Notified occupational mental disorders: associations with health and income.

BACKGROUND: Studies indicate that workers' compensation claim processes may affect patients' health negatively. However, few studies focus on patients with mental health claims, and the claim process varies between countries. AIMS: The aims of this study were to examine whether being notified to the Danish Labour Market Insurance with an occupational mental health condition was associated with changes in visits to the general practitioner (GP), use of medicine and annual income. METHODS: Study participants were 965 patients with a mental disorder examined at a department of occupational medicine. Of these, 669 patients were notified with an occupational mental disorder, 296 were not. Health-related outcomes, including GP visits and prescriptions of psychotropic drugs, were estimated at baseline during the year of medical examination, while annual income was estimated a year before the examination. The follow-up was the year after the year of examination for all outcomes. Outcomes were collected from the Danish National Bureau of Statistics. Analyses were conducted using Poisson regression and conditional logistic regression. RESULTS: All measured outcomes decreased from baseline to follow-up in both groups. These changes were not significantly different depending on notification status at baseline. CONCLUSIONS: This study suggests that being notified with an occupational mental disorder does not significantly affect health-related outcomes. A significant decrease in annual income over time was seen in both groups, the notified and the unnotified group, highlighting the importance of providing support to all employees with a mental disorder.

Using an integrated approach to the assessment of the psychosocial work environment: the case of a major hospital in northern Italy.

BACKGROUND: In 2010, Italian regulatory guidelines have been issued consisting of a stepwise procedure for the assessment and management of work-related stress. However, research that empirically examines whether this procedure proves effective in accurately identifying critical psychosocial factors and informing risk management is scarce. OBJECTIVES: To examine the differential sensitivity of two approaches to risk assessment, the first based on objective instruments only, the second consisting of an integrated approach combining different methods and theoretical perspectives. METHODS: We examined a sample of 306 healthcare employees in a large-size hospital in northern Italy, using a series of tools, both quantitative (an observational checklist and the HSE-IT and MOHQ questionnaires) and qualitative (Focus Groups). Through instrument-specific reference values, we then compared risk profiles between different homogeneous groups within the institution. RESULTS: The psychosocial work environment resulted to be far more positive when adopting the first compared to the second approach to risk assessment. The latter approach was also more sensitive in detecting between-groups differences in risk profiles. Furthermore, the Focus Groups returned a more context-specific picture of the psychosocial work environment. Finally, going beyond the emphasis on negative working conditions inherent in the other quantitative instruments, the MOHQ allowed for also identifying health-promoting factors in need for improvement. CONCLUSIONS: Although more research is needed to confirm our findings, the present study suggests that using an integrated approach to assess the psychosocial work environment may be the most effective way to accurately identify risk factors and support the management process.

Context specificity in the assessment of psychosocial risk at work: an empirical study on Italian call centre workers.

BACKGROUND: Following EU requirements, in recent years standard procedures for the assessment of work-related stress have been developed in Italy. However, while such standardization has facilitated the spread and use of these procedures, it has brought a lack of specificity in risk assessment. OBJECTIVES: To exemplify a method for the assessment of work-related stress that was developed by the University of Milan to allow the definition of risk profiles tailored to the different organizational settings. METHODS: We examined risk factors for work-related stress in call centre operators employed by two separate Italian companies. At an early stage of the assessment procedure, we conducted a wide series of consultation and training activities that allowed the identification of context-specific risk factors and homogeneous groups, which fuelled the preparation of both the "objective" and the "subjective" evaluation instruments. RESULTS: Results obtained by means of the standardized "Effort-Reward Imbalance Questionnaire" and "Job Content Questionnaire", interpreted in the light of consultations with key organizational figures and individual interviews with employees, have allowed the detection of different risk profiles and priorities for intervention at both the group and the organizational levels. CONCLUSIONS: Findings demonstrated the existence of both common and specific risk factors in the two companies, which would have remained undetected with the exclusive use of standardized approaches.

[Burnout: survey of the literature]. / Burnout ieri e oggi: stato delle conoscenze.

BACKGROUND: Past clinical research has provided varied and sometimes diverging descriptions of burnout. OBJECTIVES: As burnout is still prevalent in today's workplaces, actions are required mainly at the primary but also at the secondary and tertiary levels of prevention. METHODS: In this literature review, the concept of burnout is reread through the lens of positive psychology and the most established theoretical models in the field. RESULTS: A common view is seemingly emerging that characterizes burnout as a condition of alienation, loss of motivation and low autonomy resulting from an unbridgeable gap in the personal and/or organizational resources that one has to invest in building a stimulating and rewarding professional career, full of significant relationships that give meaningfulness to one's life project. CONCLUSIONS: Establishing clinical criteria for burnout, as it is the case in some European countries, couldfacilitate the identification of the syndrome and the estimation of its prevalence in Italian work organizations.

[Job Demands-Resources, exhaustion and work engagement in a long-term care institution]. / Modello Job Demands-Resources, esaurimento psico-fisico e coinvolgimento lavorativo nel personale di una casa di cura per lungodegenti.

In this study, we aimed at testing the main hypotheses of the Job Demands-Resources model (JD-R) in a sample of employees (n = 205, mainly healthcare workers) of a long-term care institution located in Northern Italy. Hierarchical linear regression analyses show that almost all job demands considered were significantly associated with higher general psycho-physical exhaustion (beta ranging from 0.14 to 0.29), whereas more unfavourable scores in all job resources were associated with lower work engagement (from -0.27 to -0.51). However, also significant cross-over associations were observed, mainly between job resources and exhaustion, with effect sizes comparable with those found for the relationships between job demands and exhaustion. Hence, our study only partially supports the JD-R model. Implications of results for work-related stress management are finally discussed.

[Work-related stress in nursery school educators in the Venice and Marghera districts]. / Rischio stress tra il personale degli asili nido/scuole dell'infanzia della Municipalità di Venezia e Marghera.

BACKGROUND: Based on an investigation on organizational well-being in the Municipality of Venice (2009), we examined 110 public nursery school and preschool teachers working in the Venice and Marghera districts. OBJECTIVES: The aim of this study was to develop and implement a procedure for work-related stress assessment and management in Municipality of Venice, in the light of Law 81/2008. METHODS: Occupational stress and its impact on teachers' well-being and health were assessed by means of self-administered questionnaires and semi-structured interviews. Descriptive analyses were conducted to compare teachers' data with those concerning employees operating in other services in the Venice and Marghera districts. RESULTS: According to the results, while nursery school and preschool teachers work with considerable commitment, vigor, dedication and involvement, problems were observed related to: assignment of administrative tasks without appropriate support from the district offices; difficult access to support services; shortage of temporary teachers and auxiliary personnel and, limited to some facilities, lack of adequate physical space devoted to teaching activities. Such adverse conditions result in an increase in vigilance levels required to ensure children's safety. Personnel also suffer from a lack of career prospects, with scarce opportunities for contact with other facilities in the area and inadequate involvement in the decisional processes at Municipality level. CONCLUSIONS: Improving such adverse conditions could solve the current marginalization of public nursery school and preschool teachers and encourage mutual exchange of information, which would in turn favour more appropriate methods of managing each single facility.

[The instruments for subjective assessment of work-related stress]. / Gli strumenti per la valutazione soggettiva del rischio stress lavoro-correlato.

The instruments for subjective assessment of work-related stress are aimed to evaluate individual perceptions of aspects that are crucial in the causal process linking psychosocial exposure to harmful physical and psychological health effects. Subjective assessment is most commonly performed by means of self-administered questionnaires, non least for their ability to hold down financial and economic costs of both field studies and data analyses. A common problem is that, for the major part of these questionnaires, no Italian validated (or accept) versions exist. Among available questionnaires, those that have been applied to a higher number of subjects in Italy are the Job Content Questionnaire, the Effort/Reward Imbalance Questionnaire, the Occupational Stress Indicator and the Multidimensional Questionnaire of Organizational Health. In this contribution, the main characteristics of the above-mentioned instruments are depicted. Finally, important aspects relating to the usage of self-administered questionnaires are emphasized, mainly when field evaluations are undertaken in specific work contexts.

Main and interactive effects of shiftwork, age and work stress on health in an Italian sample of healthcare workers.

Among healthcare workers, shiftwork (mostly if nightwork is also included), ageing and work-related stress may be factors leading to impaired health. Such risk factors may also operate in interaction, resulting in an even increased harm for health. The present study aims at evaluating these relationships in a sample of 1842 hospital workers in Northern Italy. Subjects were mainly women, 33.1% were aged > or = 45 yr, and they were almost evenly distributed between dayworkers and rotating shiftworkers (nights included). Shiftwork was associated with poor sleep, while it was protective against gastrointestinal disorders, poor work ability and job dissatisfaction. Work stress was the risk factor with the highest relevance for poor health. Ageing was associated with lower physical health. Few significant interactions were observed. Shiftwork with nights and high work stress significantly interacted in increasing the risk for poor sleep. The "healthy worker effect" may have played a strong role in study findings.

Nurses' health, age and the wish to leave the profession--findings from the European NEXT-Study.

BACKGROUND AND OBJECTIVES: In many industrialised countries the number of workers with low health is expected to increase in the nursing profession. This will have implications for occupational health work in health care. The European NEXT-Study (www. next-study. net, funded by EU) investigates working conditions of nurses in ten European countries and provides the opportunity to evaluate the role of health with respect to age and the consideration of leaving nursing. METHODS: 26,263 female registered nurses from Belgium, Germany, Finland, France, England, Italy, Netherlands, Poland and Slovakia were eligible for analysis. RESULTS: In most countries, older nurses considered leaving the profession more frequently than younger nurses. 'Health' was--next to 'professional opportunities' and 'work organisational factors'--strongly associated with the consideration of leaving nursing. However, more than half of all nurses with low health wanted to remain in the profession. This group reported rather positive psychosocial working conditions--but also the highest fear for unemployment. CONCLUSIONS: The findings indicate that 'the nurse with low health' is reality in many health care settings. Both positive supporting working conditions but also lack of occupational alternatives and fear of unemployment may contribute to this. Current economic, political and demographic trends implicate that the number of active nurses with low health will increase. Occupational health surveillance will be challenged by this. But NEXT findings implicate that prevention also will have to regard work organisational factors if the aim is to sustain nurses' health and to enable nurses to remain healthy in their profession until retirement age.

[Intention to leave the nursing profession]. / L'intenzione di lasciare la professione infermieristica.

BACKGROUND: The NEXT Study (Nurses' Exit Study) was initiated in 10 European countries in order to shed light on nurses' working conditions and reasons of shortage. OBJECTIVES: The study objective was to determine organisation and psychosocial conditions that lead to premature departure from the nursing profession. METHODS: The questionnaire we used took into account aspects such as work history, work demands and organisation, career prospectives and individual resources. This article describes steps related to the construction and validation of the questionnaire and sampling methods. Preliminary results are also reported. Data analysis, performed in relation to the intention to leave the nursing profession, showed the distinctiveness of the situation in Italy compared to other European countries. RESULTS: Conditions related to intention to leave are multifaceted, but they can be summarized as inadequacy of facilities to support the family needs of staff low level of trust in official structures, together with poor support by colleagues and superiors, work overload, and lack of independence at work--although the latter is foreseen in current legislation--and scant career and development possibilities. CONCLUSIONS: These results confirm the existence of a difficult situation, although certain legislative changes are aimed at solving these problems.

Role of norepinephrine in the release of prolactin induced by suckling and estrogen.

Release of prolactin from the anterior pituitary can be induced by a variety of neuronal and hormonal stimuli, including suckling and estrogen. To determine whether noradrenergic neurons in the central nervous system mediate the response to either of these stimuli, norepinephrine synthesis was inhibited by diethyldithiocarbamate (DDC; 50 mg/kg). When administered to suckled, lactating rats, DDC had no effect on suckling-induced increase in plasma prolactin. The drug also had no effect on prolactin levels in ovariectomized rats. However, when DDC was administered to ovariectomized rats treated with estrogen to increase plasma prolactin levels, there was a fall in plasma prolactin levels which correlated with a decrease in hypothalamic norepinephrine synthesis. It is proposed that estrogen increases noradrenergic neuron activity which in turn increases prolactin release from the pituitary.

Inhibition of brain catecholamine synthesis and release of prolactin and luteinizing hormone in the ovariectomized rat.

The effects of alpha-methyl-p-tyrosine (alpha-MT) on brain catecholamine synthesis and plasma prolactin and luteinizing hormone levels were determined in ovariectomized rats to ascertain whether the release of either hormone from the anterior pituitary is dependent on the release of newly synthesized dopamine and norepinephrine. Doses of alpha-MT ranging from 3.15 to 25 mg/kg were administered via a carotid cannula to unrestrained ovariectomized rats. Within 10 minutes, alpha-MT caused a significant dose-related increase in plasma concentrations of prolactin which became maximal 20 to 25 minutes after the injection. Plasma levels of luteinizing hormone were not affected. Alpha-MT caused a dose-related decrease in the accumulation of 3-H-norepinephrine and 3-H-dopamine in the brain after the administration of 3-H-tyrosine. The time course of the inhibition of catecholamine synthesis closely paralleled the increase in plasma prolactin concentration. Alpha-MT had no effect on endogenous catecholamines. The results suggest that catecholamine-containing neurons exert a tonic inhibitory influence on the release of prolactin in ovariectomized rats.