Tarja Heponiemi

Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

BackgroundViolence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention.MethodsAll health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health.ResultsOne out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress.ConclusionOur study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.

BIS/BAS sensitivity and self-rated affects during experimentally induced stress

Abstract Sensitivities of behavioral inhibition and behavioral approach as related to dispositions to experience emotions in laboratory induced stress were examined among 95 randomly selected 21–36-year-old healthy men ( n =49) and women ( n =46). Gray‘s temperament theory was used to define behavioral inhibition (BIS) and behavioral approach (BAS) with Carver and White’s BIS/BAS scales. The circumplex model of affect was used to structure the self-reported affects. Stressors used were the aversive startle task, the appetitive mental arithmetic task, and the aversive choice-deadline reaction time task. The main finding was that BAS sensitivity was generally associated with pleasant affects with an especially great increase of Activated Pleasant Affect during the appetitive task. BIS sensitivity was, on the other hand, associated with unpleasant affects with a great increase of Activated Unpleasant Affect during aversive tasks. A conclusion was that BIS sensitivity could predispose a person to emotional distress in stressful situations and, probably, to a higher stress vulnerability with its somatic endpoints.

Job strain and adverse health behaviors: The Finnish public sector study

Objective: The objective of this study was to explore the association between job strain and the co-occurrence of adverse health behaviors; smoking, heavy drinking, obesity, and physical inactivity. Methods: The authors studied cross-sectional data of 34,058 female and 8154 male public sector employees. Results: Multinomial logistic regression models adjusted for sex, age, basic education, marital status, and type of job contract showed that high job strain and passive jobs were associated with 1.3 to 1.4 times higher odds of having ≥3 (vs 0) adverse health behaviors. Among men, low job control was associated with a 1.3-fold likelihood and among women active jobs were associated with a 1.2-fold likelihood of having ≥3 (vs 0) adverse behaviors. High demands were associated with a higher likelihood of co-occurrence of one to two (vs 0) adverse behaviors among women. Conclusions: Job strain conditions may be associated with the co-occurrence of adverse health behaviors that contribute to preventable chronic diseases. Clinical Significance: Adverse job conditions may increase the likelihood of co-occurring health risk behaviors. Reducing work stress by increasing job control and decreasing psychologic demands might help efforts to promote healthy lifestyles.

Cardiac autonomic reactivity and recovery in predicting carotid atherosclerosis: the cardiovascular risk in young Finns study.

The present study examined the association of cardiac autonomic task-induced reactivity and recovery to preclinical atherosclerosis. Thirty-three men and 33 women aged 24-39 years participated in the ongoing epidemiological Cardiovascular Risk in Young Finns study. The authors measured heart rate (HR), respiratory sinus arrhythmia (RSA), and preejection period (PEP) during the mental arithmetic and speech tasks in 1999. Carotid atherosclerosis was assessed by measuring the thickness of the common carotid artery intima-media complex (IMT) with ultrasound in 2001. Higher HR, RSA, and PEP reactivity were associated with lower IMT values even after adjusting for cardiovascular risk factors (lipid levels, obesity, and blood pressure). In addition, better HR recovery after the mental arithmetic task was associated with lower IMT values, and this association persisted after all adjustments. Thus, higher task-induced cardiac autonomic reactivity and better HR recovery were related to less preclinical atherosclerosis. The authors concluded that cardiac pattern of reactivity and quick recovery may be associated with better cardiovascular health, and therefore all reactivity occurring in challenging situations should not automatically be considered as potentially pathological.

Depressive symptoms and carotid artery intima-media thickness in young adults: the Cardiovascular Risk in Young Finns Study.

Objective: Depression and coronary heart disease are often comorbid conditions, but the mechanism behind this link is largely unknown. We tested the hypothesis that a high level of depressive symptoms in healthy young adults would be related to more prevalent preclinical atherosclerosis. Methods: We studied the association between depressive symptoms and carotid atherosclerosis in 1126 young adults (410 men and 716 women) as part of the ongoing population-based Cardiovascular Risk in Young Finns Study. The participants responded to a revised version of Becks Depression Inventory in 1992, 1997, and 2001. Carotid atherosclerosis was assessed by measuring the thickness of the common carotid artery intima-media complex with ultrasound in 2001. Cardiovascular risk factors were measured in childhood/adolescence (1980) and in adulthood (2001). Results: In men, high scorers of depressive symptoms in 2001 had higher carotid artery intima-media thickness (0.63 mm) compared with those with low or moderate scores on depressive symptoms (0.57 mm). This relationship (B = 0.08, F[1, 405] = 9.24, p = .003) persisted after adjustment for age and cardiovascular risk factors in adolescence and adulthood. Depression scores in 1992 and 1997 were not predictive of intima-media thickness. In women, no association was found between depressive symptoms and intima-media thickness. Conclusions: Depressive symptoms during early adulthood seem to be associated with higher levels of carotid intima-media thickness in men, but not in women. LDL = low-density lipoprotein; HDL = high-density lipoprotein; CHD = cardiovascular heart disease; CRYF = Cardiovascular Risk in Young Finns; IMT = intima-media thickness; BDI = Becks Depression Inventory.

Effort-reward imbalance at work and the co-occurrence of lifestyle risk factors: cross-sectional survey in a sample of 36,127 public sector employees

BackgroundIn occupational life, a mismatch between high expenditure of effort and receiving few rewards may promote the co-occurrence of lifestyle risk factors, however, there is insufficient evidence to support or refute this hypothesis. The aim of this study is to examine the extent to which the dimensions of the Effort-Reward Imbalance (ERI) model – effort, rewards and ERI – are associated with the co-occurrence of lifestyle risk factors.MethodsBased on data from the Finnish Public Sector Study, cross-sectional analyses were performed for 28,894 women and 7233 men. ERI was conceptualized as a ratio of effort and rewards. To control for individual differences in response styles, such as a personal disposition to answer negatively to questionnaires, occupational and organizational -level ecological ERI scores were constructed in addition to individual-level ERI scores. Risk factors included current smoking, heavy drinking, body mass index ≥25 kg/m2, and physical inactivity. Multinomial logistic regression models were used to estimate the likelihood of having one risk factor, two risk factors, and three or four risk factors. The associations between ERI and single risk factors were explored using binary logistic regression models.ResultsAfter adjustment for age, socioeconomic position, marital status, and type of job contract, women and men with high ecological ERI were 40% more likely to have simultaneously ≥3 lifestyle risk factors (vs. 0 risk factors) compared with their counterparts with low ERI. When examined separately, both low ecological effort and low ecological rewards were also associated with an elevated prevalence of risk factor co-occurrence. The results obtained with the individual-level scores were in the same direction. The associations of ecological ERI with single risk factors were generally less marked than the associations with the co-occurrence of risk factors.ConclusionThis study suggests that a high ratio of occupational efforts relative to rewards may be associated with an elevated risk of having multiple lifestyle risk factors. However, an unexpected association between low effort and a higher likelihood of risk factor co-occurrence as well as the absence of data on overcommitment (and thereby a lack of full test of the ERI model) warrant caution in regard to the extent to which the entire ERI model is supported by our evidence.

Sense of coherence and diabetes: A prospective occupational cohort study

BackgroundSense of coherence (SOC) is an individual characteristic related to a positive life orientation leading to effective coping. A weak SOC has been associated with indicators of general morbidity and mortality. However, the relationship between SOC and diabetes has not been studied in prospective design. The present study prospectively examined the relationship between a weak SOC and the incidence of diabetes.MethodsThe relationship between a weak SOC and the incidence of diabetes was investigated among 5827 Finnish male employees aged 18–65 at baseline (1986). SOC was measured by questionnaire survey at baseline. Data on prescription diabetes drugs from 1987 to 2004 were obtained from the Drug Imbursement Register held by the Social Insurance Institution.ResultsDuring the follow-up, 313 cases of diabetes were recorded. A weak SOC was associated with a 46% higher risk of diabetes in participants who had been =<50 years of age on entry into the study. This association was independent of age, education, marital status, psychological distress, self-rated health, smoking status, binge drinking and physical activity. No similar association was observed in older employees.ConclusionThe results suggest that besides focusing on well-known risk factors for diabetes, strengthening SOC in employees of =<50 years of age can also play a role in attempts to tackle increasing rates of diabetes.

BIS–BAS sensitivity and cardiac autonomic stress profiles

This study examined the relationship of sensitivities of Grays behavioral inhibition system (BIS) and behavioral approach system (BAS) to cardiac autonomic stress responses during laboratory tasks among 65 healthy men (n=34) and women (n=31) aged 22-37 years. Carver and Whites BIS-BAS scales were used to measure BIS and BAS sensitivities. We measured heart rate (HR), respiratory sinus arrhythmia, and preejection period during mental arithmetic, a reaction time task, and a speech task. Results revealed that BAS sensitivity was related to HR reactivity and parasympathetic withdrawal during the tasks, but was unrelated to baseline levels. BIS sensitivity was unrelated to both reactivity and baseline levels of all measures. Overall, our results suggest that the relationship of the BAS with cardiac reactivity seems to be mediated by the parasympathetic nervous system.

Social support and the likelihood of maintaining and improving levels of physical activity: the Whitehall II Study

Background: Evidence on the association between social support and leisure time physical activity (LTPA) is scarce and mostly based on cross-sectional data with different types of social support collapsed into a single index. The aim of this study was to investigate whether social support from the closest person was associated with LTPA. Methods: Prospective cohort study of 5395 adults (mean age 55.7 years, 3864 men) participating in the British Whitehall II study. Confiding/emotional support and practical support were assessed at baseline in 1997–99 using the Close Persons Questionnaire. LTPA was assessed at baseline and follow-up in (2002–04). Baseline covariates included socio-demographics, self-rated health, long-standing illnesses, physical functioning and common mental disorders. Results: Among participants who reported recommended levels of LTPA at baseline, those who experienced high confiding/emotional support were more likely to report recommended levels of LTPA at follow-up [odds ratio (OR): 1.39, 95% confidence interval (CI): 1.12–1.70 in a model adjusted for baseline covariates]. Among those participants who did not meet the recommended target of LTPA at baseline, high confiding/emotional support was not associated with improvement in activity levels. High practical support was associated with both maintaining (OR: 1.34, 95% CI: 1.10–1.63) and improving (OR: 1.25, 95% CI: 1.02–1.53) LTPA levels. Conclusion: These findings suggest that emotional and practical support from the closest person may help the individual to maintain the recommended level of LTPA. Practical support also predicted a change towards a more active lifestyle.

Health, psychosocial factors and retirement intentions among Finnish physicians

BACKGROUND Early retirement among physicians is a worldwide problem and all efforts to try to minimize it are of importance. AIMS To investigate whether characteristics of work, organization factors and health factors might be associated with retirement intentions among physicians. METHODS Cross-sectional survey data from the Finnish Health Care Professional Study was used. A random sample of Finnish physicians included 682 women and 701 men aged 45-65 years. A three-level retirement intention score was constructed based on responses to two questions asking about (i) willingness to continue working or retiring and (ii) pension-applying considerations. Health indicators used were self-rated health, work ability and sickness absence during the past 12 months. Karaseks job control and Colquitts organizational justice were measured. Ordinal logistic regression models were used to analyse the data. RESULTS Self-reports of poor health [odds ratio (OR) 2.17, 95% CI 1.84-2.56], low work ability (OR 2.18, 95% CI 1.12-1.46), taking sickness absence (OR 1.28, 95% CI 1.12-1.46), low job control (OR 1.71, 95% CI 1.50-1.95) and organizational injustice (OR 1.27, 95% CI 1.17-1.39) all independently increased the likelihood of retirement intentions. Low job control strengthened the associations of poor health and low work ability with retirement intentions. In addition, organizational injustice strengthened the associations of poor health and sickness absences with retirement intentions. CONCLUSION Low job control and organizational injustice may intensify the effect of poor health on retirement intentions. Promoting control opportunities and organizational justice might help to decrease early retirement among physicians.