploid bladder tumors were more likely to have more than 10% Ki-67-positive cells than those with diploid tumors. In patients with newly diagnosed pTa or pT1 bladder tumors, a Ki-67 index above 10% is an independent predictor of shorter time to recurrence only in those with tumors larger than 3 cm.

Job strain and evolution of mental health among nurses.

The objective of this 2nd phase of a 2-year study among female nurses was to provide further empirical validation of the demands-control and social support model. The association of job strain with psychological problems and the potential modifying role of social support at work were examined. A questionnaire was sent at the workplace to 1,741 nurses. The same associations were found between psychological demands, decision latitude, and a combination of the 2 with psychological distress and emotional exhaustion for current exposure and for cumulative exposure. Social support had a direct effect on these psychological symptoms but did not modify their association with job strain. Longitudinal and prospective data are needed to study the occurrence and persistence of health problems when exposure is maintained or retrieved.

Effect of family responsibilities and job strain on ambulatory blood pressure among white-collar women.

OBJECTIVE: This study was conducted to determine whether large family responsibilities and their combination with high job strain were associated with an increase in ambulatory blood pressure (BP) among white-collar women. METHODS: A cross-sectional study was conducted in a stratified random sample of 199 white-collar women with or without children who were employed full time in jobs involving high or low strain. These women were selected from a population of 3183 women of all ages, employed in eight organizations in Quebec City, Canada. Subjects wore an ambulatory BP monitor for 24 hours during a working day. Mean BPs were calculated. Different measures of family responsibilities were used, based on the number of children and their ages, and domestic work. Job strain was measured using the Job Content Questionnaire recommended by Karasek. RESULTS: Family responsibility measures were significantly related to diurnal BP among women holding a university degree (N=69). Indeed, women having large family responsibilities had increases in systolic and diastolic BPs of 2.7 to 5.7/1.8 to 4.0 mm Hg (p< or =.05). Among women holding a university degree, increases in diurnal systolic and diastolic BPs reached 8.1 to 10.9/5.5 to 7.1 mm Hg (p< or =.01) among women having both large family responsibilities and high job strain. These results were independent of confounders. There was no significant association among women without a university degree (N=130). CONCLUSIONS: Large family responsibilities were associated with significant increases in diurnal systolic and diastolic BPs among white-collar women holding a university degree. In these women, the combined exposure of large family responsibilities and high job strain tended to have a greater effect on BP than the exposure to only one of these factors.

[The professional life and the health of nurses since the transformation of the Québec health system.]. / La vie professionnelle et la santé des infirmières depuis la transformation du réseau de la santé

Over the last years, the Quebec health system has gone through a period of transformation aimed at cost reduction and better efficiency. The present study describes the effects of the transformation on the professional life and on the health of nurses in the Quebec City urban area. Despite a cross-sectional study not allowing links from cause to effect and despite the fact that the study only includes nurses who were still employed by institutions, the research shows an increase of the prevalence of a higher level of psychological distress in nurses since the beginning of the transformation. Interventions in the work place should be geared to professional factors that nurses identify as problematical.

Job strain and ambulatory blood pressure among female white-collar workers.

OBJECTIVES: The association between job strain and ambulatory blood pressure was studied among female white-collar workers. METHODS: This cross-sectional investigation studied 210 women in high- or low-strain jobs randomly selected from 3183 women of all ages, employed as white-collar workers. The women wore an ambulatory blood pressure monitor for 24 hours during a workday. Mean blood pressures were calculated. Psychological demands and decisional latitude were measured twice (14 months before and 7 days before the blood pressure measurement) with 2 scales recommended by Karasek. RESULTS: Significant differences in blood pressure were found according to current job strain among the women holding a university degree. Their mean blood pressures during work were significantly higher [8.0 mm Hg (1.1 kPa) systolic and 6.4 mm Hg (0.8 kPa) diastolic blood pressure] in the high-strain group than in the low-strain group. Statistically significant elevations in blood pressure over the 24-hour period were also found for women with a university degree. Cumulative exposure to high strain over 14 months was also significantly associated with high systolic blood pressure at work, in the evening, and over a 24-hour period irrespective of other factors related to blood pressure. Among the women without a university degree, the blood pressure differences observed between the job strain groups were less than 1 mm Hg (0.1 kPa) and not statistically significant. CONCLUSIONS: These results provide support for the effect of job strain on ambulatory blood pressure only among female white-collar workers holding a university degree.

Job strain, psychological distress, and burnout in nurses.

The first phase of this longitudinal study consisted of a questionnaire completed by a cohort of 1,891 nurses (aged 23-65 years) from six acute care hospitals from the province of Québec. This study was set up to investigate the association between the psychosocial environment of work and mental health. After adjusting for confounding factors, a combination of high psychological demands and low decision latitude was associated with psychological distress and emotional exhaustion, one of the three dimensions of burnout. Social support at work, although associated with each of the mental health indicators, did not modify their association with job strain. The present study identified conditions of the work environment that are modifiable and provide the basis for interventions that focus beyond the modification of individual coping strategies.