Moonlighting and physician residents' compensation: is it all about money? A cross-sectional Brazilian study

ABSTRACT BACKGROUND: Moonlighting is a largely discussed, however under-explored, subject among physician residents. OBJECTIVES: To analyze the frequency of moonlighting and its related factors. DESIGN AND SETTING: This cross-sectional study enrolled medical residents from all geographical regions of Brazil. METHODS: A web-based structured closed-ended survey was applied that explored the frequency and type of moonlighting, residency programs characteristics, and psychological distress. The questionnaire was published on social networks. RESULTS: The completion rate was 71.4% (n = 1,419) and 37.7% were males aged 28.8 ± 3.2 (mean ± standard deviation) years, and 571 (40.2%) were post-graduate year (PGY) 1. There were residents from 50 medical specialties (the most common training area was clinical, 51.9%). A total of 80.6% practiced moonlighting, with an average weekly workload of 14.1 ± 9.4 h, usually overnight or in weekend shifts. Factors related to it were being PGY-2 or higher (adjusted odds ratio = 3.90 [95% confidence interval = 2.93-5.18], logistic regression), lower weekly residency duty hours (0.98 [0.97-0.99]), and a higher salary (1.23 [1.08-1.40]). In contrast, perception of a "fair/adequate" compensation was influenced by age (1.02 [1.01-1.02]), not being single (1.05 [1.01-1.10]), and residency duty hours (1.51 [1.22-1.88]). Depression, anxiety, diurnal somnolence scores, and work-personal life conflicts were not correlated with moonlighting status. CONCLUSION: Moonlighting frequency is high, and it is related to higher PGY, briefer residency duty hours, and the perception that remuneration should be higher. This study provides insights into the motivations for moonlighting and effort-reward imbalance.

O desequilíbrio esforço-recompensa está associado à hipertensão arterial entre servidores públicos brasileiros? Resultados do ELSA-Brasil / Is the effort-reward imbalance associated with hypertension among Brazilian civil servants? Results from the ELSA-Brasil study

Resumo Objetivos: analisar a associação entre o estresse no trabalho, segundo o modelo de desequilíbrio esforço-recompensa (DER), e a hipertensão arterial (HA), assim como investigar o papel modificador de efeito do excesso de comprometimento (EC) e do sexo. Métodos: análise seccional de dados de trabalhadores(as) ativos que participaram da segunda onda de coleta de dados (2012-2014) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). O estresse no trabalho foi mensurado pela versão brasileira da escala de DER, composta por três dimensões: esforço, recompensa e EC. A HA foi definida como níveis de pressão arterial sistólica/diastólica ≥ 140/90 mmHg ou uso de medicamento anti-hipertensivo. Empregou-se regressão logística, bruta e ajustada por potenciais fatores de confusão. As interações multiplicativas foram investigadas. Resultados: participaram 9.465 servidores, 51,9% do sexo feminino. A prevalência de HA foi de 34,9%. No modelo ajustado, associações limítrofes foram identificadas entre o DER (razão>1) e maior EC com maiores chances de HA (OR: 1,11; IC95%: 1,00; 1,24; e OR: 1,13; IC95%: 1,01; 1,26, respectivamente). A análise de interação indicou que sexo e EC não são modificadores de efeito. Conclusão: DER e EC associaram-se a maiores chances de HA, após ajuste. Sexo e EC não foram modificadores de efeito.

Abstract Objectives: to evaluate the association between job stress, according to the effort-reward imbalance (ERI) model, and hypertension (HTN), as well as to investigate the effect modifier role of overcommitment (OC) and sex. Methods: cross-sectional analysis of data from active workers who participated in the second data collection wave (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Job stress was measured by the ERI scale - Brazilian version, comprising three dimensions: effort, reward, and OC. HTN was defined as systolic or diastolic blood pressure levels ≥ 140/90 mmHg or antihypertensive medication use. Associations were estimated by logistic regression, crude and adjusted for potential confounding factors. Multiplicative interactions were investigated. Results: a total of 9,465 civil servants participated in the study, 51.9% females. HTN prevalence was 34.9%. The adjusted model identified borderline associations between ERI (ratio > 1) and higher OC with higher odds of HTN (OR = 1.11, 95%CI = 1.00; 1.24; and OR = 1.13; 95%CI = 1.01; 1.26, respectively). Interaction analysis indicated no differences in associations according to sex and OC. Conclusion: results show that ERI and OC are associated with higher odds of HTN after adjustment. Sex and OC were not effect modifiers.

The Effort-Reward Model and Its Effect on Burnout Among Nurses in Ecuador.

Burnout has harmful consequences for individuals and organizations. The study of its antecedents can help us to manage and prevent it. This research aims to explore the role of the effort-reward imbalance (ERI) model as well as the mediation of the working experience in the burnout processes. For this purpose, we have conducted a study in 629 employees from two hospitals in the city of Guayaquil (Ecuador). For this study, the Spanish version of the Maslach Burnout Inventory was applied, as well as the ERI Questionnaire, along with other socio-demographical and occupational variables. A statistical analysis was performed with the obtained data, using structural equation models (SEMs). Results showed that employee effort has a stronger and statistically significant direct effect on emotional burnout, whereas the perception of the obtained reward also had this effect but indirectly in a negative sense, with job experience as a mediating variable.

Characterization of young graduates perceiving underemployment: Assessment of well-being and discomfort associated with this perception / Caracterización de jóvenes egresados que perciben subempleo: evaluación del bienestar y malestar asociadas a esta percepción

Resumen Investigaciones previas han demostrado que el subempleo subjetivo está inversamente asociado a la satisfacción laboral, el bienestar psicológico y la salud. Hasta donde conocemos, este es el primer estudio que explora el subempleo subjetivo en egresados de pregrado en Colombia. Ciento cuarenta y dos trabajadores participaron en un estudio correlacional y comparativo. Los resultados replicaron hallazgos previos: a medida que aumentaba la percepción de subempleo subjetivo, disminuían la satisfacción laboral y la satisfacción con la vida en general. Se encontraron diferencias significativas en los indicadores de satisfacción laboral y satisfacción con la vida en general entre quienes perciben subempleo y quienes no. Por último, se discute el potencial ro del subempleo subjetivo en la salud de los empleados.

Abstract Previous research has shown that subjective underemployment is inversely associated to job satisfaction, psychological well-being and health. To our knowledge, the current is the first study that explores subjective underemployment in undergraduates in Colombia. One hundred and forty-two workers participated in a correlational, and comparative study. Results replicated previous findings: as subjective underemployment perception increased, job satisfaction and general life satisfaction decreased. Significant differences were found in the indicators of job satisfaction and general life satisfaction among those who perceive underemployment and those who do not. Finally, the potential role of subjective underemployment on employees' health is discussed.

Combined Use of Job Stress Models and the Incidence of Glycemic Alterations (Prediabetes and Diabetes): Results from ELSA-Brasil Study.

Evidence of psychosocial stress at work as a risk factor for diabetes and prediabetes is restricted. OBJECTIVES: Analyze the independent and combined association of the models, demand-control and social support (DC-SS) and the effort-reward imbalance and overcommitment (ERI-OC), and the incidence of glycemic alterations (prediabetes and diabetes). METHODS: A prospective study was carried out with data from 7503 active workers from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study in the period 2008-2014. Work stress was measured by two stress models. Glycemic levels were evaluated by glycated hemoglobin (HbA1c) in two moments and classified in four groups: normal, maintenance of prediabetes, incident prediabetes, and incident diabetes. Multinomial logistic regression was analyzed with 5% significance levels stratified by sex, and multiplicative interactions were investigated. RESULTS: Work stress and glycemic alterations were more frequent in women. Psychosocial stress at work was shown to be associated to the risk of prediabetes and diabetes only among women. For women, the combination of models enlarged the magnitude of the association: prediabetes (DC-ERI = OR 1.51, 95% CI 1.15-1.99) and diabetes (DC-ERI = OR 2.10, 95% CI 1.20-3.65). Highly-educated women exposed to ERI-OC were four times more likely to have diabetes. CONCLUSION: Both models may contribute to explaining the psychosocial stress load according to each pattern of glycemic alteration among women.

Effort-Reward Imbalance, Over-Commitment and Depressive Episodes at Work: Evidence from the ELSA-Brasil Cohort Study.

A growing burden of mental illness, and in particular depression, among workers is a concern of occupational public health. Scientific evidence has revealed consistent associations of work-related stress, as measured by theoretical models, with depression, but mostly so in developed countries. This contribution explores these associations in a developing Latin American country, Brazil, by applying an internationally established work stress model, the effort-reward imbalance (ERI). This model focuses on the work contract where unjust exchange between high efforts spent and low rewards received in turn contributes to stress-related disorders. The model's extrinsic ('effort', 'reward') and intrinsic components ('over-commitment'), as well as their combination, are hypothesized to be related to a higher risk of depressive episodes (DE). Using cross-sectional data from the ELSA-Brasil study, including 10,034 workers from the public sector, we observed increased prevalence ratio (PR) of DE according to ERI scales. The quartiles of highest 'effort' (PR = 1.85; 1.44-2.37), highest 'over-commitment' (PR = 3.62; 2.80-4.70) and lowest 'reward' (PR = 3.44; 2.55-4.64) were associated with DE, on adjusted models, as well was the E-R ratio (PR = 2.47; 1.92-3.17). An additive interaction was identified between the E-R ratio and 'over-commitment'. The results support the use of ERI as a screening tool for work stress in the Brazilian context and will offer guidance for worksite health promotion programs.

Prevalence of low back pain in migrant construction workers in Mar del Plata, Argentina.

BACKGROUND: We aimed to compare employment conditions, psychosocial working conditions, and prevalence of low back pain among migrant and local construction workers in Argentina. METHODS: In a cross-sectional study among workers from three contracting and eight subcontracting companies as well as 26 construction sites in the region of Buenos Aires, Argentina, 134 out of 150 local (89% response) and 141 out of 150 migrant construction workers (94% response) answered a validated questionnaire. Psychosocial working conditions were evaluated based on an imbalance between efforts and rewards (ERI). RESULTS: Compared to local workers, migrants were younger, more likely to work without a contract (57% vs 8%), to report ERI (81% vs 18%) and to suffer from low back pain during the 7-days before study (80% vs 42%) (all P < .0001). After mutual adjustment, being a migrant (prevalence ratio 2.1; 95% confidence interval [CI] 1.4-3.0) and working without a contract (1.7; 95% CI, 1.4-2.1) were statistically significant risk factors for low back pain. CONCLUSIONS: This study describes the precarious situation of migrant workers in the Argentinian construction industry and the potential health consequences. Provision of formal employment relations might help to better protect migrant workers' safety and health. Prospective studies are needed to assess the causes and effects of the findings we describe.

Occupational stress and job dissatisfaction with health work.

OBJECTIVE: The purpose of this study is to evaluate the association between psychosocial aspects at work and dissatisfaction among health workers in five cities in Bahia, Brazil. METHODS: The evaluation was based on different models proposed to measuring occupational stress and possible combinations between them: demand-control model (DCM) and effort-reward imbalance (ERI). We conducted a cross-sectional epidemiological study including 3084 health workers. The analysis considered the association between partial/full/partial (combined) occupational stress models (the variable "exposure") and job dissatisfaction (the variable "outcome"). RESULTS: Dissatisfaction rate was 26%. Full DCM and ERI models were better than partial ones to investigate job dissatisfaction. After adjustments, the combined models presented more robust measures of prevalence ratio than models evaluated separately (PR 2.93; CI 2.26-3.80). CONCLUSIONS: The combination of models has shown greater capacity to identify situations of job dissatisfaction and provided more potential information to support actions for workers' health.

Occupational stress and job dissatisfaction with health work

Abstract Objective: The purpose of this study is to evaluate the association between psychosocial aspects at work and dissatisfaction among health workers in five cities in Bahia, Brazil. Methods: The evaluation was based on different models proposed to measuring occupational stress and possible combinations between them: demand-control model (DCM) and effort-reward imbalance (ERI). We conducted a cross-sectional epidemiological study including 3084 health workers. The analysis considered the association between partial/full/partial (combined) occupational stress models (the variable "exposure") and job dissatisfaction (the variable "outcome"). Results: Dissatisfaction rate was 26%. Full DCM and ERI models were better than partial ones to investigate job dissatisfaction. After adjustments, the combined models presented more robust measures of prevalence ratio than models evaluated separately (PR 2.93; CI 2.26-3.80). Conclusions: The combination of models has shown greater capacity to identify situations of job dissatisfaction and provided more potential information to support actions for workers' health. (AU)

Situações de desequilíbrio entre esforço-recompensa e transtornos mentais comuns em trabalhadores da atenção básica de saúde / Situations of imbalancing between stress-rewards and common mental disorders in basic health care workers / Situaciones de desequilibrio entre esfuerzo-recompensa y transtornos mentales comunes en trabajadores de la atención básica de salud

Resumo Estudo da associação entre transtornos mentais comuns e situações de desequilíbrio entre esforços e recompensas em trabalhadores da atenção básica de saúde realizada em distrito sanitário de Salvador, na Bahia. Foram estudados trabalhadores que estavam em exercício profissional nas unidades de saúde do distrito, em 2012. Estudo transversal, com quatrocentos do total de 509 trabalhadores. Para avaliação de esforço e recompensa no trabalho, utilizou-se o Effort-Reward Imbalance. O Self-Reporting Questionnaire mensurou os transtornos mentais comuns. A prevalência de transtornos mentais comuns foi de 21%; 46,2% dos trabalhadores vivenciavam situações de desequilíbrio esforço-recompensa no trabalho. A prevalência de transtornos mentais comuns foi mais elevada na situação de desequilíbrio esforço-recompensa (26,9%) e no grupo dos trabalhadores operacionais (33,8%). A análise de correspondência indicou relação entre desequilíbrio esforço-recompensa e transtornos mentais comuns na primeira dimensão. O modelo de regressão logística log-binomial evidenciou associação positiva entre desequilíbrio esforço-recompensa e transtornos mentais comuns (razão de prevalência ajustada=1,91). Trabalhadores expostos a situações de desequilíbrio esforço-recompensa no trabalho apresentaram maior frequência de adoecimento mental. Os resultados reforçam a necessidade de intervir na gestão e organização do trabalho quanto às demandas dos serviços, condições precárias do trabalho e formas de recompensa ou reconhecimento.

Abstract This study focused the association between common mental disorders and situations of imbalance between efforts and rewards in primary health care workers held in sanitary district, municipality of Salvador, Bahia, Brazil. The study included workers who were active in the district's health in 2012. A cross-sectional study, with 400 out of 509 workers, was conducted. Effort-Reward Imbalance was used to evaluate effort and reward at work and the Self-Reporting Questionnaire measured common mental disorders. The prevalence of common mental disorders was 21%, 46.2% of studied workers experienced situations of work-reward imbalance at work. The highest prevalence of common mental disorders was observed in the effort-reward imbalance (26.9%) and in the operational workers group (33.8%). Correspondence analysis indicated a relationship between effort and reward imbalance and common mental disorders in the first dimension. The log-binomial logistic regression model showed a positive association between effort and reward imbalance and common mental disorders (adjusted prevalence ratio=1.91). Workers exposed to situations of effort-reward imbalance at work showed a higher frequency of mental illness. It is necessary to intervene in the management and organization of the work regarding the demands of the services, precarious work conditions and forms of reward or recognition.

Resumen Estudio de la asociación entre trastornos mentales comunes y situaciones de desequilibrio entre esfuerzos y recompensas en trabajadores de la atención básica de salud realizada en distrito sanitario, municipio de Salvador, Bahia, Brasil, siendo considerados trabajadores aquellos en ejercicio profesional en las unidades de salud del distrito. Estudio transversal analítico, con 400 del total de 509 trabajadores. Para la evaluación de esfuerzo y recompensa en el trabajo se utilizó el Effort-Reward Imbalance y el Self-Reporting Questionnaire (SRQ-20) mensuró los Trastornos Mentales Comunes. La prevalencia de trastornos mentales comunes fue del 21%, el 46,2% de ellos experimentando situaciones de desequilibrio esfuerzo-recompensa en el trabajo. La prevalencia de Trastornos Mentales Comunes más elevada en la situación de desequilibrio esfuerzo-recompensa (26,9%) y en el grupo de los trabajadores operativos (33,8%). El análisis de correspondencia indicó relación entre desequilibrio esfuerzo y recompensa y trastornos mentales comunes en la primera dimensión. El modelo de regresión logística log-binomial evidenció asociación positiva entre desequilibrio esfuerzo y recompensa y Trastornos Mentales Comunes (razón de prevalencia ajustada=1,91). Los trabajadores expuestos a situaciones de desequilibrio esfuerzo y recompensa en el trabajo presentaron una mayor frecuencia de enfermedad mental. Es necesario intervenir en la gestión y organización del trabajo en cuanto a las demandas de los servicios, condiciones precarias del trabajo y formas de recompensa o reconocimiento.

Estandarización de una batería para la evaluación de factores de riesgo psicosociales laborales en trabajadores colombianos / Standardization of a battery of tests to assess psychosocial risk factors at the workplace among Colombian workers / Padronização de uma bateria para a avaliação de fatores de risco psicossociais trabalhistas em trabalhadores colombianos

En 2010 se desarrolló una batería de instrumentos para evaluar factores psicosociales laborales de riesgo para la salud, en respuesta a la Resolución 2646 de 2008 del Ministerio de la Protección Social de Colombia. Sin embargo, esta cuenta con algunas limitaciones que, a partir de la construcción y validación de una nueva batería, en el presente estudio se buscan superar. La nueva batería ofrece, recursos adicionales para la evaluación de estos factores: incorpora los instrumentos e indicadores centrales de los modelos demanda-control-apoyo social y desequilibrio esfuerzo-recompensa, y los factores intralaborales no contemplados en dichos modelos, pero que la Resolución considera necesarios, se midieron con pruebas preexistentes o desarrolladas por los autores. Con los datos recolectados es posible calcular indicadores globales de demanda, control y apoyo social; además de condiciones familiares y sociales de riesgo, afrontamiento, personalidad e indicadores de salud y bienestar. Para la validación, la batería se aplicó a una muestra de 16.095 trabajadores de diferentes ocupaciones y municipios colombianos. Los análisis de consistencia interna y validez permiten afirmar que la batería es sencilla de aplicar en papel o por computador, permitirá comparar ocupaciones, obtener puntuaciones unificadas por variable, ofrecer un diagnóstico de un número importante de las variables sugeridas en la Resolución y comparar los resultados de los trabajadores colombianos con los de otros países.

A battery of questionnaires to assess psychosocial risk factors at work was developed in 2010 in response to Resolution 2646 created by the Colombian Ministry of Social Protection. However, this battery presents some theoretical and practical limitations. A new battery of instruments has been designed and validated that includes instruments and risk indicators of the demand-control-social support and the effort-reward imbalance models. Other factors, not included in these models, but that Resolution 2646 suggests should be assessed, have also been added, and with this additional information, the new battery allows us to also calculate a "global indicator" of demand, control, and social support; family and social risk conditions, coping and personality; and health and wellbeing. The new battery was administered to a sample of 16,095 workers from different occupations and representative Colombian regions. An analysis of the various domains indicates that internal consistency of the various scales is high. The new battery has the following properties: it is simple to use in paper format or when administered by computer, it enables comparison between occupations, it offers unified scores for each variable, and provides information to assess the risk factors suggested by resolution 2646. In addition, it will make it possible to compare the results obtained when analyzing Colombian workers with those obtained from studies of workers from other countries.

Em 2010, desenvolveu-se uma bateria de instrumentos para avaliar fatores psicossociais trabalhistas de risco para a saúde, em resposta à Resolução 2 646 do Ministério da Proteção Social da Colômbia. Contudo, esta conta com algumas limitações que, a partir da construção e da validação de uma nova bateria, neste estudo se pretendem superar. Além disso, a nova bateria oferece recursos adicionais para a avaliação desses fatores: a presente bateria incorpora os instrumentos e os indicadores centrais dos modelos demanda-controle-apoio social e desiquilíbrio esforço-recompensa e os fatores internos do trabalho não considerados nesses modelos, mas que a Resolução considera necessários, mediram-se com testes preexistentes ou desenvolvidos pelos autores. Com os dados coletados, é possível calcular indicadores globais de demanda, controle e apoio social; além de condições familiares e sociais de risco, enfrentamento, personalidade e indicadores de saúde e bem-estar. Para a validação, a bateria foi aplicada a uma amostra de 16 095 trabalhadores de diferentes cargos e municípios colombianos. As análises de consistência interna e validade permitem afirmar que a bateria é simples de aplicar em papel ou digital, permitirá comparar cargos, obter pontuações unificadas por variável, oferecer um diagnóstico de um número importante das variáveis sugeridas na Resolução bem como permitirá comparar os resultados dos trabalhadores colombianos com os de outros países.

Psychosocial risk at work and hazardous alcohol consumption among Chile's working adults.

OBJECTIVE: Karasek's demand-control model and Siegrist's effort-reward imbalance model have accumulated solid evidence regarding the associations between exposure to psychosocial risk at work (PSRW) and mental health of workers. However, there is scarce such evidence with regard to its associations with alcohol consumption. This study proposed to estimate the associations between exposure to PSRW and hazardous alcohol consumption (HAC) in Chile's working adult population. METHOD: The study was cross-sectional and a nationally representative survey was applied to 3,010 workers (65% male and 35% female, ages 20 to 65). The analysis included prevalences and logistic regression controlling for covariables. RESULTS: The adjusted analyses show that male workers exposed to low social support (OR=1.47; 95% CI:1.14-1.89), low reward (OR=1.38; 95% CI:1.07-1.78) and effort-reward imbalance (OR=1.34; 95% CI:1.04-1.73) have a higher chance of presenting with HAC compared to those who are not exposed. Female workers exposed to effort-reward imbalance (OR=2.34; 95% CI:1.10-5.58) have twice the risk of HAC compared with their reference group. CONCLUSION: This study shows evidence of the associations between HAC and exposure to a set of psychosocial risk factors from the Karasek and Siegrist models. For future research, it is recommended that HAC and PSRW factors be examined in a longitudinal study in order to control for possible confounding effects on these associations.