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Der er masser af ting du kan gøre, for at forberede dig til samtalen. Lav en grundig research på firma og stilling, så du er helt klar på, hvad jobbet drejer sig om.
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Arbejde og stress.Nye udviklingstendenser i en
globaliseret økonomi
Den 2. stressforskningskonference7-11-2005
SIF
Tage Søndergård Kristensen
The new challengesOutsourcing, downsizing, privatization,
precarious work, job insecurity
Blood pressure and pulse amongNorwegian metal workers
80
90
100
110
120
130
140
150
160
1982 1983 1984 1985 1986 1987 1988586062646668707274767880
Erikssen et al. Tidsskr Nor Laegeforen. 1990;110:2873-7.
BP (mm Hg)(N = approx. 180)Threat of closure Pulse
SBP
Pulse
DBP
129 129130135
142 145 143
63 63
6970
84 85 8690
94 9691
Hospital admissions for CVD in a group of unemployed men compared with a control group
Iversen et al. BMJ 1989;299:1073-6.
00,20,40,6
0,81
1,2
1,41,6
1,8
0.80
1.04
1.60
Before factoryclosure
(2 years)
During factoryclosure
(3 years)
After factoryclosure
(3 years)
0
1.81.61.41.2
10.80.6
0.40.2
0
1
2New cases of ischemia*
Threats to employment security among white-collar workers in Whitehall
A five-year follow-up studyN=8354
1.0
1.401.60
1.45
Controldepartments
RR
Men Women TotalDepartment under privatization
*ECG or angina
Ferrie et al. AJPH 1998;88:1030-1036.
Organisational downsizing and mortality
A 7.5 years’ follow-up study of 22.430 public employeeswho kept their jobs.
0
1
2
1.0
1.5
1.01.2
2.0
1.2
RR*
None Minor Major None Minor Major
Extent of downsizing
2.0
1.0
0
CVD Otherdeaths
Vahtera et al. BMJ 2004;328:555-558.
*Controlled for age, gender, SES, occupation
Impact of work-related events immediatelybefore myocardial infarction
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
No Yes No Yes
1.0
2.0
3.0
4.0
5.0
6.06.0
Relative risk
Möller et al. JECH 2005;59:23-30
A case-crossover study of 660 cases
1.0 1.0
6.0
High pressure deadline Pressure from competition
Last day Last week
A simple model
Job insecurity, downsizing, outsourcing, privatization
Loss of control, loss of social support, loss of meaning, loss of predictability,
loss of rewards
Stress, uncertainty, hopelessness,low self esteem
The new fatigue
The development of four different symptoms in the adult Swedish population 1986 - 2001
PercentFatigue
Back trouble
Sleep trouble
Distress
Gustafsson & Lundberg, eds. Arbetsliv och hälsa, 2004.
05
101520253035404550
Work-relatedburnout
Work-related burnout and sleeping problemstwo years later
Results from the PUMA baseline and 2 years’ follow-up
N = 1014; Data from NIOH, Denmark
25.1
32.6 34.4
44.6
Low HighQuartiles
Karolinska sleepquestionnaire (scale)
Burnout as predictor of ischaemic heart diseas
A 4.2 years’ follow-up study of 3,877 Dutch male employees from Rotterdam
”Have you ever been burned out?” No 74%Yes 26%
0
1
2
3
Burnout
* Controlled for age, BP, smoking, cholesterol. 59 cases.
Appels & Schouten. Behav Med 1991;Summer:53-59
1
2.13
No Yes
2
1
0
RR* for IHD*
Exhaustion and CHD
A 9.5 years’ follow-up study of 3,365 Dutch men.
0
10
20
30
40
50
2630
4550
40
30
20
10
0None Medium High
Degree of exhaustion by the end of the working day.
Cases per 1000
Appels & Otten. Br J Clin Psychol 1992;31:351-356
Vital exhaustion, IHD and death
6 years of follow-up of 9,563 adults from Copenhagen
* Adjusted for 13 biological, behavioural and social factors
Prescott et al. Int J Epidemiol 2003;32:990-7
Vital exhaustion0
1
2
3
0 1-4 5-9 10+
IHD
Mortality
1 1.1
1.6 1.8
1.2
2.2
1.6
3
2
1
0 1-4 5-9 10+0
RR*
Sleep quality and myocardial infarction
3 years of follow-up of 416 middle-aged German blue-collar workers
Siegrist. J Chron Dis 1987;40:571-578.
0
1
2
3
4
RR
1.0
3.8
1.0
2.6
No NoYes YesWake up early Difficulty
staying asleep
Psychological risk factors for CHD among homemakers from Framingham
*Adjusted for CVD risk factors.
Eaker et al. Am J Epidemiol 1992;135:854-864.
A 20-year follow-up study of 362 women
0
1
2
3
4
5
6
7
8
1.0
7.8RR *
6.2
3.9
1.0
876543210
- + - + - +
1.0
Tension Symptomsof anxiety
Troublefallingasleep
Sleep and risk of IHD
A study of 71,617 American nurses followed for 10 years
Ayas et al. Arch Intern Med 2003;163:205-9
0,0
0,5
1,0
1,5
2,0
2,5
1.8
1.31.1 1.0
-5
RR
1.61.4
1.2 1.1 1.0
1.4
6 7 8 9+ - 5 6 7 8 9+
Adjusted for 14 factorsAge-adjusted
The Nurses’ Health Study
0
1
2
3
4RR
CVD, sleep quality and ”need for recovery” after work
N=7,944 workers. 18-65 years. 42 cases.Van Amelsvoort et al. Occup Environ Med 2003;60:83-87.
Sleep quality Need for recovery
Results from 32 months of follow-up of the Maastrict Cohort Study on fatigue
3
2
1
0
1 11.22
3.162.82
Good Poor Low Medium High
0
1
2
RR*
Long working hours and short sleep as risk factors for AMI
*Adjusted for smoking, alcohol, BMI, BP, DM, cholesterol, heart disease in family, job type and sedentary job
Lin er al. Occup Environ Med 2002;59:447-51.
Working hours/weekpast year
Days/week with <5 hours of sleep
A case control study of working Japanese men 40-79 years of age260 cases and 445 matched healthy controls
<40 41-60 61+ 0 1 2+
11.3
1.8
1 1.1
2.1
Depression and CHDA meta-analysis
RR
Clinical depression 2.69 (1.63-4.43)
Depressive mood 1.49 (1.16-1.92)
Overall estimate 1.64 (1.29-2.08)
Rugulies. Am J Prev Med 2002;23:51-61.
Relative risk among initially healthy subjects.
Analysis of 11 studies
The new fatigue
Long workinghours
Shift work,24 h society
Family/work
conflict
High emotionaldemands
High workpace
Conflicts,bullying
Fatigue
Burnout Need forrecovery
Withdrawal Depression
Sleep problems
Cardiovasculardisease
Stress
Burnout and engagement – two sides of the same coin?
After Schaufeli et al.
Hard core business
Withdrawal/cynicism
Burnout Tired idealist
Dedication
Engagement
Exhaustion
Vigor
Family and private life
Work-family (im)balance
Do you experience a conflict between work and family, so that you feel you should be ”both places at thesame time”?
Yes, often 7%Yes, regularly 29%
Does your work take too much of your energy so thatyour private life suffers?
Yes, certainly 10%Yes, to some degree 34%
N=3517 Danish employees. 2005.
Stress at work and in the family of American men
The proportion who got a divorce during 9 years
N = 10,904 married men in the MRFIT study
Matthews & Gump. Arch Intern Med 2002;162:309-15.
0
10
20
30
0 1 2 3+
%
6.5%8.2%
11.9%
19.7%
Numberof work stressors
DK-2004-001
0
1
2
0 1 2 3+0
1
2
Still married Separaret Divorced
RR* RR*
Work stress Family stress
Stress and CVD mortality among American middle-aged men
9 years’ follow-up of 12,336 men in the MRFIT
*Controlled for eight important confounders.
Matthews & Gump. Arch Intern Med 2002;162:309-15. ENG-2004-001
1.00 1.07 1.191.34
1.00
1.43 1.40
Number of work stressors Events among married men
Is marriage worse than work?(For women)
0
1
2
3
0
1
2
3
* Adjusted for age, diagnosis, SBP, DM, smoking, lipids and estrogen status.
Orth-Gomér et al. JAMA 2000;284:3008-14.
A follow-up study of 292 female heart patients in Stockholm
Low Moderate Severe
1
2.8 2.9
2
1
0
RR* For new events
Low Moderate Severe
11.3 (NS)
1.7 (NS)2
1
0
RR* For new events
Marital Stress Work stress
0
1
2
None
Some
Perman
ent
None
Some
Perman
ent
LowM
oder
ateSe
vere
None
OneTwo o
r mor
e
RR*
Psychosocial factors and acute myocardial infarction: TheINTERHEART STUDY
Work stress Home stress Financial stress Life events
Rosengren et al. www.the lancet.com Sept. 3,2004:1-10
11,119 cases and 13,648 controls from 52 countries
2
1
0
1
1.38
1
2.14 2.12
1.52
11.19
1.33
11.23
1.48
Work and product quality –is there an association?
The Sirdal model for work environment and output quality
Output quality
Work environment Health and well-being of the employees
Client satisfaction and competence
Programs forimprovement
of work environ-ment and output
quality
Stress level amongthe nurses and patient incidents
0,0
1,0
2,0
3,0
0 - 4 4 - 5 5 - 5.5 5.5 - 6 6 - 6.5 6.5 - 7 7 - 10
A study of 293 nurses over 3 months
Average stress score (VAS scale) in 48 units
%
Patient incidents (falls, medication errors, other errors)
0.6
1.0 1.1
1.61.8
2.1 2.2
1.0
2.0
Dugan et al. J Nurs Care Qual 1996;10:46-58
Association between burnout leveland critical incidents
A study of 678 Japanese nurses at Tokyo University Hospital
Level of burnout
Low High1 2 3 4 Total
Falling patient 29% 38% 45% 51% 41%
Mistakes related to transfusions 2% 4% 7% 9% 6%
Mistakes related to medication 41% 53% 52% 62% 53%
Mistakes related to operations/anaesthesia 9% 2% 3% 3% 4%
P< 0.05
Odagiri, Kristensen & Shimomitsu, 2005
Staff workload and hospital mortality
0
1
2
3
4
1.0
2.0 1.9
3.1
Low Medium High
A 4-year study in an adult intensive care unit (337 hospital deaths)
1.0
2.0
3.0
Tarnow-Mordi et al. Lancet 2000;356:185-189
Overall workload
Relative risk for death
Patient-to-nurse ratio: Possibleconsequences for nurses and patients
0
0,5
1
1,5
2
0.5
1.0
1.5
Aiken et al. JAMA 2002;288:1987-1993
An American study including 10,184 nurses, 232,342 patients, and 168 hospitals
High burnout Job dissatisfaction Patient mortality Failure to rescue
Relative risk*
1.0
1.23
1.0
1.15
1.01.07
1.01.07
NURSES PATIENTS
* RR associated with an increase of 1 patient per nurse. Adjusted.
Errors in patient treatment beforeand after a stress management
programme
Errors per hospital per yearYear before Year after
Control hospitals 1,64 1,59Intervention hospitals 1,41 0,41*
22 hospitals in each group.Matched on three criteria.* p<0,01
Jones et al. J Applied Psychol 1998;73:727-735.
The effect of a stress management programme for theincidence of medical treatment errors
Jones et al: J Applied Psychol 1988;73:727-353
Many challenges – one solution?
• The globalized economy• Competitiveness of private business• Quality of the public services• The new fatigue• Family-work conflict
- and the ”golden nuggets” of psychosocial work environment and private life: influence, meaning, support, predictability, rewards, demands
The End
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