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[Social medicine in social work--a key for improving health-related social work].

The relation between social work and social medicine is the subject of this article. Social work is an independent discipline creating its own knowledge in scientific cooperation with other disciplines. Social Medicine is outlined with its special features as a field and as a medical discipline. The traditional relation between social work and the discipline of Social Medicine operates side by side. Since Social Medicine and social work refer to each other, new perspectives for the development of health-related social work arise. Social Medicine appeared in social work can help in elaborating a sociogenetic model of understanding health and illness as well as the development of sociotherapy in social work. Health-related social work will gain more significance in the treatment of health-related and disease-related questions.

Forecasting↗

Are individuals' nighttime sleep characteristics prior to shift-work exposure predictive for parameters of daytime sleep after commencing shift work?

This study aimed to examine prospectively whether individual nighttime sleep characteristics at baseline (prior to shift-work exposure) are related to parameters of daytime sleep after commencing shift work. A longitudinal field study was carried out with novice police officers of the Dutch Police Force. A total of 26 subjects were examined at baseline before they entered shift work and re-examined during follow-up sessions after four and twelve months of shift-work exposure. Wrist actigraphy and sleep diaries were used to study nocturnal sleep at baseline and daytime sleep after night shifts during follow-up sessions. As outcome variables, estimated total sleep time, sleep efficiency, and subjective sleep quality were analyzed. Daytime total sleep time showed a 66 min decline during the first year of shift-work exposure. Systematic inter-individual differences were observed for daytime total sleep time and subjective sleep quality (explaining 53% and 38% of the variance, respectively), suggesting potential predictability of these sleep parameters. Although no predictors were found for daytime total sleep time, the subjective quality of nighttime sleep before the onset of shift work predicted 40% of the variance in the subjective quality of daytime sleep after commencing shift work. Follow-up studies may reveal whether the subjective quality of baseline nighttime sleep also predicts long-term overall tolerance for shift work.

Adult↗

Macro-organizational factors, the incidence of work disability, and work ability among the total workforce of home care workers in Sweden.

AIMS: To investigate the importance of macro-organizational factors, i.e. organizational sociodemographic and socioeconomic preconditions, of the municipal incidence of long-term sick leave, disability pension, and prevalence of workers with long-term work ability among home care workers. METHODS: In an ecological study design, data from national databases were combined by record linkage. Descriptive and analytical statistics were used to estimate and interpret macro-organizational factors (economic resources, region, unemployment, employment, occupational rehabilitation, return to work, age structures of inhabitants and home care workers). RESULTS: The incidence of long-term sick leave among female home care workers was twice as high as that of male home care workers, and incidence of disability pension was about four times as high for the women. A great variation in municipal incidence of long-term sick leave, disability pension, and long-term work ability (101-264, 0.6-19.6, and 913-1,279 per 1,000 full-time equivalent workers and year) was also found. The strongest single factor for long-term work ability was a high proportion of part-time or hourly paid employees, which explained 35% of the municipal variation. Macro-organizational factors explained long-term work ability (47-62% explained variance) better than long-term sick leave (33% explained variance). There was a low rehabilitation activity; only 2% received occupational rehabilitation and 5% of those on sick leave longer than 2 weeks returned to work within 30 days. CONCLUSIONS: The differences in the municipal proportion of work ability incidence indicate a preventive potential, especially related to employment and return to work after sick leave.

Adult↗

Measuring attitudes toward the physically disabled: testing the 'Attitude Towards Disabled Persons' scale (A.T.D.P. Form O) on social work and non-social work students.

The aim of the study was to test the U.S.A. Validated 'Attitude Towards Disabled Persons' Inventory (A.T.D.P. Form O) on a British student population to establish norms. The objectives were to test specific hypotheses related to the sex of the respondent, contact with physically disabled people and whether social work students had different attitude scores than non social work students. In addition, a comparison was made between the British and U.S.A. 'norms'. The student population of four specific British Universities comprised the sampling frame. The sample was a non probability accidental sample of social work and non social work students. Standardised A.T.D.P. Form Os were administered in group situations. Each form was accompanied by a letter explaining the study, together with a short questionnaire eliciting the sex of respondent and type and extent of any contact with disabled people. The findings demonstrated that there are probably differences between U.S.A. and British norms but that there are general similarities between the two countries. In both countries females, scored higher than males, which by interpretation indicates possibly a more favourable attitude. Contact with the disabled is also a contributing factor in higher scores. Social work students also tended to score more highly than non social work students. The implications of these findings are discussed with regard to the possible development of professional attitudes for those who work with the disabled. It is postulated that 'idealisation' may be reflected in attitudes of students who intend to work with the disabled which, after general and professional life experience gives way to less favourable attitudes. Closeness of contact of respondents to disabled people is a factor which needs further exploration in connection with changing attitude scores.

Adult↗

Ambulatory blood pressure, heart rate, and neuroendocrine responses in women nurses during work and off work days.

OBJECTIVE: This study examined women's cardiovascular and neuroendocrine responsiveness to work. METHODS: Ambulatory blood pressure (BP) and heart rate (HR) were recorded over 24-hour periods on 2 work and 2 off days during the luteal and follicular phases of the menstrual cycle in 138 registered nurses, aged 25 to 50 years. Urinary catecholamines and cortisol were measured for day and night periods. RESULTS: During waking hours systolic BP (SBP), HR, and epinephrine were higher on work than off days. Diastolic BP (DBP) and HR were highest at work. Nurses scoring high on job demands had elevations in daytime SBP, daytime HR only on work days, and nighttime epinephrine on work days. Compared with those with short work histories, nurses employed longer had consistently higher norepinephrine levels during days and nights, and higher nighttime DBP during off days. In unmarried nurses compared with married nurses, nighttime cortisol was lower during all 4 days and norepinephrine was lower during days off. All findings were independent of actigraph-recorded activity. CONCLUSIONS: Although the work environment leads to increased activity of the cardiovascular and sympathoadrenal medullary system in healthy women, the effects are modified by the woman's domestic role, by the length of her employment, and by the demands of her job.

Adaptation, Psychological↗

Work load, job control and risk of leaving work by sickness certification before delivery, Norway 1989.

Sickness absence in pregnancy has been shown to be associated with strenuous working conditions and parity. So far, few studies have made adjustments for possible interaction and confounding. Such adjustments are needed to more precisely identify targets for preventive measures. We have, therefore, in a representative population of pregnant employees in Norway 1989, computed adjusted odds ratios for leaving work by sickness absence more than three (LSC > 3) and eight (LSC > 8) weeks before delivery according to working conditions identified as risk factors in earlier studies; adjusted for job control, domestic conditions and sickness absence the year prior to pregnancy. The cumulative percentage of LSC > 8 and LSC > 3 was 26.4 and 51.1. Ergonomically strenuous postures and heavy lifting increased the risk of both outcomes. In addition, shift work and hectic work pace increased the risk of LSC > 3. Influence on breaks reduced risk. Only para experienced reduced risk of LSC when working part-time. Sicklisting the year prior to pregnancy had no confounding effect, which suggest that pregnancy represents a new incompatibility with work. Preventive measures should address work postures and heavy lifting, as well as conditions influencing the woman's control with her time.

Adult↗

Perceived sleepiness of non-shift working men in two different types of work organization.

Increased sleepiness at work is increasingly being focused on as a safety and health issue. However, research on workers' sleepiness is very limited in scope and the characteristics of work organization, including the impact of job stress, have not been fully addressed. A questionnaire survey was conducted to investigate the prevalence of daytime sleepiness and its associated factors among non-shift working men at two manufacturing businesses: Company A, having a rapid rate of development and growth, with 564 workers (19-61 yr old, mean age: 32.7, response rate: 81.4%); and Company B, long established, possessing a huge production facility, with 1,654 workers (20-63 yr old, mean age: 37.1, response rate: 78.2%). The prevalence of daytime sleepiness was 11.3% in company A and 16.8% in company B. Multivariate logistic regression analysis revealed that, in company A, perceived sleepiness was associated with long sleep duration on non-working days and high cognitive demands and, in company B, with insufficient daily sleep, single, and depression. Psychosomatic exhaustion resulting from jobs requiring high adaptivity due to rapid frequency of operational change as in company A may have the potential to become an important factor in perceived sleepiness. However, in a comparatively stable work organization, as in company B, increased sleepiness may be mainly linked to factors outside work. It is suggested that not only lifestyle and sleep habits, but also the characteristics and dynamics of a work organization should be a focus of attention when planning measures to prevent sleepiness at work.

Adult↗

A comparison of heart rate during rest and work in shift workers with different work styles.

To determine if the type of work performed should be considered in research on shift work and cardiovascular disease, we compared the heart rates, total number of steps walked, and blood pressures of 12 shift workers on the same rotating 3-shift schedule in a pulp and paper mill. Six workers were selected from the paper manufacturing section (group 1) and six workers from the chemical products section (group 2). Average heart rate (in beats per min) monitored during duty time was 84.3 in group 1 and 87.4 in group 2. Average heart rate during work was not significantly higher than that during rest in both groups 1 (work 85.8, rest 75.3) and 2 (work 87.9, rest 83.1). There was no significant difference in the total number of steps walked. A non-significant decrease in systolic blood pressure value was found in group 1 compared with that in group 2. Although future studies will be needed to explain the relation between different work styles and their effects on the health of shift workers, our results suggest no significant difference in heart rates among workers engaged in different kinds of work on the same shift work schedule.

Blood Pressure↗

Health problems due to long working hours in Japan: working hours, workers' compensation (Karoshi), and preventive measures.

Late in the 1970s, serious social concern over health problems due to long working hours has arisen in Japan. This report briefly summarizes the Japanese circumstances about long working hours and what the Government has achieved so far. The national statistics show that more than 6 million people worked for 60 h or more per week during years 2000 and 2004. Approximately three hundred cases of brain and heart diseases were recognized as labour accidents resulting from overwork (Karoshi) by the Ministry of Health, Labour and Welfare (MHLW) between 2002 and 2005. Consequently, the MHLW has been working to establish a more appropriate compensation system for Karoshi, as well as preventive measures for overwork related health problems. In 2001, the MHLW set the standards for clearly recognizing Karoshi in association with the amount of overtime working hours. These standards were based on the results of a literature review and medical examinations indicating a relationship between overwork and brain and heart diseases. In 2002, the MHLW launched the program for the prevention of health impairment due to overwork, and in 2005 the health guidance through an interview by a doctor for overworked workers has been enacted as law. Long working hours are controversial issues because of conflicts between health, safety, work-life balance, and productivity. It is obvious that we need to continue research regarding the impact on worker health and the management of long working hours.

Accidents, Occupational↗

Another decade of social scientific work on sex work: a review of research 1990-2000.

The international, psychological and sociological research literature on prostitution from 1990 through 2000 is reviewed. The stage is set by scanning topics and perspectives in earlier writings. Then the research is discussed under the following headings: (a) HIV related research (HIV prevalence studies, factors in condom use, and prevention program evaluation); (b) workers' background and motivational issues (early victimization and connected factors, economic motives and connected factors); (c) work related issues (working routines, risks and stresses, and managing risk, work and identity); (d) research on clients, and (e) issues related to social and legal status. The literature is still much more about sex than it is about work. In addition, although an increasing number of authors have criticized the dominance of a deviance perspective over work perspectives on prostitution, the literature still reveals many features of stigmatization. For instance, the wrongs associated with sex work are all too often attributed to the nature of sex work itself instead of to the stigma attached to it or to specific negative circumstances. Likewise, the association between prostitution and negative features (in particular HIV and early victimization) is overwhelming, despite evidence that, for large groups of sex workers, these issues are of limited relevance. Generally, writers fail to adequately differentiate among types of sex workers. In particular, in relation to issues of health and well-being, differentiation among sex workers on the basis of specific features of their working situation (e.g., contexts, routines, relations, conditions) has hardly been studied and is recommended for the future.

Condoms↗

Personal factors and working conditions as predictors of work injuries among industrial workers.

The purpose of this study was to determine the personal factors and working conditions that predict work injuries among industrial workers. To fulfill this aim, a case control study was conducted including 2003 industrial workers who sustained a work injury and an equal number of controls. All were subjected to an interview questionnaire to collect relevant information. Moreover, records were reviewed to obtain the medical history of enrolled workers. Data revealed that workers in the index and control groups are comparable in respect to their sociodemographic characteristics. The multivariate logistic regression analysis pointed out that safety training significantly reduces the risk of work accidents among industrial workers. On the other hand, work accidents are more likely to occur in the main working shift. Moreover, workers who suffer from chronic health problems calling for surgical treatment, as well as those who reported family problems, are more likely to experience work accidents. These workers should receive considerable attention to reduce the extent of work injuries. More importantly, safety-training programs are mandatory for accident prevention in industrial settings.

Accident Prevention↗

Resident work hours and working environment in otolaryngology. Analysis of daily activity and resident perception.

OBJECTIVE: --To analyze the working environment and work hours of a cohort of otolaryngology--head and neck surgery residents. DESIGN: --Environmental analysis questionnaire and a log of daily activities. SETTING: --Residents were on a clinical rotation system. PARTICIPANTS: --Fifty-nine residents from six programs, including three public and three private institutions, from geographically diverse regions of the country were involved in the study. Residents were equally distributed from their second year through their fifth year of postgraduate work. All eligible residents participated in and completed the study. INTERVENTION: --The environmental analysis survey was designed to elicit resident perception of different aspects of their working environment. The daily activity log required the resident to report on activities for each half-hour period for 7 consecutive days. RESULTS: --Residents were on call an average of 52.8 hours (2.2 days) and worked 79.4 hours per week. Seventy-five percent believed that the level of faculty supervision and the degree of resident responsibility was about right. Two major inefficiencies were the time involved in completion of paperwork and the lack of nonmedical support services. Thirty-one percent of the residents responded that fatigue resulted in substandard patient care 10% of the time. Forty-seven percent responded that their educational experience was substandard 25% of the time secondary to fatigue. Two thirds responded that the demands of residency training had a negative impact on their family and personal life. CONCLUSIONS: --Seventy percent of the otolaryngology--head and neck surgery residents surveyed at six institutions believe that an 80-hour workweek, including being on call every third night with no more than 24 hours of continuous work without sleep, approximates a reasonable, maximum work schedule. Residents working the longest hours expressed concern about rendering substandard care and developing negative attitudes toward patients. Noneducational inefficiencies were identified and solutions were proposed. Demands of residency training, even within guidelines established as reasonable, can have detrimental effects on residents' educational activities and personal life.

Attitude↗

[An occupational physiology study at the Asarel Mining and Milling Works. The evaluation of the work load in the basic jobs in an open-pit mine].

This occupational physiology study was undertaken within a wider applied-research framework designed to evaluate the occupational environment and its impact on workers at "Asarel" Mining and Milling Works. Analysis of activities showed physical effort (dynamic and static) to be the major problem at the open pit, though varying in extent between jobs (most prominent for blasters and bulldozerists). Nervous/emotional strain, while not leading, was sustained mostly by diggers and blasters, followed by drivers. Organization of work (shift regimen, no regulated breaks, stepwise schedule of days off work) was hardly appropriate and did not allow for recovery. Interviewed workers qualified working conditions as extremely unfavorable; they disapproved with the physical factors of the occupational environment, the workplace, the state of machines and devices, and remuneration for work performed. Exertion from work, assessed by pulse rate and energy expended, was moderate for most activities of diggers, drivers, and drillers. The burden of physical effort was great for blasters at the open pit and for diggers and drillers performing extra repair operations (pulse rate, 100-110 strokes/min; energy expended, 5.2-5.5 Kcal/min). Hardest and least attractive was the work of blasters at stores for explosive materials (pulse rate, 120-141 strokes/min; energy expended, 5.5-6.5 Kcal/min). These adverse factors of labor activities might produce a negative impact on worker health and performance, leading to occupational impairment of their musculoskeletal system, to labor-related disorders of their cardiovascular and nervous systems, etc. Preventive measures are thus necessary to limit physical exertion, optimize the work-and-rest regimen; also, there is a need for conducting pertinent preventive medical examinations, providing social measures (conditions for transportation, rest, nutrition, sports), etc.

Adult↗

Adolescent work patterns and work-related injury incidence in rural Minnesota.

BACKGROUND: Although there have been many studies on working youth in the United States, we have noted none which have provided a broad picture of adolescent work practices in a rural community. METHODS: Six high schools in rural Minnesota were evaluated for adolescent work practices. Schools ranged in size from 173 to 525 students in grades 9 through 12. A 20 page self-administered survey examining work practices was administered to students. RESULTS: A total of 2,250 students completed the survey, representing 92% of the student body. Twenty-eight percent of students lived on a farm. Approximately 45% of the male students and slightly more than 21% of the females were involved in farm work. Only 2.6% of students were injured during this 8-month time period in farm-related activities, and 5.1% were injured doing non-farm work. Many students reported working long hours. CONCLUSIONS: Work represents a serious problem for rural youth. These data are significant in the context of national policy discussion concerning the failure of the Fair Labor Standards Act to regulate the agricultural environment.

Accidents, Occupational↗

Risk factors in health, work environment, smoking status, and organizational context for work disability.

BACKGROUND: This study examines the associations between health, work environment exposures, smoking status, and organizational context and work disability. METHODS: In a sample of 3,318 Danish employees, respondents were interviewed by telephone in 1995 about health, work environment, smoking status and organizational context of the workplace. In 1997, a follow-up to assess employment status was conducted using The Statistical Register of Transfer Payments, Statistics Denmark. RESULTS: Work disability is predicted by work environment, smoking status of the individual employee, and by organizational level factors at the workplace. Although poor mental health, chronic bronchitis or musculoskeletal symptoms in neck or shoulders were equally distributed at baseline among type of company, the 2-year incidence of work disability was higher in traditionally organized workplaces than in flexibly organized workplaces. CONCLUSION: The study suggests a potential for reducing health-related work disability from work through flexible organization of the workplace.

Adolescent↗

Work and Family Stress and Well-Being: An Examination of Person-Environment Fit in the Work and Family Domains.

Research indicates that work and family are significant sources of stress. However, this research has underemphasized the cognitive appraisal process by which work and family generate stress. This study used person-environment fit theory to examine how the comparison of work and family experiences to the person's values relates to stress and well-being. Using data from 1758 employees, we assessed fit regarding autonomy, relationships, security, and segmentation for both work and family, and examined the relationship of fit with work and family satisfaction, anxiety, depression, irritation, and somatic symptoms. In general, well-being improved as experiences increased toward values and improved to a lesser extent as experiences exceeded values. Well-being was also higher when experiences and values were both high than when both were low. These relationships were generally strongest for within-domain fit and well-being (i.e., work fit and work satisfaction, family fit and family satisfaction), and several relationships were moderated by work and family centrality. Copyright 1999 Academic Press.

Journal Article↗

Mechanical muscular power output and work during ergometer cycling at different work loads and speeds.

The aim of the study was to calculate the magnitude of the instantaneous muscular power output at the hip, knee and ankle joints during ergometer cycling at different work loads and speeds. Six healthy subjects pedalled a weight-braked cycle ergometer at 0, 120 and 240 W at a constant speed of 60 rpm. The subjects also pedalled at 40, 60, 80 and 100 rpm against the same resistance, giving power outputs of 80, 120, 160 and 200 W respectively. The subjects were filmed with a cine-film camera, and pedal reaction forces were recorded from a force transducer mounted in the pedal. The muscular work for the hip, knee and ankle joint muscles was calculated using a model based upon dynamic mechanics and described elsewhere. The total work during one pedal revolution significantly increased with increased work load but did not increase with increased pedalling rate at the same braking force. The relative proportions of total positive work at the hip, knee and ankle joints were also calculated. Hip and ankle extension work proportionally decreased with increased work load. Pedalling rate did not change the relative proportion of total work at the different joints.

Adult↗

Promotor(a)s, the organizations in which they work, and an emerging paradox: how organizational structure and scope impact promotor(a)s' work.

OBJECTIVE: To analyze how organizational structures and scope (geographic and programmatic) generate dissonance between the organization and its workers, creating a paradox with policy implications for access to health care in hard-to-reach populations. The workers are lay community health workers called promotor(a)s. The organizations are community based organizations in which the promotor(a)s work, either as volunteers, part-time or as full-time wage staff. METHOD: Ethnographic study of 12 organizations and their promotor(a)s. Data gathering included interviews with organization directors, promotor(a)s, service providers working with the organizations, and community residents served by the organizations and workers. In addition, promotor(a)s were observed in the course of their work. Sampling was a non-probability, snowball procedure for identifying the organizations and the workers within them. RESULTS: A paradox is emerging between (a) promotor(a)s who perceive their work to be locally focused and tightly integrated with the communities they serve and live in, and (b) the employing organizations that are expanding in geographical and programmatic scope because the work promotor(a)s do is in increasing demand by agencies and funding sources external to the communities served. The paradox potentially threatens to undermine and transform the work and working environment of the promotor(a)s. The challenge is to find a balance that will sustain a workable and working relationship among the organization, the workers, and the communities served. CONCLUSION: Care is needed in setting out policies that translate the paradox into greater congruence among organization, workers and communities. Policy needs discussed focus on (a) worker training, (b) worker employment and deployment, and (c) funding source recognition of the paradox.

Anthropology, Cultural↗