This paper provides an overview of recent Norwegian and international research into physicians' health problems and their use of health services, with a particular focus on more recent studies relating to The Norwegian Physicians' Survey. The review suggests that physicians' physical health is similar to the general population, although female physicians tend to be in better health than other women. Some mental disorders such as depression and suicide appear to be more prevalent. Mental health problems are known to be associated with low work control (autonomy), time pressure and demanding patients. There is little difference between the genders early in their career, but more female than male physicians seem to experience problems later on. Physicians seldom take sick leave, and tend to make less use of primary health care and some screening facilities. Self-treatment is common - even for mental problems. American impaired physician programmes have demonstrated high recovery rates (70-80%), and increasing emphasis is now being placed on psychiatric diagnoses. As certain mental disorders appear to be common among physicians, specialist psychiatric services should be made more accessible for this group. A low-threshold facility for seeking help with such problems has recently been developed in Norway (the Villa Sana Resource Centre).
Despite numerous technical advances in recent years, many occupational health problems still persist in modern dentistry. These include percutaneous exposure incidents (PEI); exposure to infectious diseases (including bioaerosols), radiation, dental materials, and noise; musculoskeletal disorders; dermatitis and respiratory disorders; eye injuries; and psychological problems. PEI remain a particular concern, as there is an almost constant risk of exposure to serious infectious agents. Strategies to minimise PEI and their consequences should continue to be employed, including sound infection control practices, continuing education and hepatitis B immunisation. As part of any infection control protocols, dentists should continue to utilise personal protective measures and appropriate sterilisation or other high-level disinfection techniques. Aside from biological hazards, dentists continue to suffer a high prevalence of musculoskeletal disorders (MSD), especially of the back, neck and shoulders. To fully understand the nature of these problems, further studies are needed to identify causative factors and other correlates of MSD. Continuing education and investigation of appropriate interventions to help reduce the prevalence of MSD and contact dermatitis are also needed. For these reasons, it is therefore important that dentists remain constantly informed regarding up-to-date measures on how to deal with newer technologies and dental materials.
Increasing interest has been focused on understanding the role working conditions play in terms of the serious issues facing hospitals today, including quality of patient care, nurse shortages, and financial challenges. One particular working condition that has been the subject of recent research, is the impact of organizational climate on nurses' well-being, including occupational health outcomes. To examine evidence-based research on the association between organizational climate and occupational health outcomes among acute-care registered nurses, a systematic review of published studies was conducted. Studies assessing the association between organizational climate variables and three common health outcomes in nurses (blood/body fluid exposures, musculoskeletal disorders, and burnout) were reviewed. Fourteen studies met the inclusion criteria. Although most were cross-sectional in design and variability was noted across studies with respect to operational definitions and assessment measures, all noted significant associations between specific negative aspects of hospital organizational climate and adverse health impacts in registered nurses. While evidence for an association between organizational climate constructs and nurses' health was found, data were limited and some of the relationships were weak. Additional studies are warranted to clarify the nature of these complex relationships.
This review targeted all research previously conducted on the topic of musculoskeletal disorders among Italian nursing personnel, with a particular focus on studies that had examined individual, physical and psychosocial risk factors. Scientific literature published in both English and Italian languages was searched using electronic and manual techniques. A total of 25 appropriate studies were located and examined, most of which had focused on the prevalence of low back pain (LBP) among nurses. From the review, it was shown that LBP prevalence rates have varied widely among different investigations conducted in Italy, ranging from 33% to 86%. Previous studies also suggest that female gender, physical factors and psychosocial factors are important LBP risk factors in this country. Since most of the data currently available describes nurses working in the northern and central regions only, further investigations should now be undertaken in southern Italy, in order to obtain a more complete overview of the problem from a national perspective. Furthermore, a standardized method for measuring these conditions is strongly recommended for future Italian research, to allow better local and international comparison of the data.
Irritant contact dermatitis is often found on the hands of healthcare workers and is generally caused by frequent hand washing, gloves, aggressive disinfectants or detergents. Alcohols have only a marginal irritation potential, although they may cause a burning sensation on pre-irritated skin. A burning sensation when using alcohols therefore, suggests that the skin barrier is already damaged. Two options for hand hygiene are generally available in clinical practice: (1) hand washing with some type of soap and water or (2) hand disinfection with alcohol-based hand rubs. Most clinical situations require the use of an alcohol-based hand rub for decontamination, which is especially useful for reducing the nosocomial transmission of various infectious agents. Washing one's hands should be the exception, to be performed only when they are visibly soiled or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids. The overall compliance rate in hand hygiene is around 50%, which is far too low. In addition, healthcare workers quite often wash their hands with soap and water, when they should use an alcohol-based hand rub. This not only adds to the degree of skin irritation, but is also potentially dangerous for patients, due to the low efficacy of hand washing when compared to hand disinfection with alcohol rubs. Adhering to evidence-based hand hygiene protocols and following international guidelines on hand hygiene practices therefore, can help prevent irritant contact dermatitis among healthcare workers.
Little is known about differences in levels of concerns or preparedness for an avian influenza (AI) pandemic among healthcare workers (HCWs) in different types of hospitals. We compared these concerns and preparedness between 326 HCWs of two community hospitals (CHs) and 908 HCWs from a tertiary hospital (TH) using a self-administered questionnaire between March-June 2006. Response rates were 84.2% and 80.0% from the CHs and TH. Most HCWs (71.6%) felt prepared for an AI outbreak and had significant concerns. They perceive an AI pandemic having adverse impacts on their personal life and work, such as people avoiding them (57.1%). A greater percentage of TH compared to CH HCWs expressed concerns such as feeling their jobs put them at great AI exposure (78.3% vs 67.5%, p=0.012). TH HCWs were more likely to report participating in readiness preparation activities, such as training for infection control (90.0% vs 82.2%, p=0.014) and feel that they (74.1% vs 64.7%, p=0.045) and their hospital (86.8% vs 71.8%, p=0.000) were prepared for an outbreak. Healthcare institutions need to include personal, psychological and family concerns on the agenda and increase participation in readiness preparation activities among HCWs to help prepare for such future crises.
Although physicians are known to experience more stress than other workers, knowledge is lacking on the course of stress from a longitudinal perspective. This study explored the course of and contributors to, different dimensions of early career job-stress among physicians by means of a nationwide mail survey, with a particular emphasis on stress relating to the work-home interference. All physicians graduating from all four Norwegian universities in 1993 / 94 (N=631), responded during their final year of medical school (N=522), during their internship (N=402), in their 4th postgraduate year (N=422), and in their 10th postgraduate year (N=390). The mean observation period was 9.2 yr (SD=0.5). The main outcomes were job stress dimensions derived from an established job stress questionnaire (Cooper / Tyssen), with emphasis placed on dimensions of the work-home interference. Stress relating to the work-home interference increased during the observation period for both genders (repeated measures: β=0.06, p<0.05), whereas stress relating to emotional pressure, time pressure, and fear of complaints and criticism, decreased. Stress relating to the work-home interference increased during their early career, mainly due to a lack of adaptive reduction in work hours and an increased number of children. Neuroticism, conscientiousness, and lack of support from one's partner and colleagues, appeared to be predictive of this stress.
Work-related violence is an important problem worldwide, and nurses are at increased risk. This study identified rates of violence against nurses in Minnesota, USA, and their perceptions of the work environment. A sample of 6,300 randomly selected nurses described their experience with work-related violence in the previous year. Differences in perceptions of the work environment and work culture were assessed, based on a nested case-control study, comparing nurses who experienced assault to non-assaulted nurses. Annual rates of physical and non-physical assault, per 100 nurses, were 13.2 (95% CI: 12.2-14.3), and 38.8 (95% CI: 37.4-40.4). Cases were more likely than controls to report: higher levels of work stress; that assault was an expected part of the job; witnessing all types of patient-perpetrated violence in the previous month; and taking corrective measures against work-related assault. Controls versus cases were more likely to perceive higher levels of morale, respect and trust among personnel, and that administrators took action against assault. Nurses frequently experienced work-related violence, and perceptions of the work environment differed between nurses who had experienced physical assault, and those who had not. Employee safety, morale, and retention are particularly important in light of the nursing shortage, and knowledge of nurses' perceptions will assist in tailoring interventions aimed at reducing the substantial risk of physical assault in health care settings.
The Japan Nurses' Health Study (JNHS) is a prospective occupational cohort study investigating the effects of lifestyle and healthcare practices on women's health. It was initiated in 2001, with a six-year entry period and a proposed ten-year follow-up. Participants comprise female registered nurses, licensed practical nurses, public health nurses, and midwives, aged 25 yr or over at the baseline survey. Participants were recruited in cooperation with the Japanese Nursing Association and the Japan Menopause Society. A self-administered baseline questionnaire was distributed, requesting demographic information, lifestyle factors, pharmaceutical drug use, physical condition, reproductive health, and disease history. A total of 49,914 women from all 47 prefectures in Japan responded to the baseline survey. Among them, approximately 18,000 agreed to be followed-up, and returned signed informed-consent sheets, together with their completed baseline questionnaires. Changes in lifestyle, healthcare, incidence of disease, and health outcomes over time will now be studied. The cohort receives annual JNHS newsletters and biennial follow-up questionnaires by mail.
The Japan Nurses' Health Study (JNHS) is a long-term, large-scale cohort study investigating the effects of various lifestyle factors and healthcare habits on the health of Japanese women. Based on currently limited statistical data regarding the incidence of disease among Japanese women, our initial sample size was tentatively set at 50,000 during the design phase. The actual number of women who agreed to participate in follow-up surveys was approximately 18,000. Taking into account the actual sample size and new information on disease frequency obtained during the baseline component, we established the prevalence of past diagnoses of target diseases, predicted their incidence, and calculated the statistical power for JNHS follow-up surveys. For all diseases except ovarian cancer, the prevalence of a past diagnosis increased markedly with age, and incidence rates could be predicted based on the degree of increase in prevalence between two adjacent 5-yr age groups. The predicted incidence rate for uterine myoma, hypercholesterolemia, and hypertension was ≥3.0 (per 1,000 women, per year), while the rate of thyroid disease, hepatitis, gallstone disease, and benign breast tumor was predicted to be ≥1.0. For these diseases, the statistical power to detect risk factors with a relative risk of 1.5 or more within ten years, was 70% or higher.
The aim of this study was to assess the risk of blood and body fluid exposure among non-hospital based registered nurses (RNs) employed in New York State. The study population was mainly unionized public sector workers, employed in state institutions. A self-administered questionnaire was completed by a random stratified sample of members of the New York State Nurses Association and registered nurse members of the New York State Public Employees Federation. Results were reviewed by participatory action research (PAR) teams to identify opportunities for improvement. Nine percent of respondents reported at least one needlestick injury in the 12-month period prior to the study. The percutaneous injury (PI) rate was 13.8 per 100 person years. Under-reporting was common; 49% of all PIs were never formally reported and 70% never received any post-exposure care. Primary reasons for not reporting included: time constraints, fear, and lack of information on reporting. Significant correlates of needlestick injuries included tenure, patient load, hours worked, lack of compliance with standard precautions, handling needles and other sharps, poor safety climate, and inadequate training and availability of safety devices (p<0.05). PAR teams identified several risk reduction strategies, with an emphasis on safety devices. Non-hospital based RNs are at risk for bloodborne exposure at rates comparable to hospital based RNs; underreporting is an important obstacle to infection prevention, and primary and secondary risk management strategies appeared to be poorly implemented. Intervention research is warranted to evaluate improved risk reduction practices tailored to this population of RNs.
The aim of this study was to determine the prevalence of musculoskeletal complaints among X-ray technologists and to examine their relationship with physical and psychosocial factors. A cross-sectional study was performed in 2006 among 203 X-ray technologists working in 13 hospitals in the Apulia region of southern Italy. A questionnaire was used to collect data on personal characteristics, physical workload, psychosocial aspects, and the presence of musculoskeletal symptoms in the neck, shoulders, low back, hand/wrist and legs. Univariate analyses and multiple logistic regression analyses were then performed. The prevalence of complaints at any body site in the previous 12 months was 67%. Low back pain was the most commonly reported symptom (59.6%), followed by shoulder (21.2%), neck (19.7%), leg (13.8%) and hand/wrist pain (12.3%). Age was associated with low back pain, while high physical workload was associated with symptoms in the neck, low back and hand/wrist. High job demands were associated with neck and shoulder pain. Overall, our study suggests high prevalence rates of musculoskeletal complaints may exist among Italian X-ray technologists. Physical workload, psychosocial and individual factors appear to be important risk factors for musculoskeletal disorders within this occupational group.
The purpose of this study was to assess the impact of self-reported job stress on menstrual patterns among nurses. We conducted a cross-sectional survey of nursing staff from five psychiatric institutions and four general hospitals in Taiwan. A total of 746 participants were eligible for the final analysis, among whom, 72.3% were ascertained as having a self-perceived high level of job stress. Self-perceived high job stress was significantly associated with irregular menstrual cycles [Adjusted odds ratio (AOR): 4.8, 95% confidence interval (CI): 3.3-7.2] and longer menstrual bleeding periods (more than 7 d) [AOR: 2.5, 95% CI: 1.7-3.7], but was not significantly related to long or short menstrual cycles. Overall, this study suggests that nurses' self-perceived job stress may be associated with certain aspects of menstrual dysfunction. Further investigations with prospective follow-up studies and urine hormonal measurements are now recommended to provide additional insight into the pathophysiological mechanisms of our findings.