Psychosocial working conditions and mental health among medical assistants in Germany: a scoping review.

BACKGROUND: Medical assistants (MA) constitute one of the largest professions in outpatient health care in Germany. The psychosocial working conditions of health care staff are generally believed to be challenging and to thereby increase the risk of poor mental health. A review of MA's psychosocial working conditions and mental health is lacking, however. We aimed to systematically identify and summarize existing research on psychosocial working conditions and mental health of MA by addressing (1) Which methods, concepts, and instruments have been used to capture the psychosocial working conditions and mental health among MA in Germany? (2) What findings are available? and (3) What are the research gaps? METHODS: We systematically searched Medline, Scopus, CCMed and Google Scholar. Using the Population Concept Context (PCC)-framework, we applied the following eligibility criteria: (a) Language: English or German, (b) publication between 2002-2022, (c) original study, (d) study population: mainly MA (i.e., ≥ 50% of the study population), (e) concept: psychosocial working conditions and/or mental health, and (f) context: Germany. Two reviewers extracted data independently, results were compared for accuracy and completeness. RESULTS: Eight hundred twenty-seven sources were identified. We included 30 publications (19 quantitative, 10 qualitative, and one mixed methods study). Quantitative studies consistently reported high job satisfaction among MA. Quantitative and mixed methods studies frequently reported aspects related to job control as favorable working conditions, and aspects related to job rewards as moderate to unfavorable. Qualitative studies reported low job control in specific work areas, high demands in terms of workload, time pressure and job intensity, and a desire for greater recognition. Social interactions seemed to be important resources for MA. Few studies (n = 8) captured mental health, these reported inconspicuous mean values but high prevalences of anxiety, burnout, depression, and stress among MA. Studies suggested poorer psychosocial working conditions and mental health among MA during the COVID-19 pandemic. CONCLUSIONS: Quantitative studies tend to suggest more favorable psychosocial working conditions among MA than qualitative studies. We suggest mixed methods to reconcile this alleged inconsistency. Future research should examine discrepancies between job satisfaction and unfavorable working conditions and if psychosocial working conditions and mental health remain changed after the COVID-19 pandemic.

Managers in the context of small business growth: a qualitative study of working conditions and wellbeing.

PURPOSE: In view of the importance of managers' wellbeing for their leadership behaviour, employee health, and business effectiveness and survival, a better understanding of managers' wellbeing and working conditions is important for creating healthy and sustainable businesses. Previous research has mostly provided a static picture of managers' wellbeing and work in the context of small businesses, missing the variability and dynamism that is characteristic of this context. Therefore, the purpose of this study is to explore how managers in small companies perceive their working conditions and wellbeing in the context of business growth. METHODS: The study is based on qualitative semi-structured interviews with 20 managers from twelve small companies. Content and thematic analysis were applied. RESULTS: The findings indicate that a manager's working environment evolves from its initial stages and through the company's growth, leading to variations over time in the manager's experiences of wellbeing and work-life balance as well as changes in job demands and resources. Managers' working situation becomes less demanding and more manageable when workloads and working hours are reduced and a better work-life balance is achieved. The perceived improvement is related to changes in organizational factors (e.g. company resources), but also to individual factors (e.g. managers' increased awareness of the importance of a sustainable work situation). However, there were differences in how the working conditions and wellbeing changed over time and how organizational and individual resources affected the studied managers' wellbeing. CONCLUSIONS: This study shows that, in the context of small business, managers' working conditions and wellbeing are dynamic and are linked to growth-related changes that occur from the start of organizational activities and during periods of growth. In addition, the findings suggest that changes in managers' working conditions and wellbeing follow different trajectories over time because of the interaction between organizational and personal factors.

Psychosocial working conditions, perceived patient safety and their association in emergency medical services workers in Germany - a cross-sectional study.

BACKGROUND: Emergency medical service (EMS) workers face challenging working conditions that are characterized by high stress and a susceptibility to making errors. The objectives of the present study were (a) to characterize the psychosocial working conditions of EMS workers, (b) to describe the perceived quality of patient care they provide and patient safety, and (c) to investigate for the first time among EMS workers associations of psychosocial working conditions with the quality of patient care and patient safety. METHODS: For this cross-sectional study, we carried out an online survey among 393 EMS workers who were members of a professional organization. Working conditions were measured by the Demand-Control-SupportQuestionnaire (DCSQ) and seven self-devised items covering key stressors. Participants reported how often they perceived work stress to affect the patient care they provided and we inquired to what extent they are concerned to have made a major medical error in the last three months. Additionally, we used parts of the Emergency Medical Services - Safety Inventory (EMS-SI) to assess various specific errors and adverse events. We ran descriptive analyses (objective a and b) and multivariable logistic regression (objective c). RESULTS: The most common stressors identified were communication problems (reported by 76.3%), legal insecurity (69.5%), and switching of colleagues (48.9%) or workplaces (44.5%). Overall, 74.0% reported at least one negative safety outcome based on the EMS-SI. Concerns to have made an important error and the perception that patient care is impaired by work stress and were also frequent (17.8% and 12.7%, respectively). Most psychosocial working conditions were associated with the perception that patient care is impaired due to work stress. CONCLUSIONS: Work stress in EMS staff is pronounced and negative safety outcomes or potential errors are perceived to occur frequently. Poor psychosocial working conditions were only consistently associated with perceived impairment of patient care due to work stress. It seems necessary to reduce communication problems and to optimize working processes especially at interfaces between emergency services and other institutions. Legal insecurity could be reduced by clarifying and defining responsibilities. Communication and familiarity between team colleagues could be fostered by more consistent composition of squads.

Association between psychosocial working conditions and well-being before retirement: a community-based study.

Psychosocial working conditions have been linked to mental health outcomes, but their association with well-being is poorly studied. We aimed to investigate the association between psychosocial working conditions and well-being before retirement, and to explore the role of gender and leisure activities in the association. From the Swedish National Study on Aging and Care in Kungsholmen, 598 community dwellers aged 60-65 years were included in the cross-sectional study. Lifelong occupational history was obtained through an interview. Job demands and job control in the longest-held occupation were graded with job exposure matrices. Psychosocial working conditions were classified into high strain (high demands, low control), low strain (low demands, high control), passive job (low demands, low control), and active job (high demands, high control). Well-being was assessed with the 10-item version of positive and negative affect schedule, and scored using confirmatory factor analysis. Engagement in leisure activities was categorized as low, moderate, and high. Data were analyzed using linear regression. Both high job control and high job demands were dose-dependently associated with higher well-being. Overall, compared to active jobs, passive jobs were associated with lower well-being (ß -0.19, 95% CI -0.35 to -0.02, P = 0.028). Passive (ß -0.28, 95% CI -0.51 to -0.04, P = 0.020) and high strain (ß -0.31, 95% CI -0.52 to -0.10, P = 0.004) jobs were associated with lower well-being in men, but not in women. The association between passive jobs and well-being was attenuated by high leisure activities, while the association between high strain and well-being was magnified by low leisure activities. In conclusion, negative psychosocial working conditions are associated with poor well-being, especially in men. Leisure activities may modulate the association. Our study highlights that promoting favorable working conditions can be a target to improve well-being among employees and active participation in leisure activities is encouraged to cope with work-related stress for better well-being.

[Influence of health care crises on the treatment of cancer pain: a presentation using the example of the COVID-19 pandemic from the provider's perspective]. / Einfluss von Versorgungskrisen auf die Behandlung von Tumorschmerzen: eine Darstellung am Beispiel der COVID-19-Pandemie aus Versorgersicht.

BACKGROUND: The COVID-19 pandemic led to significantly restricted access to pain medicine services. Patients with cancer-related pain are considered a vulnerable group in terms of care deficits. A questionnaire among providers providing treatment to this group was used to assess limitations and solutions in this critical situation. MATERIALS AND METHODS: The online survey, developed by the 'Tumour Pain Working Group' of the German Pain Society using the Delphi method, included questions on site structure, pandemic-related care problems, and burdens experienced by those treating patients. It was distributed several times via the mailing lists of the German Pain Society and the 'Palliative Medicine Working Group' of the German Society of Anaesthesiology and Intensive Care Medicine. RESULTS: In all, 175 fully completed questionnaires were analysed. Over 75% of participants reported pandemic-related staff shortages and closures of pain medicine facilities, with 32% of facilities temporarily not treating elective pain patients and 13% not treating any emergencies. Care was hampered by numerous logistical problems such as very frequent pandemic-related cancellations by patients or in the transmission of prescriptions. Alternative forms of consultation by telephone or telemedicine, rarely used before the pandemic, were reported by 79 and 31% of respondents respectively, but deficiencies were noted. In addition, 52.1% of respondents complained of severe and 26.8% of moderate psychological stress due to the pandemic, and 74.1% evaluated working conditions as moderately to severely difficult. Medical training was still possible for 86% through format changes. CONCLUSION: The COVID-19 pandemic revealed numerous deficits in the care of patients with cancer-related pain, as well as burdens on healthcare providers. The development of new concepts could help to ensure better care in future crisis situations.

Nurses' organizational climate of perceived organizational support and its relationships with psychosocial working conditions and psychological contracts: A longitudinal questionnaire study.

OBJECTIVE: The aim of the present study was to investigate the longitudinal relationships between nurses' organizational climate of perceived organizational support (POS-climate) and their psychosocial working conditions and psychological contracts. METHODS: A two-wave longitudinal cohort questionnaire study was carried out among registered nurses employed within six hospitals in two regions in Sweden (n = 711). Two cross-lagged panel models were tested after ensuring scalar factorial invariance of the measurement models. The first model investigated longitudinal relationships between psychosocial working conditions and the POS-climate, while the second model investigated such relationships between the psychological contracts and the POS-climate. RESULTS: The results indicated that influence at work and an ideology-infused psychological contract had positive effects on the nurses' POS-climate. CONCLUSIONS: These results highlight the importance of providing nurses with such influence, and of a shared ideology within the entire health-care organization, centered on the ethical values of the health-care professions.

History of working conditions and the risk of old-age dependency: a nationwide Swedish register-based study.

AIMS: There is substantial evidence that previous working conditions influence post-retirement health, yet little is known about previous working conditions' association with old-age dependency. We examined job strain, hazardous and physical demands across working life, in relation to the risk of entering old-age dependency of care. METHODS: Individually linked nationwide Swedish registers were used to identify people aged 70+ who were not receiving long-term care (residential care or homecare) at baseline (January 2014). Register information on job titles between the years 1970 and 2010 was linked with a job exposure matrix of working conditions. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Cox regression models with age as the timescale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios for entering old-age dependency during the 24 months of follow-up (n = 931,819). RESULTS: Having initial adverse working conditions followed by an accumulation throughout working life encompassed the highest risk of entering old-age dependency across the categories (job strain: HR 1.23, 95% CI 1.19-1.27; physical demands: HR 1.36, 95% CI 1.31-1.40, and hazardous work: HR 1.35, 95% CI 1.30-1.40). Initially high physical demands or hazardous work followed by a stable trajectory, or initially low-level physical demand or hazardous work followed by an accumulation throughout working life also encompassed a higher risk of dependency. CONCLUSIONS: A history of adverse working conditions increased the risk of old-age dependency. Reducing the accumulation of adverse working conditions across the working life may contribute to postponing old-age dependency.

Long-term associations of psychosocial working conditions with depressive symptoms and work-related emotional exhaustion: comparing effects in a 5-year prospective study of 1949 workers in Germany.

OBJECTIVE: To test the hypothesis that psychosocial working conditions are more strongly associated with subsequent work-related emotional exhaustion (core component of burnout) than with depressive symptoms at follow-up. METHODS: A 5-year cohort study (2011/2012-2017), based on a random sample of persons in employment subject to payment of social contributions aged 31-60 years (Study on Mental Health at Work; S-MGA; N = 1949), included self-reported measures of organisational demands (organisational layoffs and restructuring), task-level demands (work pace and amount of work) and job resources (influence at work, possibilities for development, control over working time, role clarity), all taken from the COPSOQ, except the organisational demands that were single-item measures. Work-related emotional exhaustion and depressive symptoms were measured with the Oldenburg Burnout Inventory and the Patient Health Questionnaire-9, respectively. RESULTS: Cochrane Q tests revealed stronger associations between psychosocial working conditions and work-related emotional exhaustion only for the amount of work (p = 0.013) and control over working time (p = 0.027). No differences were observed for the Demands and Resources Indexes, capturing overall exposure to psychosocial working conditions. The same differences were observed in a subsample including only participants who remained at the same employer from baseline to follow-up, although more psychosocial working conditions were associated with work-related emotional exhaustion than with depressive symptoms. Supplementary analyses employing dichotomous measures of work-related emotional exhaustion and depressive symptoms confirmed these results. CONCLUSIONS: Overall, the findings provide limited evidence supporting the hypothesis that psychosocial working conditions are more strongly associated with work-related emotional exhaustion than with depressive symptoms.

Psychosocial working conditions as determinants of concerns to have made important medical errors and possible intermediate factors of this association among medical assistants - a cohort study.

OBJECTIVE: We sought to examine the association of psychosocial working conditions with concerns to have made important medical errors and to identify possible intermediate factors in this relationship. METHODS: We used data from 408 medical assistants (MAs) in Germany who participated in a 4-year prospective cohort study (follow-up period: 03-05/2021). Psychosocial working conditions were assessed at baseline by the effort-reward imbalance questionnaire and by a MA-specific questionnaire with seven subscales. MAs reported at follow-up whether they are concerned to have made an important medical error throughout the last 3 months, 12 months or since baseline (yes/no). These variables were merged into a single variable (any affirmative response vs. none) for primary analyses. Potential intermediate factors measured at baseline included work engagement (i.e., vigor and dedication, assessed by the UWES), work satisfaction (COPSOQ), depression (PHQ-2), anxiety (GAD-2) and self-rated health. We ran Poisson regression models with a log-link function to estimate relative risks (RRs) and 95% confidence intervals (CIs). Doing so, we employed the psychosocial working condition scales as continuous variables (i.e. z-scores) in the primary analyses. Potential intermediate factors were added separately to the regression models. RESULTS: Poor collaboration was the only working condition, which was significantly predictive of the concern of having made an important medical error (RR = 1.26, 95%CI = 1.00-1.57, p = 0.049). Partial intermediate factors in this association were vigor, depression and anxiety. CONCLUSION: We found weak and mostly statistically non-significant associations. The only exception was poor collaboration whose association with concerns to have made an important medical error was partially explained by vigor and poor mental health.

Psychosocial Working Conditions Play an Important Role in the Return-to-Work Process After Total Knee and Hip Arthroplasty.

Purpose Both personal and work-related factors affect return to work (RTW) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Little is known about work-related factors associated with the recovery process. This study aimed to determine which work-related factors are associated with time to RTW for both TKA and THA patients. Methods A prospective multicenter survey study was conducted that included patients aged 18-63, had a paid job and were scheduled to undergo primary TKA/THA. Surveys were completed preoperatively, 6 weeks, and 3, 6, and 12 months postoperatively, and included four domains of work-related factors: work characteristics, physical working conditions, psychosocial working conditions and work adjustments. Control variables included age, sex, education, and comorbidity. Time to RTW was defined as days from surgery until RTW. Multivariate linear regression analyses were conducted separately for TKA/THA patients. Results Enrolled were 246 patients (n = 146 TKA, n = 100 THA, median age 56 years, 57% female). Median time to RTW was 79 days (IQR 52.0-146.0). Mainly physical tasks (TKA: B 58.2, 95%CI 9.5-106.8; THA: B 52.1, 95%CI 14.1-90.2) and a combination of physical and mental tasks (TKA: B 50.2, 95%CI 6.4-94.0; THA B 54.0, 95%CI 24.2-83.7) were associated with longer time to RTW after both TKA and THA. More possibilities for personal job development (B - 12.8, 95%CI - 25.3-0.4) and more work recognition (B - 13.2, 95%CI - 25.5 to - 0.9) were significantly associated with shorter time to RTW after TKA. Higher quality of supervisor leadership (B - 14.1, 95%CI - 22.2 to - 6.0) was significantly associated with shorter time to RTW after THA. Conclusion The findings of this study stress the importance of psychosocial working conditions, besides type of job tasks, in RTW after TKA/THA. Further research on work-related factors is needed, as arthroplasty is being performed on an increasingly younger population of knee and hip OA patients for whom participating in work is of critical importance.

How do healthcare unit managers promote nurses' perceived organizational support, and which working conditions enable them to do so? A mixed methods approach.

Healthcare unit managers are pivotal to promote nurses' Perceived Organizational Support and hence to ensure nurses' health and well-being, as well as high-quality care. Despite this fact, there is a dearth of studies addressing how healthcare unit managers act and organize their work to promote nurses' Perceived Organizational Support and which working conditions enable them to do so. Through a mixed methods approach, comprising qualitative interviews and quantitative surveys among healthcare unit managers and nurses, this paper underscores that healthcare unit managers' availability to their nursing staff was essential for their ability to promote nurses' Perceived Organizational Support, and that responsive support from the care unit managers' superior management, administration, and managerial colleagues constituted enabling working conditions. Superior manager support strongly promoted the care unit manager's own Perceived Organizational Support, which, in turn, was positively correlated with nurses' organizational climate of Perceived Organizational Support.

Association between psychosocial working conditions in mid-life and leisure activity in old age.

Aims: Leisure activity helps people engage with life, and it promotes health and well-being as we age. This study investigated whether individuals with active jobs (high psychological demands, high control) in mid-life were more active during leisure time in old age compared with those with less active jobs. Methods: Two individually linked Swedish surveys were used (N=776) with 23 years of follow-up. Data were analysed with logistic regression. Results: Having an active job in mid-life was associated with greater engagement in intellectual/cultural, social and physical activity in old age, even when leisure activity in mid-life was taken into account. Conclusions: The results suggest that active jobs in mid-life may be replaced by active leisure during retirement. Active job conditions may promote engagement in society in old age, which in turn may have positive health consequences.

Physical and psychosocial work factors as explanations for social inequalities in self-rated health.

OBJECTIVE: We investigated the contribution of physical and psychosocial work factors to social inequalities in self-rated health (SRH) in a sample of Danish 40 and 50 years old occupationally active women and men. METHODS: In this longitudinal study, the study population consisted of 3338 Danish women and men. Data were collected by postal questionnaires in 2000 (baseline) and 2006 (follow-up). The independent variable, socioeconomic position (SEP), was assessed by the highest achieved educational level at baseline. We conducted gender-stratified parallel multiple mediation analyses. In the mediation analyses, SEP was categorised as SEP I, II, III, VI and V among men. Among women, SEP was dichotomised into SEP I-IV and V. The outcome, SRH, was assessed at baseline and follow-up. A wide range of physical and psychosocial work factors were included as potential mediators. RESULTS: We found a social gradient in SRH across all levels of SEP among men. Among women, we only found a poorer SRH among those with the lowest SEP. Mediation analyses showed that work factors together accounted for 56% of the social inequalities in SRH among men and 44% among women. In both genders, ergonomic exposures and job insecurity seemed to play the major role for social inequalities in SRH. For women only, we also found noise to contribute to the social inequalities in SRH. CONCLUSION: Physical and psychosocial work factors partially explained social inequalities in SRH among both genders. Improvement of the working environment can potentially contribute to the reduction of social inequalities in health.

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

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

Surface-acting emotional labor predicts depressive symptoms among health care workers over a 2-year prospective study.

OBJECTIVE: Surface-acting emotional labor (SaEL) is the requirement to hide or suppress felt emotions to achieve acceptable job performance. It is a common feature of jobs featuring interactions with the public, such as customers or patients. Resulting emotional inauthenticity is associated with psychological strain, but there have been few prospective studies of mental health outcomes. METHODS: A self-administered questionnaire was distributed in 24 skilled nursing facilities at baseline and 23 facilities 2 years later. Permanent full-time and part-time employees in all jobs were eligible to participate. Respondents in these analyses provided survey information on the frequency of SaEL at baseline and depressive symptoms on both occasions. Those without depression at baseline were deemed at risk. Multivariable logistic regression modeling estimated adjusted odds ratios (aOR) for SaEL, other job features, and demographic characteristics. RESULTS: A total of 939 eligible participants had no depression at baseline; 15% developed depressive symptoms. About two-thirds were direct care providers, including 38% nursing and medical assistants. Adjusted for potential confounders, workers with intermediate and high SaEL had a higher risk (aORs around 2). Symptom onset was also predicted by high work-family conflict, younger age and low decision latitude at work. CONCLUSIONS: In this prospective study of long-term care workers, those who reported experiencing high SaEL at the time of the baseline survey were at higher risk of developing depressive symptoms 2 years later. Both exposure and outcome could have suffered some misclassification. Future studies should examine a broader range of strategies for coping with emotional labor demands.

Working conditions mediate the association between social class and physical function in older age in Sweden: a prospective cohort study.

BACKGROUND: Global demographics are changing as societies all over the world are aging. This puts focus on maintaining functional ability and independence into older age. Individuals from lower social classes are at greater risk of developing limitations in physical function later in life. In this study, we investigated the mediating role of working conditions in the association between occupation-based social class and physical function measured as self-reported mobility limitations and objectively measured physical impairment in older age. METHODS: Two Swedish surveys, linked at the individual level, were used (n = 676-814 depending on the outcome). Follow-up time was 20-24 years. Multiple logistic regression analyses were performed with adjustments for age, sex, level of education, mobility, and health problems at baseline. This was followed by analyses of the size of the mediating effect of working conditions. RESULTS: Working conditions seem to mediate 35-74% of the association between social class and physical impairment in older age. The pattern of mediation was primarily driven by passive jobs, i.e., low psychological demands and low control, among blue-collar workers. Working conditions did not mediate the association between social class and self-reported mobility limitations in older age. CONCLUSIONS: The results of this study indicate that working conditions are important in combating the social gradient in healthy aging, contributing to the evidence regarding the magnitude of impact exerted by both the physical and psychosocial work environment separately and in conjunction.

Psychosoziale Arbeitsbedingungen und Burnout-Symptome in der stationären somatischen und psychiatrischen Gesundheits- und Krankenpflege.

Psychosocial working conditions and symptoms of burnout in somatic and psychiatric nursing Abstract. Background: While mental workload and stress among nurses are generally well-documented, differences within the nursing profession have hardly been investigated so far. Aim: This study aims to examine the differences and associations between psychosocial working conditions and symptoms of burnout of nurses working in somatic and psychiatric settings. Methods: A cross-sectional study has been conducted with employees in one somatic and one psychiatric hospital (n = 576). The Copenhagen Psychosocial Questionnaire and the Copenhagen Burnout Inventory were used to assess psychosocial workloads and burnout symptoms. The data analysis was carried out by univariate, bivariate and multivariate (regression) analyses. Results: About 50 % of respondents report at least a moderate level of symptoms of burnout with somatic nurses more frequently affected. While quantitative and physical demands are higher in somatic nursing, psychiatric nurses have a higher degree of emotional demands, socialß = 0.33) in somatic nursing and emotional demands (ß = 0.29) in psychiatric nursing serve as strongest predictors of burnout symptoms. Conclusions: Findings suggest specific profiles of psychosocial workload in somatic and psychiatric nursing as well as a high need for differentiated approaches for occupational health promotion.

Burnout among school teachers: quantitative and qualitative results from a follow-up study in southern Sweden.

BACKGROUND: Teachers are at high risk of stress-related disorders. This longitudinal study aimed to (a) identify which occupational, sociodemographic and life-style factors and self-efficacy at baseline that were of importance for burnout, (b) explore associations between changes in the studied factors versus changes in burnout, and (c) by interviews increase the understanding of perceived job demands among teachers. METHODS: A cohort of 310 Swedish teachers in school-years 4-9 responded to a questionnaire of occupational, sociodemographic and life-style factors, self-efficacy and burnout, at baseline and at follow-up (mean 30 months later). A combined measure with four levels of burnout was crafted, based on exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey). Quantitative data were analysed with multiple ordinal regression, and qualitative data were analysed with content analysis of interview responses from a subgroup of the teachers (n = 81). RESULTS: The occurrence of high burnout (level 2 and 3 combined) were similar at baseline and follow-up (14% vs. 15%). However, many teachers fluctuated between the levels of burnout (28% increased and 24% decreased). Burnout at baseline was of importance for change of work or being off duty at follow up. In the multi-exposure model, low self-efficacy [OR 0.42; CI 0.26-0.68] and high job demands [OR 1.97; CI 1.02-3.8] were the strongest explanatory variables. Low self-efficacy remained as the strongest explanatory factor after adjustment for burnout at baseline. Increased job demands during follow-up was associated with an increased level of burnout [OR 3.41; CI 1.73-6.69], whereas increased decision latitude was associated with a decreased level of burnout [OR 0.51; CI 0.30-0.87]. Two major categories of demands emerged in the qualitative analysis; i.e. too high workload and a sense of inadequacy. CONCLUSIONS: A substantial proportion of teachers showed signs of burnout at both occasions. Low self-efficacy and high job demands was of importance for burnout, and changes in burnout was further associated with changes in decision latitude. The results points to the need of actions on individual, organizational and a societal levels.

Relationship between psychosocial working conditions, stress perception, and needle-stick injury among healthcare workers in Shanghai.

BACKGROUND: The present study aims to identify the association between psychosocial working conditions, global stress perception, and needle-stick injury among Chinese healthcare workers. It also endeavors to detect the mediating effects of global stress perception. METHODS: A total of 1956 valid samples were collected from eight teaching hospitals in Shanghai, China. A self-reported questionnaire was administered to participants after obtaining their written consent. Structural equation model was used to analyze the relationship between study variables. RESULTS: Most of the correlation coefficients between psychosocial conditions at work, stress perception, and needle-stick injury are of statistical significance ranging from 0.004 to 0.869. Results of the internal consistency test shows that Cronbach's α is between 0.770 and 0.925. All three models for effect analysis demonstrated satisfactory global goodness and acceptable path loadings. Psychosocial working conditions and stress perception were directly associated with events of needle-stick injury, as 0.39 (95%CI: 0.32 to 0.48) and 0.32 (95%CI: 0.22 to 0.39), respectively. Furthermore, stress perception had been proved to have a mediating effect (0.25, 95%CI: 0.19 to 0.31) between psychosocial working condition and needle-stick injury, which occupied over one-third of the total effect. CONCLUSIONS: Both stressful psychosocial working conditions and negative stress perception could increase the risk of needle-stick injury that occurs among healthcare workers. Management of stress perception could reduce health risk brought by stressful psychosocial working conditions.

Job strain and retirement decisions in UK general practice.

BACKGROUND: Falling retention in UK general practice is a well-described problem but there has been little previous research into its underlying causes. Poor psychosocial work conditions may help explain falling workforce morale and early retirement from the profession. AIMS: To explore the impact upon morale and retirement decisions of changes in psychosocial aspects of UK general practice over the course of a career. METHODS: Biographical narrative interviewing method (BNIM) was used to obtain and analyse career narratives of 12 London general practitioners (GPs), aged 55-65, half of whom had retired. Findings were theorized using the Job Demands-Control-Support (JDCS) model. RESULTS: A spontaneous, consistent theme was evident across all 12 interviews: changes in the psychosocial work environment had contributed to a steady decline in morale. Sequential, multilayered reductions in autonomy were the most commonly cited causes for reduced enthusiasm. Increasing demands in the form of both a rising workload as well as a complaints culture drained energy and morale. The GPs described increasingly fragmented teams and therefore reduced social support for the role. Nonetheless, retirement decisions were not straightforward, provoking complex emotions. CONCLUSIONS: The combination of increasing demands with reduced autonomy puts practitioners under intense strain, diminishing the satisfaction they derive from their work and affecting retirement decisions. The Job Demands-Control-Support (JDCS) model is an empirically tested model that could be used to inform improved work design in general practice.