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      Entorno psicosocial y estrés en trabajadores sanitarios de la sanidad pública: diferencias entre atención primaria y hospitalaria Translated title: Psychosocial stress environment and health workers in public health: Differences between primary and hospital care

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          Resumen

          Objetivos

          Describir el entorno psicosocial de los profesionales sanitarios de la sanidad pública en atención primaria y hospitalaria, compararlo con el de la población asalariada española y valorar el efecto de los factores de riesgos psicosociales sobre síntomas relacionados con el estrés percibido.

          Diseño

          Estudio observacional transversal, con muestreo aleatorio estratificado.

          Emplazamiento

          Trabajadores de atención sanitaria de la provincia de Granada, distribuidos en 5 centros hospitalarios y 4 distritos sanitarios.

          Participantes

          Se invitó a 738 empleados (personal facultativo y de enfermería) del Servicio Andaluz de Salud (SAS).

          Mediciones principales

          Cuestionario CopSoQ/Istas21, desarrollado para el análisis del ambiente psicosocial en el trabajo de forma multidimensional. Los síntomas de estrés se midieron con el cuestionario Stress Profile.

          Resultados

          La tasa de respuesta fue del 67,5%. En comparación con la población laboral española, nuestra muestra mostró altos niveles de exigencias psicológicas cognitivas, emocionales y sensoriales, posibilidades de desarrollo personal y sentido de su trabajo. El personal facultativo de atención primaria es el que presenta un ambiente psicosocial más desfavorable, aunque todos los grupos mostraron niveles elevados de síntomas relacionados con el estrés percibido. El análisis multivariante mostró que las variables asociadas con el estrés percibido fueron menor edad y posibilidades de relación social, el conflicto de rol, y mayores exigencias psicológicas emocionales e inseguridad en el trabajo.

          Conclusiones

          Nuestros hallazgos muestran que el ambiente psicosocial de los trabajadores sanitarios difiere del de la población asalariada española, siendo más desfavorable en el colectivo de facultativos/as de atención primaria.

          Translated abstract

          Objective

          To describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress.

          Design

          Cross-sectional study with stratified random sampling.

          Setting

          Health care workers in the province of Granada, distributed in 5 hospitals and 4 health districts.

          Participants

          A total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part.

          Main measurements

          CopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire.

          Results

          The response rate was 67.5%. Compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work.

          Conclusions

          Our findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners.

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          Most cited references28

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          Psychosocial work environment and stress-related disorders, a systematic review.

          Knowledge on the impact of the psychosocial work environment on the occurrence of stress-related disorders (SRDs) can assist occupational physicians in the assessment of the work-relatedness of these disorders. To systematically review the contribution of work-related psychosocial risk factors to SRDs. A systematic review of the literature was carried out by searching Medline, PsycINFO and Embase for studies published up until October 2008. Studies eligible for inclusion were prospective cohort studies or patient-control studies of workers at risk for SRDs. Studies were included in the review when data on the association between exposure to psychosocial work factors and the occurrence of SRDs were presented. Where possible, meta-analysis was conducted to obtain summary odds ratios of the association. The strength of the evidence was assessed using four levels of evidence. From the 2426 studies identified, seven prospective studies were included in this review. Strong evidence was found that high job demands, low job control, low co-worker support, low supervisor support, low procedural justice, low relational justice and a high effort-reward imbalance predicted the incidence of SRDs. This systematic review points to the potential of preventing SRDs by improving the psychosocial work environment. However, more prospective studies are needed on the remaining factors, exposure assessment and the relative contributions of single factors, in order to enable consistent assessment of the work-relatedness of SRDs by occupational physicians.
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            Psychosocial work environment and mental health--a meta-analytic review.

            To clarify the associations between psychosocial work stressors and mental ill health, a meta-analysis of psychosocial work stressors and common mental disorders was undertaken using longitudinal studies identified through a systematic literature review. The review used a standardized search strategy and strict inclusion and quality criteria in seven databases in 1994-2005. Papers were identified from 24,939 citations covering social determinants of health, 50 relevant papers were identified, 38 fulfilled inclusion criteria, and 11 were suitable for a meta-analysis. The Comprehensive Meta-analysis Programme was used for decision authority, decision latitude, psychological demands, and work social support, components of the job-strain and iso-strain models, and the combination of effort and reward that makes up the effort-reward imbalance model and job insecurity. Cochran's Q statistic assessed the heterogeneity of the results, and the I2 statistic determined any inconsistency between studies. Job strain, low decision latitude, low social support, high psychological demands, effort-reward imbalance, and high job insecurity predicted common mental disorders despite the heterogeneity for psychological demands and social support among men. The strongest effects were found for job strain and effort-reward imbalance. This meta-analysis provides robust consistent evidence that (combinations of) high demands and low decision latitude and (combinations of) high efforts and low rewards are prospective risk factors for common mental disorders and suggests that the psychosocial work environment is important for mental health. The associations are not merely explained by response bias. The impact of work stressors on common mental disorders differs for women and men.
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              The Copenhagen Psychosocial Questionnaire--a tool for the assessment and improvement of the psychosocial work environment.

              The aim of this article is to present the Copenhagen Psychosocial Questionnaire (COPSOQ), a questionnaire developed in three different lengths for assessing psychosocial factors at work, stress, and the well-being of employees and some personality factors. The purpose of the COPSOQ concept is to improve and facilitate research, as well as practical interventions at workplaces. The development of the questionnaire was based on a survey of a representative sample of 1858 Danish employees aged 20-59 years. The response rate was 62%; 49% were women. Altogether 145 questions from some international and Danish questionnaires and 20 self-developed questions were tested with factor analyses, analyses of internal reliability, and analyses of response patterns. The analyses resulted in a long research version of the questionnaire with 141 questions and 30 dimensions, a medium-length version for work environment professionals with 95 questions and 26 dimensions, and a short version for workplaces with 44 questions and 8 dimensions. Most of the scales have good reliability, and there seems to be very little overlap between the scales. A novel feature of the COPSOQ is the development of five different scales on demands at work. The COPSOQ concept is a valid and reliable tool for workplace surveys, analytic research, interventions, and international comparisons. The questionnaire seems to be comprehensive and to include most of the relevant dimensions according to several important theories on psychosocial factors at work. The three versions facilitate communication between researchers, work environment professionals, and workplaces.
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                Author and article information

                Contributors
                Journal
                Aten Primaria
                Aten Primaria
                Atencion Primaria
                Elsevier
                0212-6567
                1578-1275
                23 October 2014
                Jun-Jul 2015
                23 October 2014
                : 47
                : 6
                : 359-366
                Affiliations
                [a ]Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, España
                [b ]Centro de Salud El Palo, Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Servicio Andaluz de Salud (SAS), Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
                [c ]Servicio de Medicina Preventiva, Hospital Virgen de la Victoria, Málaga, España
                Author notes
                Article
                S0212-6567(14)00287-X
                10.1016/j.aprim.2014.09.003
                6983690
                25443765
                c1848e7d-6ca1-4ccb-b48f-d60da173f2d2
                © 2014 Elsevier Espa˜na, S.L.U.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 29 May 2014
                : 4 September 2014
                Categories
                Originales

                estrés,salud laboral,atención primaria,stress,occupational health,primary health care

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