The effect of supplementary antioxidant therapy in patients who report hypersensitivity to electricity: a randomized controlled trial.

CONTEXT: Hypersensitivity to electricity is a proposed environmental illness of unknown etiology. Patients report a variety of symptoms that they relate to electric equipment. The afflicted individuals suffer from ill health. Many interventions have been tried but, to date, there is no one specific treatment that has been proven superior to other remedial actions. In general, there is a lack of controlled prospective studies. OBJECTIVE: To test the hypothesis that antioxidant therapy reduces symptoms and improves health in patients reporting hypersensitivity to electricity. DESIGN: Randomized, double-blind, crossover, placebo-controlled study. SETTING: Patients referred to the Environmental Illness Research Centre, Stockholm County Council. PATIENTS: Sixteen patients reporting hypersensitivity to electricity. INTERVENTION: Antioxidant supplementation (vitamins C and E, selenium). MAIN OUTCOME MEASURES: Self-reported symptoms and reported degree of hypersensitivity to electricity, serum levels of uric acid and diphenylpycrylhydrazyl (DPPH). RESULTS: The results indicated no significant differences in reported symptoms, reported hypersensitivity to electricity, or oxidative status in serum between periods of antioxidant and placebo treatments. Serum levels of DPPH and uric acid showed no correlation with the reported degree of symptoms or hypersensitivity to electricity. CONCLUSIONS: The study did not show any beneficial effect of antioxidant supplementation for patients reporting hypersensitivity to electricity. The results do not support the hypothesis that oxidative stress is a major contributor to ill health in patients who report hypersensitivity to electricity.

Violence towards health care staff and possible effects on the quality of patient care.

Much of the research on violence in the health care sector has focused on the immediate and long-term effects of patient violence on staff victims. There is a lack of studies, however, examining whether individual reactions to violent episodes, such as anger and increased fear in one's work, have any measurable effect on staff behaviour toward their patients, and ultimately on the quality of patient care. The aim of the present study was to investigate whether an association exists between staff experiences with violence and patient-rated quality of patient care. A theoretical model was presented, suggesting that violence or threats experienced by health care staff have a negative effect on the quality of health care services offered, as measured by patients. In addition, it was theorised that there would be an association between staff work environment and staff reports of violence. Six questionnaire studies, three concerning hospital staff's views of their work environment and three dealing with patients' perceptions of the quality of care, provided the data for evaluating the model. Work environment and quality of care studies were carried out simultaneously at a single hospital in 1994, 1995, and again in 1997. Regression analysis was used to see which combination of work environment and quality of care variables would best predict a positive overall grade for quality of care from the patient perspective. Violence entered consistently as an important predictor into each of the three best regression equations for 1994, 1995, and 1997, respectively. The results of this analysis suggest that the violence experienced by health care staff is associated with lower patient ratings of the quality of care. The study indicates that violence is not merely an occupational health issue, but may have significant implications for the quality of care provided.

Environmental illness: fatigue and cholinesterase activity in patients reporting hypersensitivity to electricity.

The lack of a pathophysiological marker hinders studies on environmental illnesses of unknown origin. Hence, research focused on the identification of such a marker is a priority. This study investigated the nature and a possible etiology of fatigue in hypersensitivity to electricity (the most commonly reported environmental illness in Sweden). The aim was to test the hypothesis that perceived fatigue was due to alterations in cholinesterase activity. The study group consisted of 14 people who reported a hypersensitivity to electricity, including disabling fatigue. We assessed cholinesterase activity three times: twice based on current symptoms reported by the subjects (severe fatigue attributed to electromagnetic fields and absence of this symptom) and once at a randomly selected time. No significant reduction in acetylcholinesterase was identified in any subject. Examined on a group level, no significant reduction in activity was identified at the time of severe fatigue, and no correlation between reported degree of fatigue and cholinesterase activity was observed. Fatigue attributed to electromagnetic fields was nonphysical and showed a significant correlation to difficulties in concentrating. The results do not support the hypothesis that a change in cholinesterase activity mediates fatigue in people reporting hypersensitivity to electricity.

Psychosocial challenges facing physicians of today.

Fundamental changes in the organization, financing, and delivery of health care have added new stressors or opportunities to the medical profession. These new potential stressors are in addition to previously recognized external and internal ones. The work environment of physicians poses both psychosocial, ergonomic, and physico-chemical threats. The psychosocial work environment has, if anything, worsened. Demands at work increase at the same time as influence over one's work and intellectual stimulation from work decrease. In addition, violence and the threat of violence is another major occupational health problem physicians increasingly face. Financial constraint, managed care and consumerism in health care are other factors that fundamentally change the role of physicians. The rapid deployment of new information technologies will also change the role of the physician towards being more of an advisor and information provider. Many of the minor health problems will increasingly be managed by patients themselves and by non-physician professionals and practitioners of complementary medicine. Finally, the economic and social status of physicians are challenged which is reflected in a slower salary increase compared to many other professional groups. The picture painted above may be seen as uniformly gloomy. In reality, that is not the case. There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. Physicians under stress are more likely to treat patients poorly, both medically and psychologically. They are also more prone to make errors of judgment. Studies where physicians' work environment in entire hospitals has been assessed, results fed-back, and physicians and management have worked with focused improvement processes, have demonstrated measurable improvements in the ratings of the psychosocial work environment. However, it becomes clear from such studies that quality of the leadership and the physician team impact on the overall work atmosphere. Physicians unaware of the goals of the department as well as the hospital, that do not receive management performance feedback, and who do not get annual performance appraisals and career guidance, rate their psychosocial environment as more adverse than their colleagues. There is also a great need to offer personally targeted competence development plans. Heads of department and senior physicians rate their work environment as of higher quality than more junior and mid-career physicians. More specifically, less senior physicians perceive similar work demands as their senior colleagues but rate influence over work, skills utilization, and intellectual stimulation at work as significantly worse. In order to combat negative stressors in the physicians' work environment, enhancement initiatives should be considered both at the individual, group, and structural level. Successful resources used by physicians to manage the stress of everyday medicine should be identified. Physicians are a key group to ensure a well-functioning health care system. In order to be able to change and adapt to the ongoing evolution of the Western health care system, more focus needs to be put on the psychosocial aspects of physicians' work.

Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers.

Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers The aim of this study was to implement and evaluate a practical intervention programme designed to help staff in health care work-places to deal with patient violence towards staff. The programme was part of a controlled, prospective study that ran for 1 year. The study population was comprised of staff at 47 health care work-places, randomly assigned to either the intervention or control group. The Violent Incident Form (VIF), a checklist designed to simplify the registration of violent events, was introduced at all 47 work sites, where staff were instructed to register all types of violent and threatening incidents directed towards them during the 1-year study period. The intervention work-places also followed a structured feedback programme, where the circumstances concerning registered incidents were discussed on a regular basis with work-place staff. Baseline examination of the study groups revealed no statistically significant difference with regard to self-reported violence in the past year. At the conclusion of the 1-year period, the difference between groups was statistically significant (P < 0.05). Staff at the intervention work sites reported 50% more violent incidents than the control work sites during the year. Compared to the control group, intervention group staff reported better awareness: of risk situations for violence (P < 0.05); of how potentially dangerous situations could be avoided (P < 0.05); and of how to deal with aggressive patients (P < 0.05). Logistic regression analysis confirmed an increased risk for self-reported violence in the intervention group post-intervention (odds ratio 1.49; 95% confidence interval 1.07-2.06; P < 0.05). The structured feedback programme seems to have improved staff knowledge of risks for violence in the intervention group.

Impact of management change and an intervention program on health care personnel.

BACKGROUND: There has been a major shift in the organization and responsibility for the provision of geriatric care in Sweden. This was believed to be stressful. We therefore decided to launch a controlled intervention program on health care personnel aimed at enhancing their adaptation and ability to cope. The purpose of this study was to assess the impact of management change on psychosocial parameters of health care personnel and the effects, if any, of a structured intervention program. METHODS: Two separate wards were randomly allocated to be either intervention (I) or control (C) ward. The I-ward personnel were subjected to a psychologist's structured 10-session intervention program for 20 weeks. The program consisted of an initial educational part followed by a practical problem-solving discussion part. A structured questionnaire on psychosocial issues was answered by the participants before (0 weeks), immediately after (20 weeks), and 10 weeks after the intervention (30 weeks). RESULTS: There were no significant changes in the psychosocial parameters of the C-ward personnel. In the I-ward, however, there was a significant increase in work demand as well as in positive feelings about work, as compared to the C-ward at the 30-week follow-up. There was also significantly better work comfort in the I-ward. CONCLUSIONS: We did not find any anticipated negative psychosocial effects on health care personnel undergoing an organizational change. However, by offering a structured intervention program to one group of health care personnel, we found some positive psychosocial effects. Future research is needed to pinpoint which factor or factors in the intervention program were the most crucial for the effects to occur.

Predictors of good general health, well-being, and musculoskeletal disorders in Swedish dental hygienists.

The aim of the present study was to examine how different personal, physical, and psychosocial work-associated factors are related to good general health, well-being, and musculoskeletal disorders in dental hygienists. A questionnaire was mailed to 575 dental hygienists who were randomly sampled from the Swedish Dental Hygienists' Association (86% responded). Data were analyzed with multiple-logistic regression models. The results showed that high clinical-practice fraction, active leisure, and high management support increased the odds for good general health, while work and family overload decreased the odds. Management support and mastery of work increased the odds for well-being, while work and family overload and high work efficiency decreased them. Scaling work increased the odds for general and work-related musculoskeletal disorders in all parts of the upper body and arms but not in the lower back. In the upper body, active leisure decreased the odds for general musculoskeletal disorders, while the odds for work-related musculoskeletal disorders increased from work and family overload and decreased from many weekly working hours. Many years in the profession increased the odds for general finger disorders. In conclusion, the results suggest that active leisure and several psychosocial work factors strongly influence good general health and well-being. Physical tasks influence musculoskeletal disorders more than active leisure and psychosocial work factors.

Staff perception of the impact of health care transformation on quality of care.

OBJECTIVES: To study how medical professionals perceived recent organizational changes and financial cut-backs in terms of organizational and health care quality. DESIGN: A cross-sectional questionnaire survey. SETTING: County council of Stockholm. PARTICIPANTS: A random sample (n=936; 70% response rate) of physicians and nurses employed by the county council of Stockholm. MAIN OUTCOME MEASURES: Staff perception of how recent changes impacted on staff-perceived quality of care, staffs' skills development, management, and perceived organizational efficacy. RESULTS: Over 60% of the respondents rated that patients' access to health care had diminished as a result of ongoing changes. A similar percentage also perceived a decline in the quality of health care delivered in general. However, fewer staff rated a decline during the last year in the quality of care provided by their own department (44%). Staff rating that quality of care in their own department had worsened during the last year also scored substantially lower on all counts of organizational well-being. The most important determinants of staff-perceived quality of care were staff access to pertinent information concerning their daily work and organizational changes, participatory management, performance management, and job commitment. Job satisfaction was more strongly associated with organizational well-being than staff-perceived quality of care. CONCLUSION: Staff perception should be used as an additional indicator of quality of care. To improve quality of care further, management should encourage staff involvement in everyday management issues, including up-to-date information about organizational goals and mission.

Psychophysiological reactions to international adjustment. Results from a controlled, longitudinal study.

BACKGROUND: This controlled prospective study examines psychophysiological reactions in employees during their first and second year abroad to identify individual as well as work-related factors predictive of positive adjustment. METHODS: Employees (n = 47) relocating from Sweden to a foreign country on a work-related assignment were followed. The subjects completed a questionnaire before relocation and after 1 and 2 years abroad. Blood samples were collected for determination of the stressor-related hormones prolactin, cortisol and testosterone. A matched non-moving reference group of employees (n = 35) responded to the questionnaire at similar time periods, and also provided blood samples. RESULTS: During the years abroad, the expatriate employees experienced increased psychosocial stress as well as negative adjustment as reflected in circulating levels of prolactin and testosterone, worse mental well-being and worsening subjective work environment, as compared with the non-moving group. The greatest change occurred during the first year. Individual factors such as social support, internal locus of control, self-esteem and sense of coherence modified the stress response and predicted employees' ability to adjust to foreign assignments. Negative changes in the psychosocial work environment explained to a large degree the decrease in work adjustment during the first year and these findings were also reflected in physiological stress indicators. CONCLUSIONS: The study emphasises the importance for multinational organisations to look at these individual characteristics before sending employees abroad. They also need to get more involved in supporting employees to manage stressors characteristic of the first year of foreign work.

Model development and research vision for the future of multiple chemical sensitivity.

Multiple chemical sensitivity (MCS) is characterized by heightened self-reported sensitivity to extremely low concentrations of chemicals. It has numerous symptoms in common with the sick building syndrome, the Gulf War syndrome, and chronic fatigue. Despite much research, reproducible objective findings are lacking for MCS, as is a sound model to explain it. This paper proposes a 2-step model combining the needed epidemiologic terminology with that of psychophysiological activation and sensitization. It is suggested that different environmental stressors act as initiators. After initiation, the limbic system and other parts of the brain become sensitized and hyperreactive to environmental triggers. Odor acts as one important trigger. Future research should use more biological assessments in combination with environmental and psychosocial data and involve patient groups with similar symptoms, although diagnosed as suffering from different entities. The similarities and differences of patients with such entities need to be understood before the entities themselves can be understood, diagnosed, treated, and prevented.

Factors that affect health and well-being in dental hygienists; a comparison of Swedish dental practices.

PURPOSE: This study was designed to focus on the health and well-being of dental hygienists as a function of work environment and background. METHODS: A questionnaire was mailed to 471 randomly selected dental hygienists from members of the Swedish Dental Hygienists' Association (SDHA) to collect data on health, demographics, lifestyles, and working conditions in various delivery systems. Seventy-seven percent responded. RESULTS: Small dental practices were associated with better job control, work relations, management support, and development of job skills. In contrast, large practices were associated with higher finance-related and personal job demand, anxiety, collegial pressure, and demands on social job skills. In discriminant analysis, finance-related job demands, physically demanding patients, and colleague cooperation showed significant differences in working condition variables between the delivery systems and dental practices. Dental hygienists' control over their job functions and the clarity of information explained by management had a variance in the applied competencies dimension by 41 percent. Thirty-seven percent of the variance of musculoskeletal problems in the upper-body region were attributed to physical exposure from clinical job tasks, work breaks, and anxiety over role competition with dentists. CONCLUSION: More job control and clearer information from management enables dental hygienists to optimally apply their competencies in the workplace. Physical job exposure, such as demands on manual/motor job skills, should be decreased and work breaks, as well as working relationships, with dentists should be improved to promote health and well-being.

Hypersensitivity to electricity: working definition and additional characterization of the syndrome.

Those who believe that electric appliances trigger adverse symptoms have coined the label hypersensitivity to electricity. Scientific research has not been able to identify a direct link between electromagnetic fields and symptoms, and no diagnostic criteria exist. Groups with reported hypersensitivity are very heterogeneous. A need exists for an operational working definition and improved characterization of groups. We report an investigation of symptoms and risk indicators associated with reported hypersensitivity to electricity-based on a survey at a high-technology, multinational telecommunications corporation. Comparisons are also made with patients referred to a university department of occupational and environmental health. No association was found between specific psychosocial work characteristics nor personal traits and hypersensitivity to electricity. We present skin and neurovegetative symptom indices. Results indicate that skin, and not neurovegetative symptoms, characterize the syndrome, at least during the first years of illness. For characterization, we propose a set of dimensions, including triggering factors, behavior, and duration of symptoms.

Cognitive behavioural therapy for patients with electric sensitivity - a multidisciplinary approach in a controlled study.

BACKGROUND: Electric sensitivity is a syndrome that still lacks diagnostic criteria and proven aetiology. The suffering of afflicted persons motivates development and evaluation of effective handling and treatments. The aim of the study was to evaluate the effect of cognitive behavioural therapy in patients with electric sensitivity. METHODS: Cognitive behavioural treatment, as part of a multidisciplinary treatment package for patients with electric sensitivity, was evaluated in a controlled trial. Ten patients who received treatment were compared to 12 controls. Outcome measures included different dimensions such as symptoms, beliefs, behaviour, and biochemical measurements of stress-related variables. All outcome measures were collected prior to the study, post-treatment, and after an additional 6-month follow-up. RESULTS: The therapy group rated their electric sensitivity as significantly lower than did the control group at the 6-month follow-up, and reduction of self-rated discomforts from triggering factors was significant in the therapy group. There were no systematic changes in the biochemical variables. The symptom indices were significantly reduced over time, and ability to work continued to be good in both groups. CONCLUSION: The prognosis for this syndrome is good with early intervention and cognitive therapy may further reduce the perceived hypersensitivity. This may have important implications on handling of patients with electric sensitivity.

Violence toward health care workers. Prevalence and incidence at a large, regional hospital in Sweden.

The aim of this study was to establish data for career prevalence and 1 year incidence of work-place violence for major categories of health care workers. Three consecutive work environment questionnaire studies at a large Swedish hospital provided the basis for the study. Prevalence and incidence rates of violence were age and gender adjusted to the Swedish working population. Prevalence of violence in the study population was compared to data from a national sample of Swedish registered nurses. Incidence of violence in each professional group was compared to that of the largest group of hospital employees, registered nurses. Standardized prevalence ratios for violence were significantly higher for all nursing personnel and physicians, and were highest for practical nurses (1.56). Standardized incidence rates ranged from 18/100 person years for physicians to 31/100 person years for practical nurses. The relative risk for violence at work over a 1 year period was significantly higher only for practical nurses (1.59) as compared to registered nurses. Nursing personnel and physicians were at considerable risk for workplace violence in the course of their careers. One year incidence rates were highest for practical nurses.

Psychosocial stressors and well-being in health care workers. The impact of an intervention program.

There have been few prospective studies of the impact of workplace interventions on employee and organizational well-being within health care settings. This study was conducted at a large regional hospital in Sweden in 1994 with a follow-up in 1995. Effects of a structured organizational and staff intervention program on perceived psychosocial work quality, supporting resources and self-reported health and well-being were evaluated. Based on department-specific results from the baseline assessment in 1994, each department formulated their own improvement goals. They also made their own decisions on relevant improvement activities. Since there was no formal reference group in this study, departments with high and low rating levels, respectively, with regard to intervention activities were compared. Despite an overall worsening in most of the measures most likely due to a notice of 20% staff reduction prior to the follow-up assessment, the intervention appeared to have attenuated negative changes in the high as compared with the low activity group. Manager-rated impact of the program as well as positive staff attitudes and staff involvement in the enhancement process were identified as important determinants for more favourable changes. The study points out the relevance of structured workplace interventions for organizational and employee well-being especially in times of cut-backs and organizational turmoil. Department-specific factors will determine the impact of such programs. The study indicates that the psychosocial impact of personnel cut-backs in health care may be attenuated through management initiatives.

Stress and sensitization in children: a controlled prospective psychophysiological study of children exposed to international relocation.

This controlled prospective study investigated the development of sensitization as a result of international relocation in children, using the analyzing system Phadiatop. The effects of climate and predisposition to allergy were also measured. Children were examined prior to and during their first year of living abroad. A control group living at home was also examined during the same period. Participants answered a questionnaire before and after 1 year abroad, and blood samples were collected to determine sensitization. Before going abroad, there were no significant differences in atopic sensitization between groups nor in other key variables. After 1 year abroad, the proportion of children showing sensitization had increased significantly as compared with the control group at home. The exposed group reported an increase in skin symptoms during the year abroad. This study suggests that unidentified factors associated with foreign relocation increase the risk of sensitization in predisposed children. Stress might be one factor.

Measuring psychosocial work quality and health: development of health care measures of measurement.

Demands on workload and work efficiency have increased because of ongoing global changes in health care organizations. Assessing and evaluating effects of changes on organizational and individual well-being require valid and reliable methods. Questionnaires from 3 large health care studies were used to develop instruments for work quality and health. Variable fields of work quality, health and well-being, and modifying factors were factor analyzed with replicated structures in new samples, including 6 factors of work quality, 5 health factors, and 2 modifying factors. All except 2 factors had high internal consistency (Cronbach's alpha = .69-.84) and low factor intercorrelations within areas. Social climate (but not individual resources) had, according to our model, a modifying effect on the work-health interaction.

Technological stress: psychophysiological symptoms in modern offices.

Increasingly, employees in modern office environments report suffering from psychosomatic symptoms. Studies of employees in high-technology industries suggest that psychosomatic symptoms are related in part to high perceived mental demands in combination with lack of sufficient skills. Employees with symptoms more commonly report that they are not sufficiently recognized by their employer, as compared with nonsymptomatic peers. Low perceived organizational efficiency correlates with high mental stress among employees. In a controlled stress management program, we observed lower mental stress levels among participants, as compared with controls, and lower physiological arousal, measured as circulating levels of prolactin. It is suggested that organizational reengineering and the introduction of information technologies constitute potential stressors challenging employees' cognitive resources. It is predicted that psychosomatic syndromes in the workplace will most likely increase in the foreseeable future due to the rapid changes currently transcending working life.

Physicians' view of their work environment and organisation.

BACKGROUND: The objective of this study was to assess physicians' perception of their work, organisation and professional development. METHODS: All major disciplines at a major regional hospital were studied. Participants responded to a structured questionnaire concerning broad aspects of physicians' work. The response rate was approximately 78%, with 356 respondents. RESULTS: The results show that even though physicians are overall very satisfied with their work, they list high workload, lack of influence on daily work and work processes as dissatisfactory. Skills utilisation and development are some major areas for improvement. Physicians that were aware of the overall mission statement for their hospital were more satisfied with and informed about departmental goals. Perceived organisational efficiency and leadership qualities were important determinants of perceived workload and work climate. CONCLUSIONS: Stress among physicians is a growing occupational health concern, impacting negatively on patient care. In this article important individual and organisational factors related to physician stress are identified and suggestions to assess stress and intervene are provided.