WHC4001 Determinants of Health and Labour Participation Summary PDF

WHC4001 SUMMARY Determinants of health and labour participation geschreven door StudentUM www.stuvia.com [email protected]...

WHC4001 SUMMARY Determinants of health and labour participation geschreven door StudentUM www.stuvia.com [email protected] Dit document is auteursrechtelijk beschermd, het verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | Stuvia - Koop en Verkoop de Beste Samenvattingen WHC4001 – Determinants of health and labour participation Case 1 – Asbestos (physical environment, mono-causal) 1) What is asbestos? (Characteristics, types, what it is used for) Prazakova S, Thomas PS, Sandrini A, & Yates DH. (2014). Asbestos and the lung in the 21st century: an update. The Clinical Respiratory Journal, 8(1), 1-10. Asbestos is the collective name for a group of fibrous silicates (naturally occurring) with high durability, tensile strength and heat resistance. Asbestos was extensively used in many products including thermal insulation, electrical wiring, building materials, friction products and others. - e.g. used in carpet linings for fire resistance, in cement of buildings, breaks of cars Asbestos is a generic term for a group of fibrous silicates, and can be divided into two groups that differ in mineralogical and chemical properties: amphiboles and serpentines. Amphiboles include crocidolite, amosite, anthophyllite and tremolite. Chrysotile is the only serpentine and represents 95% of the commercial asbestos ever used around the world (1). Crocidolite is recognized to be the most carcinogenic and fibrogenic, but there has been vigorous debate about the relative potency of chrysotile in carcinogenesis in the past 30 years. The general consensus currently is that chrysotile is capable of inducing malignant mesothe lioma (MM), although it is less potent in this regard than other types of asbestos Asbestos is a generic term for a group of fibrous silicates, and can be divided into two groups that differ in mineralogical and chemical properties: amphiboles and serpentines. - Amphiboles include crocidolite, amosite, anthophyllite, tremolite and actinodite. Crocidolite is recognized to be the most carcinogenic and fibrogenic, but there has been vigorous debate about the relative potency of chrysotile in carcinogenesis in the past 30 years. o Really dangerous, when inhaled fibres make a chemical reaction and get stuck in the lung veoli (tissue) o Carcinogenic (potential to cause cancer) o Prohibited - Chrysotile is the only serpentine and represents 95% of the commercial asbestos ever used around the world. The general consensus currently is that chrysotile is capable of inducing malignant mesothelioma (MM), although it is less potent in this regard than other types of asbestos o Really small fibres, body is able to dispose the fibles, easy to breath out (exhale) from respiration system o Also dangerous, but less like to occur o Controlled use is still aloud o Softer and more flexible 1 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het  Stuvia - Koop en Verkoop de Beste Samenvattingen Although the use of asbestos was prohibited in the Netherlands in 1993 (and 2005 in the EU), people are still being exposed, because asbestos used in the past is still present in many settings. Occupational exposure can still occur when homes and other buildings are demolished, when soil purification activities are undertaken, and when ships, drilling. Asbestos is still used in for example Asia (64% of the world’s asbestos use). 2) What are the health effects of the different types of asbestos? Health Council of the Netherlands. (2010). Asbestos: Risks of environmental and occupational exposure. The Hague: Health Council of the Netherlands, publication no. 2010/10E. §2.3 Health effects Inhaled asbestos fibres can enter the smallest parts of the respiratory tract and the alveoli. Those that are not too large are then engulfed by macrophages; larger fibres can migrate into the tissue. Fibres that are coughed up are liable to be swallowed, and then leave the body after passing through the digestive tract. However, they can also enter the lymphatic system and thus be transported to parts of the body far from the lungs. The number of asbestos bodies is indicative of the level of asbestos exposure that a person has suffered. In response to the accumulation of asbestos fibres in the lung, fibrous tissue formation (pulmonary fibrosis) occurs; the particular form of diffuse pulmonary fibrosis caused by exposure to asbestos is referred to as asbestosis. In the surrounding tissue, asbestos can subsequently trigger the development of malignant growths. When a worker breaths, asbestos fibres enter the mouth and nose and flow down the air passages deep into the lungs. The fibres lodge in the delicate lung tissue where oxygen is absorbed into the blood. Immune system cells try to break down the asbestos fibres and become damaged and die. Scar tissue forms around the dead cells and spreads as more fibres embed in the lungs. Asbestos fibres can remain in the lungs for long periods of time and the scar tissue that results continues to develop for many years after exposure. Eventually, so much scar tissue develops that the lungs stop working. Exposure to asbestos can cause cancer in various organs. Because these types of cancer often do not develop until years after exposure (long latency period), environmental and occupational exposure to asbestos in the past continues to cause mortality. Prazakova S, Thomas PS, Sandrini A, & Yates DH. (2014). Asbestos and the lung in the 21st century: an update. The Clinical Respiratory Journal, 8(1), 1-10.  The Health effects are irreversible. Asbestos produces the following lung disorders: asbestosis (diffuse interstitial pulmonary fibrosis due to asbestos inhalation), pleural plaques (PPs), diffuse pleural thickening (DPT), benign asbestos pleural effu sion (BAPE), rounded atelectasis (RA), lung cancer (LC) and MM. Asbestos produces the following lung disorders: - Asbestosis = scar tissue on the lungs (diffuse interstitial pulmonary fibrosis) due to asbestos fibres inhalation. The more the exposure, the higher the risk. The latency period for disease development is usually 15 years or more, and is influenced by duration and intensity of exposure. Relatively high levels of asbestos inhalation are required to produce asbestosis (cumulative exposure ≥25 fibres/mL-years), o You need asbestos exposure  mono-causal 2 [email protected] Gedownload door: phielophetveld1 | Dit document is auteursrechtelijk beschermd, het  verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Stuvia - Koop en Verkoop de Beste Samenvattingen - pleural plaques (PPs) = (kind of the same as asbestosis, but there are more forms of PPs). The thickening of pleural (lining of the lungs) that will compress part of the lung. PPs are the commonest manifestation of asbestos exposure affecting up to 58% of asbestos-exposed workers and up to 8% of general environmentally exposed populations, with a latency period of 20–30 years. - benign asbestos pleural effusion (BAPE) = excess fluid in pleural space. Latency period is 10 years, not that deadly, asymptomatic. - diffuse pleural thickening (DPT) = characterized by extensive thickening of the visceral pleura. It can develop within a year of exposure but can also take up 40 years. - malignant mesothelioma (MM) (worst)= MM is an aggressive and incurable tumour arising from mesothelial cells of the pleura, peritoneum and rarely elsewhere. Can develop even after short and low exposure. Latency period 40 years. Survival depends on the stage of the disease when diagnosed. Overall poor prognosis with median survival of 8-14 months. o No MM without asbestos exposure  mono-causal - lung cancer (LC) = heavy asbestos exposure produces an increased risk of LC, with a latency period of approximately 15–20 years. Asbestos-related LCs account for about 3–8% of all LCs. The risk of developing LC is linearly related to cumulative asbestos exposure. - Stomach cancer = since you can also swallow asbestos fibres after you cough them up. 3) Is asbestos actively used? (actual use worldwide – Global perspective) Prazakova S, Thomas PS, Sandrini A, & Yates DH. (2014). Asbestos and the lung in the 21st century: an update. The Clinical Respiratory Journal, 8(1), 1-10. All forms of asbestos are now banned in 52 countries, and safer materials have replaced many products that once contained it. However, asbestos mining still continues. Nowadays, asbestos is used mainly in developing countries, while in many countries where most types of asbestos have been banned, the controlled use of chrysotile asbestos is still allowed. Annual world production remains at over 2 million tons with Russia as a leading producer of asbestos worldwide, followed by China, which is also the largest consumer. As a consequence, an epidemic of asbestos-related disorders (ARDs) is expected in next decades in these countries. - China/India big consumers - Banned in Netherlands since 1993, in Europe 2005, rest of the world no ban yet. Exposure ways to asbestos Asbestos usage peaked in 1950s, 1960s and 1970s in most developed countries. World Health Organisation officials estimate that 125 million people worldwide are annually exposed to asbestos in occupational set tings, and more than 107 000 people die annually of diseases associated with asbestos exposure Asbestos usage peaked in 1950s, 1960s and 1970s in most developed countries. World Health Organization officials estimate that 125 million people worldwide are annually exposed to asbestos in occupational settings, and more than 107 000 people die annually of diseases associated with asbestos exposure. The phenomenon of para-occupational or ‘take home’ asbestos exposure has been recognised for over 50 years and can be described as exposure to asbestos 3  verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen  Gedownload door: phielophetveld1 | verspreiden van dit document is strafbaar. [email protected] € 912 per jaar extra verdienen? Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen that occurs in the worker’s home generally because of dust that has accumulated on the worker’s clothing or hair. Many studies have described cases of ARDs caused by para-occupational exposure (12–14). However, the vast majority of the cases occurred among family members of workers in industries char acterized by high exposures and nearly always to amphibole fibres. Direct occupational exposure to raw asbestos or asbestos products remains the predominant cause of ARDs. However, recently attention has been focused on the potential dangers of non-occupational expo sure associated with home renovation of asbestos containing building products and car maintenance (7). Asbestos-containing materials are present in many residential and commercial buildings built after World War II and may create an exposure hazard to the occu pants or to the renovators. One study in Western Australia showed a marked increase of MM cases asso ciated with home maintenance and renovation over the previous 10 years (15). It is expected that MM cases as a result of non-occupational exposure to asbestos will continue to increase over next decades. The phenomenon of para-occupational or ‘take home’ asbestos exposure has been recognized for over 50 years and can be described as exposure to asbestos that occurs in the worker’s home generally because of dust that has accumulated on the worker’s clothing or hair. Direct occupational exposure to raw asbestos or asbestos products remains the predominant cause of ARDs. However, recently attention has been focused on the potential dangers of non-occupational exposure associated with home renovation of asbestos-containing building products and car maintenance. Asbestos-containing materials are present in many residential and commercial buildings built after World War II and may create an exposure hazard to the occupants or to the renovators. It is expected that MM cases as a result of non-occupational exposure to asbestos will continue to increase over next decades. Article Rice – the global reorganization and revitalization of the asbestos industry The asbestos industry is going to developing countries because of: - Low wages in African countries for instance - Cost of pollution - The demand for a clean environment falls as wealth decreases. So there is a risk transfer from the developed countries to the developing (low developed) countries. Asbestos consumption in the industrialized countries declined over this period, in juxtaposition to a notable increase in consumption in the developing countries. In 2007, asbestos consumption in the developing countries was more than two million metric tons but negligible elsewhere in the world economy. The author argues that as asbestos increasingly became the focus of government oversight in the industrialized countries, continued capital accumulation efforts necessitated displacement of risk to the developing countries.  the death of a African worker is less costly than the death of a worker in an industrialized worker.  4 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen The prevailing rhetorical strategy employed by the global asbestos lobby suggests that chrysotile asbestos is safe under “controlled use” conditions. Given the typical lack of government and industry oversight in the developing countries and the absence of strong labor unions, however, the argument for the controlled use of chrysotile is untenable. The relative weighing of the costs and benefits of asbestos use in the developing countries, the author argues, is too often based on the short-term advantages of asbestos as a cheap and durable construction material. The long-term costs in terms of its deleterious effects on human health are less frequently considered. It is increasingly asserted that the only viable policy to counteract the rise of a truly widespread asbestos cancer epidemic is a global ban on all types of asbestos production and manufacturing, an initiative now supported by both the ILO and the WHO. 4) What is the health related threshold for the intake of asbestos? a) Dose-response relation of asbestos Dose response is the relationship between the size of a dose and the extent of the response to it (effect, build up in amount of time).  The higher the exposure, the higher the risk.  No safe dose.  Asbestos has a linear dose-response curve.  Dose expressed in fibres-years (work years)  number of fibres in ml air per year  1 fibres-year = 1 fibre per ml air for a whole year. b) Occupational exposure limits (what is the limit for asbestos nowadays) There still exists a limit because there are people working with asbestos. As a society we accept that a certain amount of people will be killed. Occupational norms do not protect you 100%, it is what we accept as a society. They differ per country. The value of having an exposure limit is to reduce the risk, not to eliminate it. Workplace environments in the Netherlands (and in the EU) are currently subject to an permissible exposure limit (PEL) of 0.01 fibres/ml (10.000 fibres/m3 & 1.0 fibres/cm3) for all types of asbestos and for an average exposure duration of eight hours per day (8 hour time-weighted average: TWA). 5) How is asbestos measured and when is it measured? (occupational exposure measurement)  Samples of the air & optical microscopy  5 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen o Taking a sample of air with a pump with a screen/filter, the fibres will stay on the screen so you can count them with a microscope (phase contrast microscopy: PCM) and you know how much air you used.  Very time consuming, directly, may differ from day to day and workplaces. o According to the US-Environment Protection Agency (US-EPA) this measurement should be done every 6 months.  Job-exposure matrix is another approach Checkoway, H., Pearce, N., & Kriebel, D. (2004). Characterizing the workplace environment. In: Research methods in occupational epidemiology, 2nd ed. (Chapter 2, pp. 17-34). New York: Oxford University Press Characterizing the workplace environment - Exposure = the presence of a substance in the environment external to the subject. The substance is present at greater than background (ambient) levels. Exposure levels are assessed in reference to the intensity of the substance in the workplace environment and the duration of time during which the substance is encountered. - Intensity = generally measured as a concentration, which refers to the amount of the substance per unit of a relevant environmental medium (e.g., milligrams of dust per cubic meter of air). Exposure concentration is a dynamic quantity because it usually changes over time, although frequently in occupational epidemiology, a single measure, such as the average concentration, is used to characterize intensity. The characteristics of exposure (patterns of intensity and duration) that are most relevant to an epidemiologic study depend on the presumed causal mechanism between the exposure and the health outcome of concern.  An acute irritant response, for example, may be related to short-term peak exposures that occur during a span of several minutes, in which case neither the daily nor the weekly average would be the appropriate exposure value.  At the other extreme, if the study focused on a chronic disease with a long induction period, the annual average exposure might be most relevant in an epidemiologic analysis. More generally, the hypothesized disease mechanism underlying the studied exposure-risk relation should be considered when choosing the summary metric of exposure that will be used to summarize the exposure data for use in the epidemiologic model. The most common summary measures of exposure (external to the body) are: The average exposure intensity - The duration of exposure - The cumulative exposure, which is the product of average exposure intensity and exposure duration. As an illustration, if a worker is exposed to styrene at 25 ppm for 3 years and at 20 ppm for 10 years, the worker’s cumulative exposure would be (25 X 3 ) + (20 X 10) = 275 ppm-years. Cumulative exposure can also be thought of as the area under the intensity-duration curve. Exposure intensity, exposure duration, and cumulative exposure all pertain to the environment external to the body. We can define two other terms, burden and dose (internal to the body), that refer to the amount of a substance that reaches organs and tissues within the body. - Burden = the amount of a substance in the body, or, more specifically, the target organ  or tissues, at a point in time. Typical units of burden are in concentration of the substance per quantity of hum an tissue. Example: fibers/ug lung tissue for asbestos. o Like exposure concentration, burden is a dynamic measure that changes over time. It is an instantaneous measure that is determined by the net effects of 6 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen exposure intensity (external concentration), uptake or absorption (how much of the exposure enters the body), deposition in body organs and tissues, and clearance (the rate of removal from the body). Clearance is sometimes expressed as its opposite, retention or persistence in the body or tissue (e.g., half-life). o The concept of burden is relevant for substances such as metals and fibers that remain in solid form for some time and can persist in body tissues. For agents that are distributed differentially by organ or tissue, it may be possible to estimate organ- or tissue-specific burdens. Lead, for example, is distributed in blood, soft tissues (e.g., kidney), and bone, each with a characteristic rate of clearance and consequent burden o The concept of burden applies less well for chemicals that have relatively short retention times (e.g., vinyl chloride monomer). o In general, burden is most important in studies of effects of substances that have relatively long retention times (on the order of years), that remain biologically active in the body, and that can be mobilized to reach target sites for activity. - Dose = the amount of a substance that remains at the biological target during some specified time interval. Dose is thus the time integral of burden, in the same way that cumulative exposure is the time integral of exposure intensity. Dose has units of concentration-time. Example: a dose of lead in blood might have units of ug/dl-days. Exposure assessment - Industry-based studies  the population being studied is drawn from a single workplace or class of workplaces - Community-bases studies  the population is employed in a wide variety of different workplaces Industry-based exposure assessments generally offer the best opportunities to estimate levels of exposures to agents characteristic of particular industries. Because of the focus on a single industry, extensive field investigations were possible, which enabled development of an exposure quantification protocol specifically tailored to that industry. On the other hand, a community-based study of occupational risk factors for spontaneous abortion would be more likely to examine associations with a wider range of exposures from many industries, but probably would be less effective in quantifying levels of specific agents because of the high economic and time costs of measuring exposures in detail in numerous industries. - Identifying hazardous exposures Occupational epidemiologic studies usually begin with an assessment of the hazards in a workplace. In addition to agents with established or suspected toxicity, we can develop a priority list of agents based on their frequency and quantity of use. Symptoms or illnesses reported by workers to plant health and safety professionals sometimes guide agent selection - Identifying routes of exposure For an exposure to exert toxic effects, it must reach the human body; consequently, a careful consideration of the routes of exposure is a very important aspect of an exposure assessment. A clear understanding of exposure routes will be of great benefit in determining the sources of exposure data that are needed for valid assessments. Because many occupational exposures, including most dusts and gaseous vapors, occur as airborne contaminants, the predominant exposure route is inhalation. For example other important 7 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen sources such as dermal exposure, as occurs with some pesticides or solvents. Some exposures, such as lead, may occur from ingestion via hand-to-mouth contact. Because exposure by inhalation is better understood and more easily monitored, there is a danger that the inhalation route may be emphasized over other routes, even when, for example, the dermal route is probably much more important. Biological monitoring is one method to estimate exposures via multiple routes. - Specifying available data sources and needs The types of exposure data needed in an industry-based study depend on the health outcomes of interest and the study design that will be applied. - Historical exposure reconstruction The goal of historical exposure assessment, or reconstruction, is to estimate workers’ past exposures throughout their periods of employment. First, we would develop a classification system in which the industrial processes that occur in the facility are divided broadly by type. Within each of these divisions, sub-areas and job categories are classified in such a way that the component jobs and tasks have common types of exposures. The classification is then used to generate a list of job titles, or job dictionary, that describes distinct work activities. The most commonly used source of job titles is personnel records that contain workers’ employment records. Each worker’s experience can be depicted by his or her employment history in specific tasks that, in principle, should reflect exposures more accurately than would job titles. Assembling a job dictionary, although conceptually straightforward, often proves to be a complex, time-consuming endeavor. After assembling the job dictionary, the next step in exposure reconstruction is to develop a job-exposure matrix in which exposure levels are estimated by job and time. A separate job-exposure matrix is needed for each agent under study. Various measures of intensity might be entered into such a matrix. - Concurrent and prospective exposure assessment  Cross-sectional and prospective (longitudinal) studies require exposure assessments that often entail newly obtained exposure data. The duration and frequency of exposure measurement will be determined by the health outcome under investigation. The data sources useful for prospective monitoring are the same as those for historical exposure reconstruction (Table 2.2). 8 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen 6) What causes lung cancer? Smoking, asbestos exposure or a combination? (case)  There is an interaction between smoke and asbestos. In this case 1. it is hard to say if the disease is because of smoking or exposure to asbestos. When it is MM, than it has to be exposure to asbestos. Article Frost – the effect of smoking on the risk of lung cancer mortality for asbestos workers in Great Britain Smoking tobacco is the major determinant of lung cancer and accounts for 90% of all cases. Asbestos is also an important lung carcinogen, accounting for an estimated 2–3% of lung cancer deaths in Britain during 1980–2000. For those asbestos workers who smoked, an estimated 2% of lung cancer deaths were attributable to asbestos only, 68% to smoking only, and 26% to the interaction of asbestos and smoking. Conclusions: This study emphasizes the importance of smoking prevention and cessation among those who work in the asbestos industry. Additive effect  each factor acts independently (summarizing) Multiplicative effect  the effect of asbestos exposure on lung cancer risk is proportional to the effect of smoking Smoking x Asbestos exposure  More than summarizing but less than multiplication. RR: Smoker 10 times higher risk of lung cancer than none smoker. RR: Asbestos exposed 5 times higher risk of lung cancer than non-exposed.  Additive would be 15, multiplicative would be 50, but it is in between. However, it looks more like multiplicative (±40)  9 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen Case 2 – Work stress (psychosocial environment, multi-causal) 1) What are the components of the psychosocial environment? (Source - Houkes) 4 groups:  Work content o Characteristics of the work tasks o Difficulties, monotonous work, autonomy, feedback how you perform the work, freedom, responsibilities o Distinguishes an interesting job from a boring job  Working conditions o How can you fulfill the tasks? o Mental conditions (time pressure, emotional e.g. nurse at the IC) vs physical conditions (heavy, dangerous, noise, working with chemicals) o Working hours (demand), working load, work schedule, bullying, time pressure  Work schedule is both mental and physical (can influence both your mind and physical condition)  Conditions of employment o Working hours, Salary, option of promotion, type of contract e.g. temporary, educational opportunities, social security  Labour relations o Relationship between employees and employers/colleagues.  o Employee participation (if the employee has influence on the decision making process in the organization) o Social support (from colleagues vs management vs family/friends)  Negative: bullying, (sexual) harassment  Neutral  Positive  everything can be both positive (resources) and negative (demands) - depends among other on personal preferences, U-curve = too little is not good but too much is also not good, U-curve also depends on the person)  psychosocial environment is modifiable, but is harder and often takes more time than changing the physical environment, since the physical environment is more dynamic - it is a choice how we organize work Cooper, C.L. , J. Campbell Quick & M.J. Schabracq (Eds.).(2009) International Handbook of Work and Health Psychology, 3d ed.. New York: Wiley. Chapter 9: Spector, P.E. (2009). The role of job control in employee health and well-being, pp. 173-198 Control = the extent to which individuals are able to influence their environment. Control at the workplace: e.g. when and where to work, and how to perform job tasks or being able to influence how others will do their jobs. 10 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen Control variables play a prominent role in the job stress process. Control affects how people view their work environment, and it may serve to buffer the emotional impact of that environment. Furthermore, control can affect people’s behavioural coping responses to workplace stressors. A high control individual will show initiative to solve problems (e.g. seeking help of colleagues to handle a heavy work load) that might otherwise become stressors. We can distinguish: - objective control = characteristics of the work environment - perceived control = people’s personal view of the environment The perception of control has the most important impact on health and well-being. Objective control is certainly an important element in the job stress process, but likely much of its effect is mediated by perceptions of control. There are a number of control-related personality constructs/personal control predispositions that reside in the individual: - Locus of control = the tendency to believe one does or does not have control o Individuals who believe they have control over rewards and success at work are said to be internals, whereas individuals who believe luck, fate or powerful others control such things are said to be externals. - self-efficacy = the belief one can effectively perform tasks. Control and stress in the workplace Most theories of stress in general and job stress in particular have adopted some form of an environment-reaction or stressor-strain approach. The figure beneath presents a general model of stress linking the environment to the individual’s reactions. The individual is seen as monitoring his or her environment, perceiving and evaluating or appraising that environment. Conditions or events seen as overly challenging or threatening are perceived as job stressors that lead to physical and psychological strains, both in the short and long term. Short-term strains include immediate negative emotional responses, most likely anger or anxiety and associated physiological responses, such as increased heart rate and blood pressure. The immediate emotional response can contribute to a variety of behavioural, physical and psychological strains: - Behavioural strains = are actions taken by the individual to cope with the stressful event or condition, and might include alcohol or drug (e.g., tranquilizer) consumption, or withdrawal from the situation (e.g., absence from work). - Physical strains = include immediate physiological reactions as well as headache or stomach distress. - Psychological strains = might be job dissatisfaction as the byproduct of being in a disagreeable situation. Longer-term strains = are the cumulative effect of short-term strains, and could include post traumatic stress disorder (PTSD) in response to continued exposure to stressor or heart disease from the continued exposure to elevated cortisol, might lead ultimately to sick leave. Individuals will engage in a number of coping strategies designed to eliminate or escape the stressor, or reduce the strain response. 11 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen  12 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen The following figure incorporates the likely role that control plays in the job stress process: 2) What is stress & burn-out? (and other outcomes, both positive & negative) Le Blanc, P., De Jonge, J. & Schaufeli, W.B. (2008). Job stress and occupational Health. In: N. Chmiel (Ed). Introduction to work and organisational psychology. A European perspective. (2nd ed., chapter 6, pp. 119 – 147). Oxford: Blackwell. Stress The original meaning of the term ‘stress’ is derived from engineering. It refers to external pressure exerted on a person (demands), which results in tension or strain (stress reaction). Within certain limits, people are able to deal with this pressure and adapt to the situation, and to recover when the stressful period is over. The threshold value differs per person and is determined by personal and situational factors. There is no general theory of stress. Job stress  an experienced incongruence between job demands and job or individual resources that is accompanied by cognitive, emotional, physical or behavioral symptoms. Job demands (stressors) are constantly changing due to social developments. The nature of job demands has shifted from purely physical to mental and emotional demands. Individual differences Three main categories of individual difference variables can be distinguished: - genetic characteristics (gender, constitution and physique) - acquired characteristics (education, social class and skills) - dispositional characteristics (coping styles, preferences) No worldwide accepted definition of stress. In general, 3 different ways of defining stress: 1) Job stress as a stimulus  stress would be seen as a determinant, happens not so often Stressful stimuli can be categorized under two broad main categories:  Job demands  the degree to which the work environment contains stimuli that require sustained cognitive, emotional and/or physical effort o E.g. workload, emotional labor, physical exertion o More general demands: bullying, role conflicts, role ambiguity, work-home conflicts o 3 types:  Cognitive demands  processes involved in information processing 13 Gedownload door: phielophetveld1 | verspreiden van dit document is strafbaar. [email protected] € 912 per jaar extra verdienen? Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen   Emotional demands  emotional labour, effort needed to deal with organizationally desired emotions during interpersonal transactions  Physical demands  musculoskeletal system  (lack of) job resources  a kind of energetic reservoir tapped when the individual has to cope with stressful stimuli o E.g. job autonomy, job variety, workplace social support o 3 types:  Cognitive-informational component  colleagues providing information  Emotional component  colleagues providing sympathy and affection  Physical component  instrumental help of colleagues or ergonomic aids 2) Job stress as a response  MAJORITY sees stress as a response so we can see stress as an outcome In psychophysiology and occupational medicine stress is viewed as a psychological/physiological response of the organism to some kind of threat. General Adaption Syndrome (GAS): exposure to a noxious stimulus triggers a complex of nonspecific physiological reactions that are intended to protect the individual against harmful consequences. Consists of three stages: the alarm reaction (mobilization by means of physiological and hormonal changes), the resistance stage (optimal adaption by activating appropriate systems) and exhaustion (depletion of adaptation energy). Stress reactions (strains)/outcomes of stress can be expressed in different ways and on different levels: - Affective o Anxiety, anger (personal level) o Oversensitivity or irritability (interpersonal level) o Job dissatisfaction (organizational level) - Cognitive o Powerlessness, difficulties in decision making (personal level) o Hostility, suspicion (interpersonal level) o Not feeling appreciated by supervisors (organizational level) - Physical o Headache, psychosomatic disorder e.g. coronary heart disease (personal level) - Behavioural o Hyperactivity (personal level) o Interpersonal conflicts, violent outburst, isolation (interpersonal level) o Decreased productivity, sick leave (organizational level) - Motivational o Loss of enthusiasms (personal level) o Less of interest in others, discouragement (interpersonal level) o Resistance to go to work, low work motivation (organizational level) 3) Job stress as a mediational process According to the mediational approach, stress reactions are a result of the interaction between person and environment. Potentially stressful stimuli may lead to different types of stress reactions of different individuals, depending on their cognitive evaluations (appraisals) of the situation and the resources they have at their disposal to cope with the stressful situation. 14 Dit document is auteursrechtelijk beschermd, het Gedownload door: phielophetveld1 | verspreiden van dit document is strafbaar. [email protected]  € 912 per jaar extra verdienen? Stuvia - Koop en Verkoop de Beste Samenvattingen Burnout  (Job) stressors  (Job) stress  Strain  A period of too long in stress (short-term) can lead to burn-out (long-term)  There is no ICD-10 code for burn-out, only in the Netherlands and Spain burn-out is recognized as a disease  Burnout: Mismatch between job and person, can occur in 6 domains  Burnout is a specific work-related psychological health problem as a reaction to a prolonged period of stress, consisting of: o emotional exhaustion o depersonalization/cynicism o reduced personal accomplishment (feeling that you’re not performing as you’re used to)  Multidimensional: you lose the ability to cope with it, so your behavior changes on different topics (become less empathic, more cynic, more emotional exhaustion etc.)  COR: Conservation Of Resource theory o It is difficult for people to cope with organizational changes  Work engagement  the positive opposite of burn-out Cooper, C. L., Quick, J. C., & Schabracq, M. (2009). International handbook of work and health psychology (3rd ed.). Chichester etc.: Wiley-Blackwell. Chapter 10: Baruch, Y. Stress and careers, pp. 197-220 It is a schematic framework, and there are a number of other inputs and factors that determine prospects of fit and either negative or positive impacts of stress at work. These factors include a range of personal sensitivities and a variety of possible stressors. The framework presented in the figure above relates to the theory of person–job fit (Cable & Judge, 1996; Edwards, 1991) and career choice (Holland, 1959). Holland claims that high fit between personal attributes and the characteristics of the work environment would lead to both high job performance and job satisfaction. The four quadrants are: 1. Q1 Low-pace fit = This quadrant represents cases where people have low stress tolerance, prefer to avoid a high-stress, high-demanding work atmosphere, and where the work environment provides them with such needs. 15  verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen 2. Q2 Under-load related stress = In this quadrant, people with a high need for stimulation, who look for challenges and possibly high rewards, are placed in a non demanding work environment. 3. Q3: High-pace fit = Some people enjoy the rough and tumble of business life. Stock market traders flourish when they are constantly put under pressure, given high (but manageable) targets, immerse themselves in the job, and gain high personal and financial benefits. For such people this quadrant represents a best-fit model. 4. Q4: Over-load related stress = The contemporary business environment is very dynamic and competitive. It puts high demands on people, and for many it is more than they can cope with. The pressure may be to reach unattainable performance targets, stay for long hours, or work in hazardous and risky environments, to name a few factors. Examples can be overwork and long working hours. As a sense-making rule of thumb, people should aim to avoid both Q2 and Q4, because operating under such conditions is very likely to generate negative stress, possibly leading to distress and burnout, and subsequently ending with negative career outcomes such as poor performance, withdrawal and career frustration or crisis. Q2 environments lead to boredom and feeling of being undervalued and underperforming, whereas Q4 environments lead to both psychological (e.g. anxiety) and physiological or medical setbacks. Right level of stress Too low level of stress might lead to withdrawal, lack of interest and stimuli. Too high level of stress might lead to lack of ability to cope, and withdrawal due to over-load. The cognitive activation theory of stress (CATS), suggested by Ursin and Eriksen (2004), used the term ‘stress’ for four aspects: stress stimuli; stress experience; the non-specific, general stress response; and experience of the stress response. Activation theory argues that people, employees in the context of work and careers, try to alter their stimulus field so as to attain an optimal level of the potential to create personal stimulation. When the actual stimulation is below the optimal level, discomfort in the form of boredom results. When the stimulation is above that optimal level, it produces discomfort in the form of stress. Both boredom and stress are negative affective states. The stress response is a general alarm in a homeostatic system, producing general and unspecific neurophysiological activation from one level of stimulation to another. Stress response is an essential and necessary response. The unpleasantness of the alarm is no health threat. However, if sustained, the response may lead to negative results. Stress management on the organizational level  16 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen While change in an organization (e.g. downsizing) might cause stress, having no change is not an option in the current dynamic business and social environment. Steadiness in time of environmental dynamism means lack of ability to respond. This too can generate stress. The CAST – Career Active System Triad – manifests how individuals and organizations plan and manage careers at three different levels. The challenges for the organization are to maintain a fit between individual needs, competences and career aims and the organizational operational and future goals. Gaining both procedural and distributive justice is of high relevance in generating acceptable psychological contracts. Matching individual career plans and organizational career management is a real test for managing the new psychological contract. 3) What models and theories are related to psychosocial determinants?  Exam: what is the main factor/focus of each model? What does the model explain? Which relation is presented in the model? Most models have stress as the main dominator A process model of job stress Different types of demands can lead to different types of stress reactions. The relationship may be moderated by personal resources (e.g. coping styles) and situational resources (job autonomy, workplace social support) Vitamin model (VM)  17 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen The absence of certain job characteristics impairs mental health, whereas the presence initially has a beneficial effect on employee mental health (A). Beyond a certain required level, vitamin intake no longer had any positive effects: a plateau has been reached and the level of mental health remains constant (B). The next segment shows that further increase of job characteristics may either produce a Constant Effect (CE) or may be harmful and impair mental health (AD: Additional Decrement). Which of the two effects will occur depends on the particular job characteristic: Person-Environment Fit model/Michigan (organizational stress) model (French & Kahn) Block 1: observed/objective environment, how the environment actually is (same for all colleagues). Block 2: psychological environment, how does the employee experiences this environment (perception, could be different for two colleagues). This block is also called ‘Subjective environment’. 18 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen The Michigan Model is a rather broad stress model that reflects several work-related variables, which may be of influence on the origination of strains. The Michigan Model consists of six categories of variables. The four categories “objective environment”, “subjective environment”, “strains” and “sickness” form the so-called causal path. The objective environment determines the subjective environment. Further, when a person is no longer able to deal with the demands in his subjective environment, strains (physical, psychological or behavioral) may ensue. In the long term, these strains may cause sickness and disablement for work. All relationships in this causal path may be moderated by the fifth and the sixth category of variables: social support and personal characteristics. First, the Michigan Model is rather a conceptual model that specifies relationships between broad categories of variables, than a model that aims to predict specific outcome variables (i.e., it is not a theoretical model). Second, the Michigan Model is a process model rather than a state model. Third, the variables in the model have not been defined precisely. The model rather includes categories of variables, therefore, the model can be operationalized in many ways and is generalizable over different occupational groups, but it is also another factor leading to poor testability of the model. Fourth, the Michigan Model is not useful to predict specific outcome variables, but it does provide a framework for formulating predictions. Job Characteristics Model (JCM) (Hackman & Oldham) (not specifically a stress model)  o Shows which job characteristics lead to motivation  + Skill variety 19 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen  The degree to which a job requires a variety of different activities in carrying out the work, involving the use of a number of different skills and talents of the person  + Task identity (sense of what you doing, visible outcome)  The degree to which a job requires completion of a whole and identifiable piece of work , doing a job from beginning to end with a visible outcome  + Task significance (meaningful/important work)  The degree to which the job has a substantial impact on the lives of other people, whether those people are in the immediate organization or in the world at large  + Getting (positive) job feedback  The degree to which carrying out the work activities required by the job provides the individual with direct and clear information about the effectiveness of his or her performance  + High autonomy  The degree to which the job provides freedom, independence and discretion to the individual in scheduling the work and in determining the procedures to be used in carrying it out (Job) Demand-Control(-Support) model (Karasek & Theorell) Control demand model The negative effects of being exposed to stressors can be buffered by having high control. Job strain is particularly caused by the combination of high job demands (particularly work overload and time pressure) and low job control (the working individual’s potential control over his tasks and his conduct during the working day). One basic premise in the demand control model is that employees who can decide themselves how to meet their job demands do not experience job strain (e.g. job-related anxiety, health complaints, exhaustion, and dissatisfaction). Strain: risk of psychological strain and physical illness Active: learning motivation to develop new behavior patterns  The model above isn’t focusing on the different coping styles of employees. It’s more focusing on the job, not on a person. 20 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen Control demand support model The control-demand model has been expanded to include the additional buffer of social support. The combination of high control and high support would jointly buffer the effects of job stressors on strain. Conversely, high stressor jobs with low control and low support will be the most stressful. Effort-Reward Imbalance (ERI) model (Siegrist) The effort-reward imbalance (ERI) model (Siegrist, 1996) emphasizes the reward, rather than the control structure of work. The ERI-model assumes that job strain is the result of an imbalance between effort (extrinsic job demands and intrinsic motivation to meet these demands) and reward (in terms of salary, esteem reward, and security/career opportunities, i.e. promotion prospects, job security and status consistency). The basic assumption is that a lack of reciprocity (wisselwerking) between effort and reward will lead to arousal and stress, which in turn may lead to cardiovascular risks and other strain reactions. Unlike the Job demand control model, the Effort-reward imbalance model introduces a personal component in the model as well. Overcommitment is defined as a set of attitudes, behaviours and emotions reflecting excessive striving in combination with a strong desire of being approved and esteemed. According to the model, over commitment may moderate the association between effort-reward imbalance and employee wellbeing.  The Job Demand Resources (JD-R) model is more flexible than DCM & ERI models. 21 Gedownload door: phielophetveld1 | verspreiden van dit document is strafbaar. [email protected] € 912 per jaar extra verdienen? Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen Job Demands Resources (JDR) model (Demerouti & Bakker) At the heart of the Job Demands-Resources (JD-R) model lies the assumption that whereas every occupation may have its own specific risk factors associated with job stress, these factors can be classified in two general categories, namely job demands and job resources. - Job demands refer to those physical, psychological, social, or organizational aspects of the job that require sustained physical and/or psychological (cognitive and emotional) effort or skills and are therefore associated with certain physiological and/or  psychological costs. Examples are a high work pressure, an unfavourable physical environment, and emotionally demanding interactions with clients. Although job demands are not necessarily negative, they may turn into job stressors when meeting those demands requires high effort from which the employee has not adequately recovered. - Job resources refer to those physical, psychological, social, or organizational aspects of the job that are either/or: o Functional in achieving work goals o Reduce job demands and the associated physiological and psychological costs o Stimulate personal growth, learning, and development Hence, resources are not only necessary to deal with job demands, but they also are important in their own right. Job resources may be located at the level of: o the organization at large (e.g. pay, career opportunities, job security) o the interpersonal and social relations (e.g. supervisor and co-worker support, team climate) o the organization of work (e.g. role clarity participation in decision making) o the level of the task (e.g. skill variety, task identity, task significance, autonomy, performance feedback) Dual process  two different underlying psychological processes play a role in the development of job strain and motivation, leading to different organizational outcomes: - Upper pathway (job demands and strain): leads to exhaustion  health impairments process - Lower pathway (job resources and motivation): leads to engagement (and better job performance)  motivational process o (Job resources may play either an intrinsic motivational role because they foster employees’ growth, learning and development, or they may play an extrinsic motivational role because they are instrumental in achieving work goals) 22 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen In addition to the main effects of job demands and resources, the JD-R proposes that job resources may buffer the impact of job demands on job strain, including burnout. This assumption is consistent with the demand-control model, but whereas the DCM states that control over the execution of tasks (autonomy) may buffer the impact of work overload on job stress, the JD-R model expands this view and states that different types of job demands and job resources may interact in predicting job strain. Demand Induced Strain Compensation (DISC) model/HHH-model Multidimensionality of concepts: job demands vs job resources and off job recovery time, leading to job related outcomes, may compromise at least: - Hands = physical components (associated with the musculoskeletal system) - Heart = emotional components (needed to deal with organizationally desired emotions during interpersonal interactions) - Head = cognitive components (associated with brain processes involved in information processing) Triple balance principle  these three concepts need to be in balance Triple match principle  the strongest relationships among concepts should be observed if they are based on qualitatively identical dimensions and processes e.g. emotional demands vs 23 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen emotional resources in prediction emotional exhaustion Interventions to prevent or reduce job stress Job stress interventions may focus on three levels: - the organization  by changing the work situation through organization-based interventions, the source of the problem is tackled and the employee’s negative reaction is reduced - the individual/organization interface  by increasing the employee’s resistance to specific job stressors, his or her vulnerability decreases - the individual  by learning to cope better with stress in general, the individual prevents negative psychological effects of job stressors Job stress interventions may serve five purposes: - identification (early detection of job stressors and stress reactions) - primary prevention (reduction of job stressors) - secondary prevention (altering the way employees respond to job stressors) - treatment (healing those who suffer severely from job stress) - rehabilitation (planned return to the previous job) 24 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen 4) How do the psychosocial factors differ across the lifespan? (both in the work- and social environment)  psychosocial determinants that are changing across the psychosocial psychosocial determinants that are changing across the determinants psychosocial determinants that are changing across the that psychosocial determinants that are changing across the are psychosocial determinants that are changing across the changing psychosocial determinants that are changing across the across psychosocial determinants that are changing across the the psychosocial determinants that are changing across the lifespan - Young: challenge, feedback important - Older: Chrystal intelligence increases, autonomy important - Fluid intelligence decreases with ageing, while crystallized intelligence increases: o Fluid intelligence  concerns the degree of flexibility in thinking and the ability to abstract reasoning. o Crystallized intelligence  concerns the extent to which an accumulation of knowledge and skills has taken place during the life course. Makes you a good leader, manager, etc. o  Problem solving may require both types of intelligence - Work-home conflict changes over time (e.g. having children, taking care of parents) Truxillo, D.M., Cadiz, D.M., & Rineer, J.R. (2012). Designing jobs for an aging workforce: An opportunity for occupational health. In J. Houdmont, S. Leka & R.R. Sinclair (Eds.). Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice. Volume 2. 1st ed. (chapter 7, pp. 109-125). Job design has largely been approached as a “one size fits all” proposition. Yet, lifespan development approaches and a growing body of empirical work suggest otherwise. As the workforce ages, organizations that are able to develop jobs that accommodate workers across the lifespan will be at a competitive advantage – by improving not only employee retention rates and attitudes, but health and wellbeing as well. Cooper, C. L., Quick, J. C., & Schabracq, M. (2009). International handbook of work and health psychology (3rd ed.). Chichester etc.: Wiley-Blackwell. Chapter 10: Baruch, Y. Stress and careers, pp. 197-220 Personal differences Different people have different ‘stress triggers’. Cattell’s 16PF (Cattell & Kline, 1977) is an example of a validated tool that can help to identify right or wrong fit: - emotional vs. emotionally stable; - shy, restrained vs. venturesome, bold; - tough minded vs. tender minded; - confident, complacent vs. worrying, insecure; - relaxed, tranquil vs. tense, frustrated. These factors are crucial in figuring out which type of person might be inclined to high stress if allocated a role in the Q2 or Q4 quadrants. Someone who is ‘venturesome, bold’, who finds himself positioned in a quiet, monotonous role, would suffer stress due to under-load. Mainiero and Sullivan (2006), in their Kaleidoscope Careers, identified three ‘mirrors’ through which people examine their career priorities. These are: - Authenticity: a striving to be genuine, to be one’s true self, to create a healthy alignment between one’s values and outward behaviours. - Balance: finding a healthy congruence between work and non-work. - Challenge: the need to continuously learn and find stimulating, exciting work. They argue that two factors are instrumental in setting career priorities across the three ‘mirrors’ – career stage and gender. Alpha and Beta are identified as two ‘archetypes’: - Alpha – mostly characterizing males: o early life into midlife: focus on challenge;  o latter part of midlife: focus on authenticity; 25 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen o later life: focus on balance. - Beta – mostly characterizing females: o early life: focus on challenge; o midlife: focus on balance; o later life: focus on authenticity. Looking at an integrated model of career stages different sources for stress, which might arise in different stages of a person’s career, can be identified. It is different from other models because of the ability of re-running stages (b) - (e). People with different career aims are inclined to suffer stress for different reasons. Derr pointed out five individual career success indicators or dimensions: (a) Getting ahead: motivation derives from the need to advance both in professional standing and up the organizational ladder. (b) Getting secure: having a solid position within the organization. (c) Getting high: being inspired by the nature and content of the work performed. (d) Getting free: being motivated by a need for autonomy and the ability to create your own work environment. (e) Getting balanced: attaching equal or greater value to non-work interests. 5) How do the models and theories fit in the ICF-framework?  You can start with the ICF to get a general understanding of the problem/relation  You can continue with a specific model to focus on this specific problem/relation - a model can help you to see relations clear - regarding the ICF, the models can be used to get a focus towards outcomes - use the model that helps you the most - there are no worse or better models - you start with the ICF and zoom in on specific models to understand certain relations better - the reality is far too complex to build in 1 model, therefore each model focusses on specific outcomes o furthermore, the work environment is constantly changing  26 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen Case 3 – Physically demanding work (MSDs & LBP) (both physical & psychosocial environment, multi-causal) 1) What are musculoskeletal disorders? (MSDs) European Agency for Occupational Health and Safety: E-Facts 9: Work-related musculoskeletal disorders (MSDs): an introduction. MSDs are disorders that affect the musculoskeletal system, resulting from a repetitive exposure to loading. MSDs are caused when the physical capacity of the muscles, joint etc. is not in balance with external forces that act upon the body. Upper limbs (the hand, wrist, elbow and shoulder), the neck and lower back are particularly vulnerable to MSDs. Lower limbs and the upper back may also be affected. Many people will suffer from an MSD once in their life, and many will experience symptoms more than once. MSDs may be characterized as episodic diseases because the pain often subsides and disappears for a while and recurs a few months or years later. A large number of MSDs are transient, in that the pain (or other symptoms) disappears with rest or when an activity is changed. However, dependent on the tissue involved and on the forces that act upon the body, some MSDs may become persistent or irreversible. Most physicians and researchers classify MSDs either as specific or nonspecific disorders. - specific = in that they have clear clinical features; they include lumbosacral radiculair syndrome in the low back, carpal tunnel syndrome in the wrist, and patellar tendonitis in the low extremities. Hernia, tumor in your back. - non-specific = in that pain is present without evidence of a clear specific disorder. The vast majority of low back pain is non-specific. o 90-95% of low back pain, also called common low back pain o It is not fake or subjective, it is there but we don’t understand it yet Psychosocial environment has an influence on both specific and non-specific disorders, but the non-specific disorders are mostly influenced by psychosocial environment. Compressed nerves and muscles can be the cause of the pain. - Acute = current attack is less than 6 weeks o Most common o Return to work quite rapidly - Subacute = current attack is 6 weeks to 3 months - Chronic = current attack is more than 3 months o Sick leave becomes also chronic  The classification is used for the prognosis. There are interventions for each fase. Sickness absence and permanent disability due to MSDs MSDs are the work-related health problem with the highest impact on sickness absenteeism in Europe; 39% of total sickness absence of 2 or more weeks is due to work-related MSD symptoms (in comparison, 19% of total sickness absence is due to stress, depression and anxiety). MSDs are also the work-related health problem with the highest impact on permanent incapacity; 61% of permanent incapacity is due to MSDs (compared to 10% due to 27 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen stress, depression and anxiety and 10% due to cardiovascular disorders). Almost 24% of workers who have suffered from a work-related MSD complaint in the past 12 months have a sick leave period of between 1 and 13 days. 11 % have a sick leave period of between 2 weeks and 1 month, and about 20% have a sick leave period of more than 1 month. All our postures and movements are dependent on the functioning of the musculoskeletal system. Being physically active is beneficial for our musculoskeletal system, but an overload of physically strenuous tasks may pose a threat to it. External forces may cause acute trauma during an accident, resulting in fractures, lacerations and contusions. However, work-related MSDs are mostly cumulative disorders. They result from repeated exposure to high or low intensity loads over a certain period of time. What factors may contribute to MSDs? 4 different groups of factors may potentially contribute to MSDs: Physical or biomechanical work-related factors Organizational or psychosocial work-related factors Individual or personal factors Factors relating to social content - Physical factors(physically demanding work) = Physical factors include the work procedures, equipment and environment that lead to biomechanical stress in the muscles, tendons, spinal discs and nerves: o Applying manual force with the intention of moving objects, persons or animals loads the muscles and tendons of the arms o Repetitive work using the same muscles and tendons for a considerable part of the working day may be responsible for fatigue and injuries. o In awkward postures (with the hands above shoulder height or with the wrists noticeably bent) the joints are more susceptible to injuries and the muscles have less capacity for exerting force. o Excessive work with hand-powered tools like hammer drills and other percussive  breakers like concrete crushers, hand-held portable grinders, jig saws and chainsaws, may expose the hands to vibration and contribute to potential disruption to the blood circulation in the fingers and to the nerves of the hand and arm. o Cold environments compromise muscle efficiency and may cause vascular and neurological damage. Workers with cold hands may exert more force then necessary, affecting muscles, soft tissues and joints. This can lead to a more rapid onset of fatigue and to the development of disorders. o Hairdressers, dentists, computer operators and musicians are examples of workers who have long-term static postures: the shoulder muscles are tensed, without movement, in order to maintain the arms raised, while the hands work without the opportunity to rest. This type of repeated static posture can give rise to injuries, particularly when repeated for months or years.  Prolonged standing may result in fatigue and discomfort in the legs. It can lead to the development of musculoskeletal disorders (e.g. painful feet and other foot problems) and varicose veins. Prolonged sitting requires the muscles to hold the trunk, neck and shoulders in a fixed position. This squeezes the blood vessels in the muscles, reducing the blood supply. An insufficient blood supply accelerates fatigue and makes the muscles prone to injury. 28 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen  Manual handling refers to the transfer, pushing, pulling and carrying of loads by one or more employees. When heavy manual handling is repetitive, and combined with awkward work postures (e.g. with the trunk bent forward, or bent and twisted at the same time) there may be a high risk of MSDs in the lumbar region. However, some loads may be considered favourable; they contribute to the dynamic s of movement and to the efficiency of blood circulation (particularly when the load is suitable for the duration of the activity and the recovery time allowed).  Repetitive, forceful work with the joints in an awkward position is one of the most important combinations of risk factors. It can be seen for example in grocery checking, meat, poultry and fish preparation, manual assembly line work, helping patients to move, serving food and drink, cleaning, paint-spraying, using hand-held machines and using hand tools. - Organizational and psychosocial factors = Daily exposure to physical risk factors and insufficient rest or recovery time are among the principal organisational factors that can lead to MSDs. Providing knowledge, skills and information on working methods and techniques, and on working movements, postures and loads, can reduce the risk of MSDs. Mental strain can cause muscular tension, and increase existing physical strain. Work conditions that may increase mental strain include: o Psychologically demanding activities, in which the workers are exposed to high levels of work stress, work pressure and mental demands, as a consequence for example of tight deadlines and low levels of autonomy o Activities in which there is little support from colleagues, supervisors and managers. Stress is an important concept in this which causes tension on your muscles/nerves. - Individual factors = history, physical capacity and age are very important. Obesity, pregnancy, rheumatoid arthritis, acute trauma and endocrinological disorders are other examples of individual non-occupational factors that may affect the occurrence of MSDs. - Factors relating to social context = Social context provides some important non-work risk factors relating to MSDs. Some types of sport, leisure activities and housekeeping work at home can all increase susceptibility to MSDs.  a) What is low back pain? Burton, K., & Waddell, G. (2004). The epidemiology of low back pain. In: G. Waddell: The back pain revolution, 2nd ed. (chapter 5, pp. 71-90). Edinburgh: Churchill Livingstone There is a problem defining low back pain. Do we include any low back symptoms, no matter how mild or how brief their duration? How do we draw a line between symptoms, ache, and pain? Many surveys ask about pain that lasts for a certain time, e.g., for a day or more. Is the pain severe enough to stay off work? but then we are talking about disability or incapacity for work rather than pain. We must distinguish back pain, associated disability, and health care for back pain. We have already seen that pain and disability are not the same..  Hard to compare studies, different definitions, different measurements and different prevalence (although same questionnaire due to the inclusion/exclusion criteria different prevalence)  Pain is perceived different and influenced by a lot of variables e.g. culture, environment, country 1. 60-80% of people get back pain at some time (lifetime prevalence) 29 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen 2. Most acute clinical attacks settle rapidly, but residual symptoms and recurrences are common. 3. 35-40% of people report low back pain lasting 24 hours or more each month and 15- 30% of people have some low back symptoms each day. 4. The strongest predictor of a further episode of low back pain is a history of previous episodes. 5. People with back pain often report other symptoms (comorbidity). Despite popular belief, there never was an epidemic of back pain. Back pain has always been a common bodily symptom. The evidence is of an epidemic of disability associated with ordinary backache. More specifically, all western countries had a dramatic increase in sick certification, social security benefits, and early retirement attributed to back pain between the 1950s-1960s and the early-mid-1990s. More a social epidemic.  Pain and disability are not the same. Burton, K., & Waddell, G. (2004). Risk factors for low back pain. In: G. Waddell: The back pain revolution, 2nd ed. (chapter 6, pp. 91-115). Edinburgh: Churchill Livingstone. Potential risk factors for back pain - Individual: o Genetics o Gender = Women report a slightly higher prevalence of back pain, as is the case for most bodily symptoms. Women seek slightly more health care for back pain, as is the case for most health conditions. Back injuries at work, time off work, sickness benefits, and compensation claims may reflect different social and work patterns rather than any biologic difference between men and women. 30 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen o Age = U-curve. During adolescence and teenage years the prevalence of back pain increases to adult levels. Most adolescent back pain is not due to any significant medical condition and does not present for health care. o Body build = height, weight, leg length inequality  The four factors above don’t directly cause LBP o Physical fitness o Smoking o Social class, education  social class reflects occupation, particularly manual vs non-manual, and social disadvantage. The prevalence of back pain may be slightly greater in those from a lower social class. o Emotional distress Environmental: - Physical o Manual handling  o Heavy lifting o Bending and twisting o Repetitive movements o Static work postures and sitting o Driving and whole-body vibration o Leisure activities and sports  on the short term it causes sick leave because of injuries, on the long term it is good for the productivity. - Psychosocial aspects of work o Job satisfaction o Work “stress“ o High job demands and pace o Poor job content: low decision latitude, low job control, and monotonous work o Low social support o Job “strain” b) Prevalence of MSDs (per sector)? Frequency MSDs are the most common work-related disorders, affecting workers both in physically strenuous work (e.g. mining) and in low-intensity static work (e.g. computer work). The costs of treating MSDs, together with the costs of absenteeism, have been estimated at between 0.5% and 2% of Gross National Product in the Nordic countries. MSDs account for 50% of all new cases of occupational disorders in the EU (2003 data), and 50% of all work-related health problems in Europe (1999 data). Moreover, the number of MSD cases is increasing over time. In 2001, around 19 workers in every 100,000 suffered from a new MSD. This number had almost doubled by 2003 (32 per 100,000 workers). MSDs per sector Mining and quarrying, manufacturing and construction (mijnbouw, steengroeven, productie, bouw) 3 1 Gedownload door: phielophetveld1 | verspreiden van dit document is strafbaar. [email protected] € 912 per jaar extra verdienen? Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen are the sectors with the highest relative number of MSD cases: 960 new cases per 100,000 workers, which is 30 times the average number of 32 per 100,000. However, in terms of work-related MSD complaints, the health and social work, transport, communication and construction sectors (gezondheidszorg en maatschappelijk werk) have the highest rate of symptoms (1.2 to 1.6 times higher than the average in the total population). MSDs per occupation Of all European workers, blue collar employees experience almost 20 times as many MSDs as white collar employees (legislators, professionals and clerks). Compared to service workers and shop and market sales workers (for example salespersons and demonstrators), the number of MSDs among blue collar workers is 4 times higher. Of the blue collar workers, craft and trade workers, plant and machine operators and assemblers, and workers in elementary occupations have the highest risk of MSDs: they accounted for 84% of all new certified cases reported in 2003 in EU countries. Among craft and trade workers, the number of MSDs is 101/100,000 workers and among workers in elementary occupations it is 71/100,000 workers. The relative number of work-related MSD complaints is highest among service workers and shop and market sales workers (3,700/100,000 workers) and also among workers in elementary occupations (labourers in mining, construction, manufacturing and transport) and plant and machine operators. MSDs by sex and age The risk of male workers suffering from an MSD is 1.3 times higher than the risk to female workers: 35/100,000 compared to 27/100,000. In terms of (self-reported) work-related MSD complaints, the risk is only slightly higher among male workers (1.07 times higher). The number of work-related MSD complaints increases with age. At the age of 55-64 years the number of self-reported symptoms is 1.7 times higher than at the age of 25-34 years. 2) What are the guidelines for physically demanding work? (legislation) Employers in Europe are required to comply with laws and regulations in their Member States relating to working conditions and the workplace. These are based to a large extent on European Directives. Some Directives are very important for the prevention of MSDs: 90/269/EEC on the minimum health and safety requirements for the manual handling of loads, where there is a risk particularly of back injury to workers With regard to the manual handling of loads, specific attention must be paid to risks relating to characteristics of the load (eg whether it is too large, unstable or difficult to grasp), the physical effort required (eg whether it is too 32 verspreiden van dit document is strafbaar. € 912 per jaar extra verdienen? Gedownload door: phielophetveld1 | [email protected] Dit document is auteursrechtelijk beschermd, het Stuvia - Koop en Verkoop de Beste Samenvattingen strenuous, or can only be achieved through a twisting movement of the trunk), characteristics of the working environment (eg uneven or slippery floors or unsuitable temperature) and the requirements of the activity (e.g. over frequent physical effort or insufficient recovery periods). 90/270/EEC on the minimum safety and health requirements for work with display screen equipment With regard to work with display screen equipment, workstations must comply with minimum requirements (eg with space in front of the keyboard, a work desk with a sufficiently large surface, adjustable seat and available footrest, satisfactory lighting). Also, work on a display screen should be  periodically interrupted by breaks or changes of activity. Finally, attention should be paid to the operator-computer interface (eg providing suitable software). 2002/44/EC on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents ( vibration ) Council Directive 89/391/EEC on the introduction of measures to encourage improvements in the safety and health of workers at work.  These Directives set out the obligations of employers to put in place preventive organizational measures, to provide mechanical aids, to perform risk assessments, and to assess the demands of a specific task. Employers must also give workers the information and training they need to work in a healthy manner.  in the guidelines there are certain exposure limits, e.g. maximum amount of lifting (25 kg), to avoid MSDs. If exceeding this amount, there should be lifting equipment. 3) What are the consequences of physically demanding work on low back pain and labour participation?  Sick leave, less productivity, less working hours, high risk of accidents  MSDs are the work-related problem with the highest impact on sickness absenteeism in Europe (39%)  MSDs are the work-related health problem with the highest impact on permanent incapacity (61 %) Bos, E., Krol, B., van der Star, L., & Groothoff, J. (2007). Risk factors and musculoskeletal complaints in non specialized nurses, IC nurses, operation room nurses, and X-ray technologists. International Archives Of Occupational And Environmental Health, 80(3), 198-206  IC nurses have less back pain, because there psychosocial environment is better (more rewards e.g. higher salary, more influence over work). The prevalence rate of neck-shoulder complaints in operation room nurses (69%) is higher than in non-specialized nurses and IC nurses (also high prevalence rates; 58%). The exposure to risk factors is perceived differently by each of the professional groups. Interventions need to be specified for each of the professional groups  there is not one solution, tailoring is important. With regard to the exposure of risk factors, there is an indication that the job content of non specialized nurses and IC nurses include different occupati