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The aim of the present study was to investigate reactions in trapezius muscle blood flow (MBF), muscle activity, heart rate variability (HRV) and systemic blood pressure (BP) to autonomic tests in subjects with chronic neck-shoulder pain and healthy controls. Changes in muscle activity and blood flow due to stress and unfavourable muscle loads are known underlying factors of work-related muscle pain. Aberration of the autonomic nervous system (ANS) is considered a possible mechanism. In the present study, participants (n = 23 Pain, n = 22 Control) performed autonomic tests which included a resting condition, static hand grip test (HGT) at 30% of maximal voluntary contraction, a cold pressor test (CPT) and a deep breathing test (DBT). HRV was analysed in time and frequency domains. MBF and muscle activity were recorded from the upper trapezius muscles using photoplethysmography and electromyography (EMG). The pain group showed reduced low frequency-HRV (LF) and SDNN during rest, as well as a blunted BP response and increased LF-HRV during HGT (a dagger systolic 22 mm Hg; a dagger LF(nu) 27%) compared with controls (a dagger systolic 27; a dagger LF(nu) 6%). Locally, the pain group had attenuated trapezius MBF in response to HGT (Pain 122% Control 140%) with elevated trapezius EMG following HGT and during CPT. In conclusion, only HGT showed differences between groups in systemic BP and HRV and alterations in local trapezius MBF and EMG in the pain group. Findings support the hypothesis of ANS involvement at systemic and local levels in chronic neck-shoulder pain.

Several studies show increases in activity for certain frequency bands (10-14 Hz) and visually scored parameters during sleep after exposure to radiofrequency electromagnetic fields. A shortened REM latency has also been reported. We investigated the effects of a double-blind radiofrequency exposure (884 MHz, GSM signaling standard including non-DTX and DTX mode, time-averaged 10 g psSAR of 1.4 W/kg) on self-evaluated sleepiness and objective EEG measures during sleep. Forty-eight subjects (mean age 28 years) underwent 3 h of controlled exposure (7:30-10:30 PM; active or sham) prior to sleep, followed by a full-night polysomnographic recording in a sleep laboratory. The results demonstrated that following exposure, time in Stages 3 and 4 sleep (SWS, slow-wave sleep) decreased by 9.5 min (12%) out of a total of 78.6 min, and time in Stage 2 sleep increased by 8.3 min (4%) out of a total of 196.3 min compared to sham. The latency to Stage 3 sleep was also prolonged by 4.8 min after exposure. Power density analysis indicated an enhanced activation in the frequency ranges 0.5-1.5 and 5.75-10.5 Hz during the first 30 min of Stage 2 sleep, with 7.5-11.75 Hz being elevated within the first hour of Stage 2 sleep, and bands 4.75-8.25 Hz elevated during the second hour of Stage 2 sleep. No pronounced power changes were observed in SWS or for the third hour of scored Stage 2 sleep. No differences were found between controls and subjects with prior complaints of mobile phone-related symptoms. The results confirm previous findings that RF exposure increased the EEG alpha range in the sleep EEG, and indicated moderate impairment of SWS. Furthermore, reported differences in sensitivity to mobile phone use were not reflected in sleep parameters.

Objective To investigate whether patient involvement during hospitalization for acute myocardial infarction (MI) was associated with health and behavioural outcomes 6–10 weeks after hospital discharge. Background Patient involvement has been associated with improved health outcomes in chronic disease, but less research has focused on the effects of patient involvement in acute conditions, such as MI. Design Self-administered questionnaire study. Questionnaire results were run against medical outcome data in a national database of cardiac patients. Setting and participants Cardiac patients (n = 591) on their first follow-up visit after hospitalization for MI at 11 Swedish hospitals. Main outcome measures Patient ratings of three questionnaire scales related to involvement; cardiovascular symptoms, medication compliance, participation in cardiac rehabilitation, and achievement of secondary preventive goals. Results More positive patient ratings of involvement were significantly associated with fewer cardiovascular symptoms 6–10 weeks after hospital discharge. In contrast, patients who attended cardiac rehabilitation and achieved the goals for smoking cessation and systolic blood pressure were significantly less satisfied with their involvement. No association was found between involvement ratings and medication compliance. Conclusion This study represents a first attempt to examine associations between patient involvement in the acute phase of illness and short-term health outcomes. Some significant associations between involvement and health and behavioural outcomes after acute MI were found. However, higher involvement ratings were not consistently associated with more desirable outcomes, and involvement during hospitalization was not associated with MI patient health and behaviour 6–10 weeks after hospital discharge to the extent hypothesized.

Background: Patients' involvement in their healthcare has been associated with better health outcomes. However, few studies have examined whether patient involvement affects the work of healthcare professionals. A better understanding of professionals' views and behaviour is necessary for improving clinical practice and optimizing patient involvement. Aim: To measure perceptions and behaviour regarding patient involvement among physicians and nursing staff caring for patients with acute myocardial infarction. Methods: A questionnaire study conducted in 2005 among cardiology staff at twelve Swedish hospitals. The questionnaire included six scales measuring staff views and behaviour. Results: Physicians, registered nurses, and practical nurses did not differ significantly in their views of patient involvement, but did differ significantly in behaviour (p<.001). All three groups felt that an actively involved patient enriched their work, at the same time increasing their work load and taking time from other tasks. Physicians discussed daily activities and lifestyle changes with myocardial infarction patients before hospital discharge to a greater extent than nursing staff (p<.001). Conclusion: Physicians and registered nurses viewed time constraints as a hinder for patient involvement, while practical nurses felt unsure in communicating with patients. Considering these organizational and professional issues may improve patient involvement and health outcomes in myocardial infarction care. (C) 2007 European Society of Cardiology. Published by Elsevier B.V All rights reserved., Conference Information: International Conference of the European-Association-for-Communication-in-Healthcare (EACH) Basel, SWITZERLAND, SEP 05-08, 2006

BACKGROUND Patients' involvement in their healthcare has been associated with improved treatment outcomes in chronic illness. Less is known about the affects of patient involvement on the outcomes of acute illness, such as myocardial infarction. A better understanding of patients' views and behaviour during hospitalization might improve clinical practice and enhance patient involvement. AIM The aim of this study was to develop and evaluate a questionnaire for measuring patients' perceptions of their involvement during hospitalization for myocardial infarction care. METHODS Focus groups with myocardial infarction patients provided the basis for the construction of the questionnaire. Questionnaire validity and reliability were evaluated in a small pilot study and a larger cross-sectional study among myocardial infarction patients at eleven Swedish hospitals. RESULTS The questionnaire demonstrated good validity and reliability, with six factors measuring patient views and behaviour regarding involvement. CONCLUSION The questionnaire appears to be a useful tool for evaluating the perceptions and behaviour of patients regarding patient involvement in myocardial infarction care. Use of this questionnaire may provide insight regarding areas of patient-staff interaction that need improvement. Pinpointing such areas may lead to improved patient involvement, satisfaction with care, and treatment outcomes., Conference Information: 24th International Conference of the International-Society-for-Quality-in-Health-CareBoston, MA, SEP 30-OCT 03, 2007

Findings front prior studies of possible health and physiological effects from mobile phone use have been inconsistent. Exposure periods in Provocation studies have been rather short and personal characteristics of the participants poorly defined. We studied the effect of radiofrequency field (RF) on self-reported symptoms and detection of fields after a prolonged exposure time and with a well defined study group including Subjects reporting symptoms attributed to mobile phone use. The design was a double blind, cross-over provocation study testing a 3-h long GSM handset exposure versus sham. The study group was 7 1 subjects age 18-45, including 38 subjects reporting headache or vertigo in relation to mobile phone use (symptom group) and 33 non-symptomatic Subjects. Symptoms were scored on a 7-point Likert scale before, after 11/2 and 23/4 It of exposure. Subjects reported their belief of actual exposure status. The results showed that headache was more commonly reported after RE exposure than sham, mainly due to an increase in the non-symptom group. Neither group could detect RF exposure better than by chance. A belief that the RF exposure had been active was associated with skin symptoms. The higher prevalence of headache in the non-symptom group towards the end of RE exposure justifies further investigation of possible physiological correlates. The current study indicates a need to better characterize study participants in mobile phone exposure Studies and differences between symptom and non-symptom groups.

Physiological and psychological mechanisms have been proposed to link stress and musculoskeletal pain (MSP), and a number of stress biomarkers in patients with chronic pain have shown to be associated with stress-related disorders as well as health and recovery. The aim was to study if similar results might be found in a working population, in stress and computer intensive occupations with mild/moderate pain in neck, shoulder and back. The questions were if there are: (1) associations between self rated neck, shoulder and back pain (VAS) on one hand and stress-related (catabolic), recovery related (anabolic) variables, cardiovascular/lifestyle factors and immune markers on the other hand. (2) associations between long term changes in pain and stress marker values (6 month period). (3) predictive values in stress biomarkers for pain (12 month period) A study group with 121 media workers, 67 males (average 45 years) and 53 females (average 43 years), at three news departments of a media company was recruited. Pain occurrence and pain level in neck, shoulder, upper and low back were self-rated at three times with a 6-month interval towards the last month. Stress biomarker sampling was performed, at the same intervals. An additional similar questionnaire with momentary ratings focusing on "at present" i.e. within the same hour as stress biomarker sampling was performed. There were no changes in medicine intake or computer working hours during the 12 month study period. The total pain level and prevalence of pain decreased between baseline and 12 months follow-up. The rate of participation was 95%. Cross-sectional analyses on differences in stress biomarkers in groups of "no pain" and "pain" showed less beneficial stress biomarker levels (P < 0.05) in the "pain" group after age and gender adjustments in: S-DHEA-S and P-endothelin, S-insulin and P-fibrinogen. Analyses of each gender separately, adjusted for age, revealed in males differences in S-insulin, saliva cortis

The shortage of registered nurses in the healthcare sector is a problem in most countries. Swedish nurses tend to leave or seek new positions. However, few Swedish studies have addressed questions regarding what factors are of importance for nurses to perceive work satisfaction although satisfied nurses are linked to many positive organizational outcomes, e.g. improved quality of patient care. The aim of this study was to investigate what factors are of importance for nurses at a university hospital to perceive work satisfaction. Eight hundred and thirty-three nurses responded to the mailed Quality Work Competence questionnaire and the Huddinge University Hospital Model Questionnaire. Regression analyses identifies five factors linked to the head nurses leadership contributing to the nurses' feelings of work satisfaction: 'professional competence is made good use of', 'feeling of satisfaction with immediate superior regarding support for nursing research and development', 'opportunities for developing one's own competence for the current job', 'career opportunities in one's own profession' and 'yearly dialogue for performance appraisal with immediate superior'. The nurses also reported work-related exhaustion. Few saw opportunities for making a career as a nurse. In conclusion, the study identified specific amenable factors linked to the head nurses leadership that are of importance in creating attractive workplaces for nurses.

Aim: To identify predictors of nurses' self-reported barriers to using research findings in clinical practice. Background Several studies have shown that nurses perceive barriers to research utilization but to our knowledge predictors of nurses perceptions of barriers to research utilization have not been identified before. Methods Three questionnaires were answered by 833 nurses: the Barriers Scale, the Quality Work Competence questionnaire and a questionnaire including questions on professional issues. Results Dissatisfaction with support from immediate superiors for participating in research and/or development projects, having no academic degree and unclear and unrealistic workplace goals were identified as factors increasing the risk of perceiving barriers to the use of research findings in clinical practice. Conclusions The results imply that head nurses, nursing managers and other health care leaders should create strategies for supporting nurses' professional development and possibilities to implement research findings in clinical practice. Implications for nursing management To support research utilization and evidence-based care health care leaders, head nurses and nurse managers should create clear and realistic goals for the work place including demands on evidence-based care. It is also important for head nurses and nurse managers to create strategies for supporting nurses' professional development and possibilities to implement research findings in clinical practice.

Increased work complexity and financial strain in the health care sector have led to higher demands on staff to handle ethical issues. These demands can elicit stress reactions, that is, moral distress. One way to support professionals in handling ethical dilemmas is education and training in ethics. This article reports on a controlled prospective study evaluating a structured education and training program in ethics concerning its effects on moral distress. The results show that the participants were positive about the training program. Moral distress did not change significantly. This could be interpreted as competence development, with no effects on moral distress. Alternatively, the result could be attributed to shortcomings of the training program, or that it was too short, or it could be due to the evaluation instrument used. Organizational factors such as management involvement are also crucial. There is a need to design and evaluate ethics competence programs concerning their efficacy.

OBJECTIVE: The aim of this study was to examine the prevalence of subjective health complaints (SHCs) among satisfied and dissatisfied workers. The second aim was to evaluate whether any SHC differences were attributable directly to the work environment or mediated by the individual perception of the environment (satisfactory or not). METHOD: In a cross-sectional study of 458 employees (56% women) in 5 different organizations, work environment, job satisfaction, and SHC were measured. RESULTS: Satisfied workers reported an average of five to six subjective health complaints that correspond to the prevalence found in a Norwegian general population. Work environment explained 43% of the variance for job satisfaction and 9% of the variance in SHCs. CONCLUSION: SHCs are common among satisfied workers. Work environment has only a limited influence on this validated health indicator.

OBJECTIVES: To assess "at-home" preparedness and barriers to preparedness in a cohort of public health employees. METHOD: Conducted a cross-sectional survey involving 100 employees attending emergency preparedness training that emphasized incident command training and included a segment on "at-home" preparedness. RESULTS: Fifteen percent of participants were rated as "better prepared," and only 8% of participants would be considered "most prepared." There was no relationship between the concern for bioterrorism and other disasters and preparedness. The principal barrier involved challenges in getting the task done versus lack of desire or knowledge. CONCLUSIONS: There is great potential for distraction of public health workers during an emergent event if they are not prepared at home and have concern for family members. At-home preparedness training efforts that emphasize what should be done and why are likely to have limited impact on changing behavior. Strategies that ensure that small steps are taken are likely to be more successful.

BACKGROUND Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. OBJECTIVE To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. DESIGN AND PARTICIPANTS From 2000 to 2005, 22–32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. MEASUREMENTS Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. RESULTS Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. CONCLUSIONS A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk.

Background: Only a few studies of psychosocial determinants of employee health and organizational development have been prospective, involving more than one organization and applying standardized assessment tools. This limits the ability of providing evidence-based guidance as how to carry out healthy organizational transformations. Methods: A total of 6,000 employees responded twice to a validated psychosocial-leadership questionnaire within a 2-year period. The assessment focused on changes over time in the three outcome measures - mental health, efficacy, and leadership, determined to be important indicators of a healthy organization. Changes within and between organization were assessed statistically using regular t tests and general linear modeling. Results: There were major differences between organizations in psychosocial measures, both at the baseline and over time. At the organizational level, changes between study periods in management performance feedback, participatory management, and work tempo were the most consistent predictors of improvements over time in the three outcome measures. Conclusions: Performance feedback and participatory management might be two common predictors of healthy workplaces. Some of the psychosocial determinants of healthy organizations suggested in previous research might not be universally valid. It is suggested that future research should to a larger degree make use of multiple departments and organizations in studies of psychosocial determinants of healthy organizations.

A series of organizational changes during the last decades in health care organizations have resulted in an uncertain and turbulent working life with negative effects on health and job satisfaction. The aim of this longitudinal study was to assess affects on health and sickness absence among health care employees after organizational changes. The population consisted of 278 employees divided in a study group, structurally concerned of the changes and a control group. The response rate was 81% and 74% respectively at baseline and follow up measurements. Group differences were analyzed both for an open (n= 226) and closed cohort (n= 156) using one-way ANOVA as well as a two-way ANOVA for repeated measurement in a closed cohort. To explain predictors for changed health a stepwise linear regression analysis was used. The results in the open cohort showed that the study group experienced significantly worse self-rated health and worse work satisfaction after the reorganization compared with the control group. The study group had also increased their level of work related exhaustion. The results from the closed cohort showed that the recovery hormone DHEA-S had significantly decreased and sickness absence increased among employees in the study group compared to those in the control group. Factors that best predicted changed health after the reorganization were work related exhaustion, age and coping ability. Sickness absence had increased significant for the study group at the 1-year follow up (7% and 2% respectively)., Posterpresentation vid World Stress Conference in Budapest, aug. 2007

Objective: Stress is one of the leading reasons for sickness absence and especially the health care sector appears to be at risk and this study aimed to identify risk-factors of absence due to stress among health care employees in a cross-sectional study. Methods: 225 health care employees was categorized into two groups based on self-rated sickness absence or not. Questionnaire data and stress sensitive hormones measurements were used. Results: Strong significance between the groups was emphasized for work-related factors, social – and home situation. Stress-related sick leave was explained by unsatisfactory work conditions, social situation and less ability to recover. No statistically significant differences were identified regarding stress-sensitive hormones. Conclusions: Factors on different levels (social, work-site and individual) were found to be predictive for stress-related absence. Unexpected result, despite of the study’s cross-sectional nature, was the non-existing significance between stress hormones and stress-related absence., Föredrag vid 14 th European Congress of Work and Organizational Psychology.

Psychosocial stressors have been reported to be a risk factor for musculoskeletal symptoms (MSS) in modern offices. The exact mechanisms are not known but there are two theories. One concerns mentally induced muscle tension, and the other concerns impact on muscle fibers from stress hormones. To date, there have been only descriptive studies and short-term studies of the possible role of stress in the etiology of MSS symptoms. Furthermore, none have involved hormonal end-points and the use of a prospective and controlled design. The aims of this study were to (i) assess the possible impact on MSS (in neck and back/lower arm, respectively) from structured stress management programs, and (ii) determine the possible mediating role of stress hormones in linking stress and MSS symptoms. The subjects were telecommunications systems design engineers. Participants responded to a standardized questionnaire on MSS. Each subject also responded to a comprehensive questionnaire on psychosocial and physical work environments. Blood samples were collected as well, in order to measure possible changes in the psychobiological markers. Half of the subjects participated in one of three stress management programs (n=66), while the other half functioned as a reference group (n=50). Stress management significantly reduced lower-arm symptoms during the active training period of the study. There was an interaction between higher testosterone levels and stress management on the one hand and lower-arm symptoms on the other. No remaining effects on lower-arm symptoms were seen at the 5-month follow-up after the formal training was terminated. Results suggest that stress management might be beneficial for certain types of MSS in the short term, with active coaching from a group leader. There is support for theories suggesting that stress-sensitive hormones have a role in linking stress to MSS.

BACKGROUND: It has become increasingly clear that workplace contextual factors make an important contribution to provider and patient outcomes. The potential for health care professionals of using research in practice is also linked to such factors, although the exact factors or mechanisms for enhancing this potential are not understood. From a perspective of implementing evidence-based nursing practice, the authors of this article report on a study examining contextual factors. AIM: The objective of this study was to identify predictors of organizational improvement by measuring staff perceptions of work contextual factors. METHOD: The Quality Work Competence questionnaire was used in a repeated measurement survey with a 1-year break between the two periods of data collection. The sample consisted of 134 employees from four neonatal units in Sweden. FINDINGS: Over the study period significant changes occurred among staff perceptions, both within and between units, on various factors. Changes in staff perceptions on skills development and participatory management were the major predictors of enhanced potential of overall organizational improvement. Perceived improvement in skills development and performance feedback predicted improvement in leadership. Change in commitment was predicted by perceived decreases in work tempo and work-related exhaustion. CONCLUSIONS AND IMPLICATIONS: These findings indicate the potential for organizational improvement by developing a learning and supportive professional environment as well as by involving staff in decision-making at the unit level. Such initiatives are also likely to be of importance for enhanced use of research in practice and evidence-based nursing. On the other hand, high levels of work tempo and burnout appear to have negative consequences on staff commitment for improving care and the work environment. A better understanding of workplace contextual factors is necessary for improving the organizational potential of

Stress is one of the major reasons for sickness absence and especially the health care sector appears to be at risk. This cross sectional study aimed to identify risk factors of absence due to self-reported stress among health care employees. 225 health care employees were categorized into two groups based on self-rated sickness absence for stress or not. Questionnaire data and stress sensitive hormones measurements were used. Results: Employees with stress related sick leave experienced their health, work satisfaction as well as their social- and home situation worse than employees without stress- related sick leave. No statistically significant differences were identified regarding stress-sensitive hormones. The risk for employees not satisfied at work to become absent due to stress compared to those with a sufficient work situation appears to be nearly three times higher, 2.8 (95% CI 1.3 to 5.9). For those not satisfied with their social situation, the risk for being sickness absent appears to be somewhat higher, 3.2 (CI 1.2 to 8.6). Individual factors as recovery potential and meaning of life and work related factors as skill development and work tempo predicted employee’ s work satisfaction. Conclusion: Based on cross sectional data, work-site and individual factors as well as social situation appear to increase the risk for absence due to stress among health care employees. Lower recovery potential, higher work tempo and a worse leadership appeared to be related to the high degree of work related exhaustion among the employees., Posterpresentation vid årlig EUPHA- konferens i Montreux, 2006

Background: Stress is one of the major reasons for sickness absence and especially the health care sector appears to be at risk. This cross sectional study aimed to identify risk factors of absence due to self-reported stress among health care employees. Methods: 225 health care employees were categorized into two groups based on self-rated sickness absence for stress or not. Questionnaire data and stress sensitive hormones measurements were used. Results: Employees with stress related sick leave experienced their health, work satisfaction as well as their social- and home situation worse than employees without stress- related sick leave. No statistically significant differences were identified regarding stress-sensitive hormones. The risk for employees not satisfied at work to become absent due to stress compared to those with a sufficient work situation appears to be about three times higher (OR 2.8, 95% CI 1.3 - 5.9). For those not satisfied with their social situation, the risk for being sickness absent appear to be somewhat higher (OR 3.2; CI 1.2 - 8.6). Individual factors as recovery potential and meaning of life and work related factors as skill development and work tempo predicted employee’ s work satisfaction. Conclusion: Based on cross sectional data, work-site and individual factors as well as social situation appear to increase the risk for absence due to stress among health care employees. Lower recovery potential, higher work tempo and a worse leadership appeared to be related to the high degree of work related exhaustion among the employees.

Background Stress is a major cause of sickness absence and the health care sector appears to be especially at risk. This cross sectional study aimed to identify the risk factors for absence due to self-reported stress among health care employees. Methods: 225 health care employees were categorized into two groups based on presence or not of self-rated sickness absence for stress. Questionnaire data and stress sensitive hormones measurements were used. Results Employees with stress related sick leave experienced worse health, poorer work satisfaction as well as worse social and home situations than those employees without stress-related sick leave. No-significant differences were identified regarding stress-sensitive hormones. The risk for employees, not satisfied at work, of becoming absent due to stress was approximately three fold compared to those who reported being satisfied (OR 2.8, 95% confidence interval; (CI) 1.3 - 5.9). For those not satisfied with their social situation, the risk for sickness absence appeared to be somewhat higher (OR 3.2; CI 1.2 - 8.6). Individual factors such as recovery potential and meaning of life as well as work related factors such as skill development and work tempo predicted employee’ s work satisfaction. Conclusions Based on cross sectional data, work-site and individual factors as well as social situations appear to increase the risk for absence due to stress among health care employees. Lower recovery potential, higher work tempo and poor leadership appeared to be related to the high degree of work related exhaustion experienced by employees.