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The identification of modifiable factors that could maintain cognitive function is a public health priority. It is thought that some work-related psychosocial factors help developing cognitive reserve through high intellectual complexity. However, they also have well-known adverse health effects and are considered to be chronic psychosocial stressors. Indeed, these stressors could increase low-grade inflammation and promote oxidative stress associated with accelerated telomere shortening. Both low-grade inflammation and shorter telomeres have been associated with a cognitive decline. This study aimed to evaluate the total, direct, and indirect effects of work-related psychosocial factors on global cognitive function overall and by sex, through telomere length and an inflammatory index. A random sample of 2219 participants followed over 17 years was included in this study, with blood samples and data with cognitive function drawn from a longitudinal study of 9188 white-collar workers (51% female). Work-related psychosocial factors were evaluated according to the Demand–Control–Support and the Effort–Reward Imbalance (ERI) models. Global cognitive function was evaluated with the validated Montreal Cognitive Assessment (MoCA). Telomere length and inflammatory biomarkers were measured using standardised protocols. The direct and indirect effects were estimated using a novel mediation analysis method developed for multiple correlated mediators. Associations were observed between passive work or low job control, and shorter telomeres among females, and between low social support at work, ERI or iso-strain, and a higher inflammatory index among males. An association was observed with higher cognitive performance for longer telomeres, but not for the inflammatory index. Passive work overall, and low reward were associated with lower cognitive performance in males; whereas, high psychological demand in both males and females and high job strain in females were associated with a higher cognitive performance. However, none of these associations were mediated by telomere length or the inflammatory index. This study suggests that some work-related psychosocial factors could be associated with shorter telomeres and low-grade inflammation, but these associations do not explain the relationship between work-related psychosocial factors and global cognitive function. A better understanding of the biological pathways, by which these factors affect cognitive function, could guide future preventive strategies to maintain cognitive function and promote healthy aging.

ObjectivesPsychosocial stressors at work have been proposed as modifiable risk factors for mild cognitive impairment (MCI). This study aimed to evaluate the effect of cumulative exposure to psychosocial stressors at work on cognitive function.MethodsThis study was conducted among 9188 white-collar workers recruited in 1991–1993 (T1), with follow-ups 8 (T2) and 24 years later (T3). After excluding death, losses to follow-up and retirees at T2, 5728 participants were included. Psychosocial stressors at work were measured according to the Karasek’s questionnaire. Global cognitive function was measured with the Montreal Cognitive Assessment. Cumulative exposures to low psychological demand, low job control, passive job and high strain job were evaluated using marginal structural models including multiple imputation and inverse probability of censoring weighting.ResultsIn men, cumulative exposures (T1 and T2) to low psychological demand, low job control or passive job were associated with higher prevalences of more severe presentation of MCI (MSMCI) at T3 (Prevalence ratios (PRs) and 95% CIs of 1.50 (1.16 to 1.94); 1.38 (1.07 to 1.79) and 1.55 (1.20 to 2.00), respectively), but not with milder presentation of MCI. In women, only exposure to low psychological demand or passive job at T2 was associated with higher prevalences of MSMCI at T3 (PRs and 95% CI of 1.39 (0.97 to 1.99) and 1.29 (0.94 to 1.76), respectively).ConclusionsThese results support the deleterious effect of a low stimulating job on cognitive function and the cognitive reserve theory. Psychosocial stressors at work could be part of the effort for the primary prevention of cognitive decline.

ObjectivesTo assess the effectiveness of a workplace intervention reducing psychosocial stressors at work in lowering blood pressure and hypertension prevalence.MethodsThe study design was a quasi-experimental pre–post study with an intervention group and a control group. Post-intervention measurements were collected 6 and 36 months after the midpoint of the intervention. Participants were all white-collar workers employed in three public organisations. At baseline, the intervention and the control groups were composed of 1088 and 1068 workers, respectively. The intervention was designed to reduce psychosocial stressors at work by implementing organisational changes. Adjusted changes in ambulatory blood pressure and hypertension prevalence were examined.ResultsBlood pressure and hypertension significantly decreased in the intervention group while no change was observed in the control group. The differential decrease in systolic blood pressure between the intervention and the control group was 2.0 mm Hg (95% CI: −3.0 to –1.0). The prevalence of hypertension decreased in the intervention group, when compared with the control group (prevalence ratio: 0.85 (95% CI: 0.74 to 0.98)).ConclusionsFindings suggest that psychosocial stressors at work are relevant targets for the primary prevention of hypertension. At the population level, systolic blood pressure reductions such as those observed in the present study could prevent a significant number of premature deaths and disabling strokes.

Population-based strategies targeting modifiable risk factors are needed to improve the prevention of hypertension. Long working hours have been linked to high blood pressure (BP), but more longitudinal research is required. The objective of this study was to examine the effect of long working hours (≥41 h/week) on ambulatory BP mean over a 2.5-year follow-up. The effect modification of family responsibilities was also investigated. A repeated longitudinal design was used. Data collection was performed at three-time points over a 2.5-year follow-up among over 2000 white-collar workers. Working hours were self-reported assessed by questionnaire. BP was measured using Spacelabs 90207. The outcomes were systolic and diastolic BP mean. Cross-lagged GEE linear regressions were used to examine whether working hours were associated with BP means at the next measurement time. Women working long hours had a higher diastolic BP mean at follow-up compared to women working regular hours (+1.8 mm Hg (95% CI: 0.5-3.1)). In men, those working long hours had both higher systolic and diastolic BP means increases (systolic: +2.5 mm Hg (95% CI: 0.5-4.4)) and diastolic: +2.3 mm Hg (95% CI: 1.0-3.7)). This association was greater among workers having high family responsibilities. This longitudinal study showed that women and men working long hours had higher BP means when compared those working 35-40 h per week. These findings suggest that strategies that promote work weeks not exceeding 40 h might contribute to the primary prevention of hypertension, especially for workers with high family responsibilities.

ObjectivesThis study assesses the validity of a self-reported mental health problem (MHP) diagnosis as the reason for a work absence of 5 days or more compared with a physician-certified MHP diagnosis related to the same work absence. The potential modifying effect of absence duration on validity is also examined.MethodsA total of 709 participants (1031 sickness absence episodes) were selected and interviewed. Total per cent agreement, Cohen’s kappa, sensitivity and specificity values were calculated using the physician-certified MHP diagnosis related to a given work absence as the reference standard. Stratified analyses of total agreement, sensitivity and specificity values were also examined by duration of work absence (5–20 workdays,>20 workdays).ResultsTotal agreement value for self-reported MHP was 90%. Cohen’s kappa value was substantial (0.74). Sensitivity was 77% and specificity was 95%. Absences of more than 20 workdays had a better sensitivity than absences of shorter duration. A high specificity was observed for both short and longer absence episodes.ConclusionThis study showed high specificity and good sensitivity of self-reported MHP diagnosis compared with physician-certified MHP diagnosis for the same work absence. Absences of longer durations had a better sensitivity.

ObjectivesWomen have a higher incidence of mental health problems compared with men. Psychosocial stressors at work are associated with mental health problems. However, few prospective studies have examined the association between these stressors and objectively measured outcomes of mental health. Moreover, evidence regarding potential differences between women and men in this association is scarce and inconsistent. This study investigates whether psychosocial stressors at work are associated with the 7.5-year incidence of medically certified work absence due to a mental health problem, separately for women and men.MethodsData from a prospective cohort of white-collar workers in Canada (n=7138; 47.3% women) were used. We performed Cox regression models to examine the prospective association between self-reported psychosocial stressors at work (job strain model) at baseline and the 7.5-year HR of medically certified work absence of ≥5 days due to a mental health problem.ResultsDuring follow-up, 11.9% of participants had a certified work absence, with a twofold higher incidence among women. Women (HR 1.40, 95% CI 1.01 to 1.93) and men (HR 1.41, 95% CI 0.97 to 2.05) exposed to high strain (high demands and low control) had a higher incidence of work absence compared with those unexposed. Among women only, those exposed to an active job situation (high demands and high control) also had a higher risk (HR 1.82, 95% CI 1.29 to 2.56).ConclusionsPrevention efforts aimed at reducing psychosocial stressors at work could help lower the risk of work absence for both women and men. However, important differences between women and men need to be further studied in order to orient these efforts.

Previous studies on the effect of long working hours on blood pressure have shown inconsistent results. Mixed findings could be attributable to limitations related to blood pressure measurement and the lack of consideration of masked hypertension. The objective was to determine whether individuals who work long hours have a higher prevalence of masked and sustained hypertension. Data were collected at 3-time points over 5 years from 3547 white-collar workers. Long working hours were self-reported, and blood pressure was measured using Spacelabs 90207. Workplace clinic blood pressure was defined as the mean of the first 3readings taken at rest at the workplace. Ambulatory blood pressure was defined as the mean of the next readings recorded every 15 minutes during daytime working hours. Masked hypertension was defined as clinic blood pressure < 140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg. Sustained hypertension was defined as clinic blood pressure ≥140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg or being treated hypertension. Long working hours were associated with the prevalence of masked hypertension (prevalence ratio 49+ =1.70 [95% CI, 1.09–2.64]), after adjustment for sociodemographics, lifestyle-related risk factors, diabetes mellitus, family history of cardiovascular disease, and job strain. The association with sustained hypertension was of a comparable magnitude (prevalence ratio 49+ =1.66 [95% CI, 1.15–2.50]). Results suggest that long working hours are an independent risk factor for masked and sustained hypertension. Workplace strategies targeting long working hours could be effective in reducing the clinical and public health burden of hypertension.

ObjectiveWe aimed to measure the prevalence of psychological distress among Quebec healthcare workers (HCWs) during the second and third pandemic waves and to assess the effect of psychosocial risk factors (PSRs) on work-related psychological distress among SARS-CoV-2 infected (cases) and non-infected (controls) HCWs.MethodsA self-administered survey was used to measure validated indicators of psychological distress (K6 scale) and PSR (questions based on Karasek and Siegrist models, value conflicts and work-life balance). Adjusted robust Poisson models were used to estimate prevalence ratios.Results4068 cases and 4152 controls completed the survey. Prevalence of high work-related psychological distress was 42%; it was associated with PSRs (mainly work-life balance, value conflicts and high psychological demands) but not with SARS-CoV-2 infection.ConclusionPrimary prevention measures targeting PSRs are needed to reduce mental health risks of HCWs.

Background Psychological distress is a strong and independent predictor of major depression. Assuming multiple roles (such as being both a mother and an employee) under stressful conditions may lead to psychological distress. This study evaluated, for the first time, the longitudinal effect of the simultaneous exposure to psychosocial work stressors and high family responsibilities on women's psychological distress. Methods Women were assessed at baseline (N = 1307) and at 3- and 5-year follow-ups. Psychosocial work stressors of the demand-control and effort-reward imbalance models were measured with validated questionnaires. Family responsibilities were also self-reported and referred to the number of children and their age(s) as well as housework and childcare. Psychological distress was measured with the validated Psychiatric Symptoms Index questionnaire. Prevalence ratios (PR) of psychological distress were modeled with log-binomial regressions. Results Having high family responsibilities did not increase women's prevalence of psychological distress. However, being exposed to either job strain or effort-reward imbalance led to a higher prevalence of psychological distress at the 3- and 5-year follow-ups (PR of 1.25-1.62). Being simultaneous exposed to these psychosocial work stressors and high family responsibilities also increased the prevalence of psychological distress (PR of 1.44-1.87), but no interactions were observed between stressors and responsibilities. Conclusions In this 5-year prospective study, simultaneous exposure to psychosocial work stressors and high family responsibilities increased the prevalence of psychological distress among women. Work stressors were, however, driving most of the effect, which reinforces their importance as modifiable risk factors of women's mental health problems.

It is unclear how to effectively protect healthcare workers’ mental health during infectious disease epidemics. Targeting the occupational determinants of stress may hold more promise than individual stress management, which has received more focus. Through a systematic review of the 2000–2021 English- and French-language scientific literature, we evaluated the effectiveness of organizational and psychosocial work environment interventions to protect healthcare workers’ mental health in an epidemic/pandemic context. Evidence from medium- and high-quality studies was synthesized using GRADE. Among 1604 unique search results, 41 studies were deemed relevant, yielding 34 low-quality and seven medium-quality studies. The latter reported on promising multi-component prevention programs that combined staffing adjustments, work shift arrangements, enhanced infection prevention and control, recognition of workers’ efforts, psychological and/or logistic support during lockdowns (e.g., accommodation). Our confidence in the effectiveness of reviewed interventions is low to very low, however, owing to methodological limitations. We highlight gaps in the reporting of intervention process and context elements and discuss theory and implementation failure as possible explanations for results. We conclude by urging authors of future studies to include and document detailed risk assessments of the work environment, involve workers in solution design and implementation and consider how this process can be adapted during an emergency.

Background Chronic low-grade inflammation has been associated with high risk of several chronic diseases such as cardiovascular diseases, diabetes, depression, and dementia. As low-grade inflammation could be present long before the apparition of the disease, identifying modifiable risk factors could allow to act upstream. Psychosocial stressors at work have been suggested as modifiable risk factors of low-grade inflammation, but few longitudinal studies have evaluated the association between these stressors and inflammatory biomarkers, such as C-reactive protein (CRP) and interleukin-6 (IL-6). Objective This longitudinal study evaluate the associations between exposure to psychosocial stressors at work and CRP and IL-6, separately and combined into an inflammatory index. Methods Data came from a cohort of 9188 white-collar workers recruited in 1991–1993 (T1) and followed-up after 8 (T2, 1999–2000) and 24 (T3, 2015–2018) years. Participants included in this study were randomly selected at T3 for serum biomarkers studies (n = 2557). CRP and IL-6 were measured using standardized protocols. Psychosocial stressors at work were assessed at T2 according to recognized models: Karasek’s Demand-Control-Support model and Siegrist’s Effort-Reward Imbalance (ERI) model, using validated questionnaires. High job strain was defined by an exposure to high psychological demand combined with low job control, and iso-strain was defined by an exposure to high job strain combined with low social support at work. ERI was defined by an imbalance between psychological demand and social, economic, and organizational reward. Several covariates were considered including sociodemographic, anthropometric, and lifestyle characteristics, and comorbidities. Prevalence ratios (PRs) and 95% confidence interval (CI) for the highest quartile of CRP, IL-6 and inflammatory index at T3 according to psychosocial stressors at work measured at T2 were calculated using generalized estimating equations. Multiple imputation and inverse probability of censoring weighting were done. Results In men, an association was observed between exposure to iso-strain and the inflammatory index (PR of 1.42 (95% CI: 1.06;1.90)), mainly among men aged less than 65 years (PR of 2.00 (95% CI: 1.37;2.92)). In this same age group, associations with inflammatory biomarkers were also observed among men with exposure to ERI, and among women with exposure to low reward at work or moderate social support at work. Conclusion These results suggest that psychosocial stressors at work may increase low-grade inflammation. However, further studies are needed to corroborate these results and to clarify the potential differences between men and women. As these stressors are frequent and modifiable, their reduction is important for public health and could play a role in the primary prevention of chronic diseases.

Les entrepreneurs sont partout, y compris dans les plus petites communautes, souvent loin des grands centres et des universites. La formation a distance peut rendre accessible le soutien aux entrepreneurs du monde entier, notamment ceux des pays emergents.

Background Work-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to analyze the cost-benefit results of organizational-level ergonomic workplace-based interventions aimed at preventing WMSD, (2) to explore factors related to the implementation process of these interventions (obstacles and facilitating factors) in order to identify whether economic results may be due to a successful or unsuccessful implementation. Methods Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design. Results Out of 189 records, nine studies met selection criteria and were included in our review. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions given the quality and the limited number of studies identified. Our review shows that among the nine included studies, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors in training sessions or a lack of financial resources and when adequacy of intervention to workers’ needs was low. In studies where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation. Conclusion Studies investigating the determinants of financial outcomes of prevention related to implementation process are very seldom. We recommend that in future research economic evaluation should include information on the implementation process in order to permit the interpretation of economic results and enhance the generalizability of results. This is also necessary for knowledge transfer and utilization of research results for prevention-oriented decision-making in occupational health and safety. Electronic supplementary material The online version of this article (10.1186/s12889-017-4935-y) contains supplementary material, which is available to authorized users.

The literature shows substantial differences in occupational exposures between men and women, both between and within occupations, but remains very sparse on whether interventions are tailored to gender differences in the workplace. Our objective was to determine whether gender differences are taken into account when designing prevention interventions. This study is part of a project on the evaluation of interventions implemented in the framework of the “Healthy Enterprise” standard in Quebec organizations. Three sets of quantitative and qualitative data were collected in seven organizations and triangulated. Our results show that in the process of elaborating and implementing activities, the main objectives were to reach a maximum number of workers and meet the needs identified in a health and risk diagnosis. Activities were not tailored to the needs of specific subgroups of employees, such as gender or age. Not distinguishing men’s and women’s situations in this diagnosis may play a role in intervention design. Résumé La littérature montre des différences d'exposition au travail importantes entre les hommes et les femmes, y compris à catégories d'emploi identiques. Les études sur l'adaptation des interventions de prévention aux différences de genre dans les milieux de travail sont quasiment inexistantes dans la littérature. Notre objectif était de déterminer dans quelle mesure les différences de genre sont prises en compte lors de la conception des interventions de prévention. Cette étude fait partie d'un projet d'évaluation des interventions mises en œuvre dans le cadre de la norme «Entreprises en santéé au Québec. Trois séries de données quantitatives et qualitatives ont été collectées auprès de sept organisations et analysées par triangulation. Nos résultats montrent que lors du processus d'élaboration des activités, les principaux objectifs étaient d'atteindre un nombre maximal de travailleurs et de remplir les besoins identifiés dans le diagnostic des risques et de la santé des travailleurs. Le fait que la situation des hommes et des femmes n'ait pas été analysée séparément dans le diagnostic peut avoir joué un râle dans ce résultat. Les activités de prévention n'ont pas été conçues en tenant compte de sous-groupes de travailleurs en fonction du genre ou de l'âge.

OBJECTIVE Accumulating evidence shows that psychosocial work factors of the demand-control and effort-reward imbalance models may contribute to increase blood pressure (BP). Women are more likely to be exposed to these psychosocial factors than men. Moreover, women spend twice as much time per week performing family responsibilities than men. This study aimed to evaluate the longitudinal association of the double exposure to psychosocial work factors and high family responsibilities in women with BP for a 5-year follow-up. METHODS At baseline, the study sample was composed of 1215 working women. Psychosocial work factors were measured using validated scales. Family responsibilities were measured using items related to "the number of children and their age" and "housework and children care." Ambulatory BP measures were taken every 15 minutes during a working day. Associations between psychosocial measures and BP were examined using analyses of covariance. RESULTS Women with a double exposure to effort-reward imbalance and high family responsibilities had significantly higher BP means than women not exposed to these factors at baseline (diastolic: +2.75 mm Hg), at 3-year follow-up (systolic: +2.22 mm Hg and diastolic: +2.55 mm Hg), and at 5-year follow-up (systolic: +2.94 mm Hg and diastolic: + 3.10 mm Hg). No adverse effect on BP was observed for the double exposure to the psychosocial work factors of the demand-control model and high family responsibilities. CONCLUSIONS A double exposure to effort-reward imbalance at work and high family responsibilities might contribute to elevated ambulatory BP at work among women. BP elevations related to this double exposure may persist for several years.

To determine whether white-collar workers treated for hypertension who are exposed to psychosocial stressors at work have a higher prevalence of uncontrolled hypertension than unexposed workers, this study conducted three waves of data collection over a 5-year period (repeated cross-sectional design). The study sample was composed of 464 white-collar workers treated for hypertension. At each collection time, ambulatory blood pressure (ABP) was measured every 15 min during the workday. Uncontrolled hypertension was defined as a mean daytime systolic ABP ≥135 mmHg and/or diastolic ABP ≥85 mmHg for non-diabetic participants and systolic ABP ≥125 mmHg and/or diastolic ABP ≥75 mmHg for diabetic participants. Job strain was evaluated with Karasek's demand-latitude model using validated scales for psychological demands and decision latitude. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated using generalized estimating equations, adjusting for sociodemographic and lifestyle-related risk factors. Men with job strain (high demands and low latitude) and active jobs (high demands and high latitude) had a higher prevalence of uncontrolled hypertension (PR job strain = 1.46, 95% CI: 1.07-1.98 and PR active = 1.47, 95% CI: 1.12-1.94). When considered separately, high demands were associated with a higher prevalence of uncontrolled hypertension in both men (PR highest tertile = 1.60, 95% CI: 1.25-2.06) and women (PR highest tertile = 1.60, 95% CI: 1.03-2.47). Workers exposed to psychosocial stressors at work according to the demand-latitude model had a higher prevalence of uncontrolled hypertension. Reducing these frequent exposures could help to reduce the burden of uncontrolled hypertension.

A number of prospective studies have documented the effect of adverse psychosocial work factors (work stress) on high blood pressure (BP). Weight gain could be an important pathway by which work stress exerts its effect on BP. No previous prospective study has examined this mediating effect. The aim of the present study was to examine the mediating effect of body mass index (BMI) in the association between psychosocial work factors from Siegrist’s effort–reward imbalance model (ERI) and ambulatory BP (ABP). A prospective study was conducted among 1436 white-collar workers. Data were collected three times during a 5-year period. ERI was measured using validated scales, at each time. BMI was measured by a trained assistant. ABP was measured every 15 min during a working day. ERI exposure onset over 3 years was indirectly associated with ABP changes (0.49 mmHg; 95 % CI 0.05, 1.22), through BMI changes, in women with baseline BMI ≥25 kg/m2. An effect of similar magnitude and of borderline significance was observed for ERI chronic exposure. No mediating effect was observed among men, and using ERI exposure over 5 years. The mediating effect of BMI was of small magnitude and observed in certain subgroups and time frame only. Subgroup-specific mediating pathways might be involved to explain the effect of work stress on cardiovascular diseases risk.

Introduction A la suite de signaux d’alerte emanant des pediatres seniors (problemes de sante mentale, demissions, courrier denoncant un mal-etre), la direction a souhaite l’evaluation de leurs RPS par le service de sante au travail, puis la mise en place d’une serie d’actions preventives. Methodes Une grille d’identification developpee par une equipe canadienne a ete utilisee, qui offre des reperes pour la comprehension et la reduction des risques ayant un impact sur la sante ? Psychologique et physique. Son contenu porte sur des caracteristiques du milieu de travail et certains aspects lies aux pratiques de gestion et s’appuie sur des modeles theoriques. Les elements qualitatifs entendus lors des entretiens, ont servi de base pour le developpement par la Direction, d’un plan concret de prevention des RPS, au sein de ce CHU. L’ensemble de ce projet a ete accompagne par un comite de pilotage pluridisciplinaire (direction, medecin du travail, praticiens de terrain). Resultats Trente-quatre medecins et 3 directeurs, sans interactions hierarchiques entre eux, formant 18 groupes, ont pu s’exprimer librement. Le contexte de l‘organisation a ete juge particulierement defavorable pour les aspects de retour au travail a la suite d’un probleme de sante, et de conciliation travail et vie personnelle. En termes de pratiques de gestion, les signaux d’alerte pointaient la charge de travail, le manque de reconnaissance, les difficultes de communication. Les aspects protecteurs restaient le soutien des collegues, la latitude decisionnelle et de facon inegale, le soutien de la hierarchie. Le plan de prevention, dont les actions ont ete identifiees par les participants aux entretiens, appuye par la direction, repose sur 8 grands axes et une cinquantaine d’actions : – carriere ; – absenteisme ; – sante au travail, devoir d’alerte ; – organisation du travail (charge de travail, charge mentale) ; – qualite de vie au travail (reconnaissance) ; – management (projet de service, entretien annuel) ; – dialogue (transparence des orientations, dialogue de gestion) ; – gestion des situations de violence. Conclusion A la suite de cet audit, des pistes d’amelioration au niveau de la gestion des ressources humaines, de la communication, de la reconnaissance, de la charge de travail et de la sante au travail ont ete mises en place par la direction, les chefs de pole et de services, des acteurs de terrain. L’objectif obtenu a ete de mobiliser les acteurs de l’hopital, les faire se rencontrer et echanger autour de la question de la sante au travail et de la prevention des RPS en etablissant un dialogue constructif, afin de trouver des solutions pour depasser les difficultes et agir collectivement, face aux enjeux de sante psychologique au travail.

Introduction A la suite de signaux d’alerte des pediatres, et de l’evaluation de leurs RPS par le service de sante au travail, la direction a instaure un plan de prevention de ces risques. Le service de sante au travail a souhaite faire une evaluation de sa mise en place. Methodes Cette evaluation a ete realisee en utilisant le cadre theorique de Psychosocial safety climate (PSC). Il s’agit d’une ressource organisationnelle d’amont, la cause des causes, qui depend des politiques, pratiques et procedures organisationnelles pour la protection et la securite de la sante psychologique. Il est predictif des RPS, de la sante psychologique et de l’engagement dans le travail. Un questionnaire reprenant les 4 dimensions de la PSC, a ete propose sous forme electronique aux 188 pediatres du pole concerne. Les 3 premieres dimensions interrogent les 8 axes du plan de prevention des RPS, mis en place par la direction : carriere, absenteisme, sante au travail, organisation du travail, qualite de vie au travail, management, dialogue avec la hierarchie, gestion de la violence. Les reponses sont cotees selon 4 modalites, de 0 a 3. Chaque score de dimension est la somme de chaque question, permettant la creation d’un score global. L’analyse statistique des scores a ete faite selon la specialite, le grade et l’engagement ou non dans le projet de prevention. Resultats Le nombre de participants etait de 54. Pour les 2 premieres dimensions, « la direction demontre sa preoccupation pour la demarche par son implication et son engagement » et « la met en œuvre, avec la participation et la consultation des medecins », les reponses « d’accord et fortement d’accord » sont : sante au travail, 43 % a 46 %, gestion situations de violence, 45 % et 54 %, communication, 40 % et 38 %, qualite de vie au travail, 29 % et 34 %, absenteisme, 28 % et 25 %, carriere, 20 %, management, 20 % et 9 %, organisation du travail, 18 % et 16 %. Pour la 3e dimension, « mes preoccupations, besoins et interets ont ete pris en compte », les reponses « d’accord et fortement d’accord » sont : communication, 40 %, gestion situations de violence, 40 %, absenteisme, 32 %, sante au travail, 32 %, organisation du travail, 27 %, qualite de vie au travail, 27 %, carriere, 23 %, et management 18 %. La 4e dimension, « la demarche implique tous les niveaux hierarchiques de l’organisation », obtient 75 % de reponses positives. Pour l’ensemble des questions, il n’y a pas de difference significative d’appreciation en fonction du grade et de la specialite mais celle-ci est significativement meilleure parmi les pediatres qui declarent s’etre impliques dans le projet de prevention. Conclusion Les pratiques de gestion, l’organisation du travail et la carriere sont des points de vigilance.

Importance Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis. Objective To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers. Data Sources Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019. Study Selection Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review. Data Extraction and Synthesis This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies–Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models. Main Outcomes and Measures Sickness absence due to a mental disorder with a diagnosis obtained objectively. Results A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]). Conclusions and Relevance This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients’ mental health and work capacity.

Objective The aim of this study was to evaluate the effect of the Quebec Healthy Enterprise Standard (QHES) on adverse physical and psychosocial work factors and work-related musculoskeletal problems (WMSP). Methods Workers of 10 organizations completed questionnaires before (n = 2849) and 2 to 3 years following (n = 2560) QHES implementation. Outcomes were assessed using validated instruments. Results Workers exposed to adverse physical and psychosocial work factors had a higher prevalence of WMSP. After interventions, the prevalences of one adverse physical and three adverse psychosocial work factors were lower among workers exposed to interventions. Among men exposed to physical and psychosocial interventions, the lower prevalence of neck WMSP is compatible with a beneficial intervention effect. Other results generally showed few effects on WMSP. Conclusion Results suggest that QHES implementation lead to a decrease in some adverse physical and psychosocial work factors. Few effects were observed on WMSP.

IntroductionMental health problems (MHPs) are frequent and disabling and are the first or second leading cause of certified sickness absences from work in industrialised countries. They are generally long lasting and generate a considerable human and socioeconomic burden. The deleterious effect of adverse psychosocial work factors on MHP has been documented. However, the evidence regarding the effect of these factors on absences from work for an MHP has not been synthesised since 2007. The proposed systematic review aims to synthesise the effect of adverse psychosocial work factors from three validated theoretical models (the demand–control–support, effort–reward–imbalance and organisational justice models) on the risk of certified absences from work for diagnosed MHP among workers.Method and analysisA systematic search strategy will be conducted in seven databases: Medline, Embase, CINAHL, Web of Science, PsycInfo, Sociological abstracts and IBSS. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, a multistep screening process by independent reviewers will lead to study selection. The search strategy was first run in 16 January 2017 and will be updated in October 2018. Only quantitative, prospective studies evaluating the effect of at least one psychosocial work factor from the validated theoretical models on certified absence from work for a diagnosed MHP will be considered for inclusion. Extracted data will be used for quantitative and qualitative evidence synthesis as well as to assess risk of bias and methodological quality. Meta-estimates will be provided for high-quality studies and by each psychosocial work factor, after considering homogeneity and number of studies.Ethics and disseminationAs this study will be based only on published studies, ethics approval is not required. Given that psychosocial works factors are frequent and modifiable, the results of this systematic review may provide evidence to support prevention strategies that can help to reduce the human social and economic burden associated with medically certified absences from work for an MHP.PROSPERO registration numberCRD42018091632.

Introduction Work-life balance (WLB) refers to the harmonisation of one’s professional and personal roles. A growing body of research suggests that this conflict may be associated with various mental and physical health problems. An increasing number of organisations are implementing measures to promote WLB, but the effects of these on workers’ health are not well known. Implemented in 2008, the voluntary Healthy Enterprise Standard (HES) targets four intervention areas, including one to promote WLB. The objective of this study was to evaluate the impact of HES implementation on workers’ WLB and their self-rated health. Methods This was an intervention study with a before-after design derived from secondary data. Organisations adopted the standard of their own initiative and were responsible for implementing interventions. All active employees were solicited to participate before (T1, n=2849) and 24–38 months (T2, n=2560) following the standard’s implementation. At both time points, participants completed a questionnaire. WLB was measured using one item evaluating participants’ ability to maintain balance in their professional and personal responsibilities. Self-rated health was assessed using a validated self-report item. Exposure to the WLB intervention area was determined by qualitative analyses. Result The overall results show a deterioration of WLB for both women and men from T1 to T2. Of the two organisations that implemented specific interventions to promote WLB, only one implemented recognised interventions (flexible schedule and telecommute). In this organisation, a slight improvement in WLB was observed for men and especially for women. However, an increase in the prevalence of negative self-rated health was also observed in both sexes. Discussion These results suggest that workplace interventions implementing recognised and specific measures to promote workers’ WLB may be effective. The results of this study illustrate the importance of implementing concrete and recognised interventions in this field.

Introduction Adverse psychosocial work factors are recognised as a significant source of psychological distress. The Healthy Enterprise Standard (HES) targets four intervention areas: Lifestyle, Work-life balance, Workplace environment and Management practices ; this latter area referring to interventions aimed at improving the psychosocial work environment. The aim of this study was to evaluate the impact of implementing the HES on exposure to adverse psychosocial work factors and the prevalence of psychological distress among ten Quebec organisations. Methods This was an intervention study with a before-after design derived from secondary data. Organisations adopted the standard of their own initiative and were responsible for implementing interventions. All active employees were solicited to participate before (T1=2849) and 24–38 months (T2=2560) following the standard’s implementation. At both time points, participants completed a questionnaire. Psychosocial work factors were assessed with the validated demand-control-support and effort-reward imbalance models. Psychological distress was assessed with the validated K6. Intervention exposure was measured by questionnaire and complemented by qualitative analyses. Result The prevalence of low social support at work and high psychological distress decreased among all participants between T1 and T2. In organisations that were less exposed to interventions in the Management practices area, an increase in the prevalence of several adverse psychosocial work factors was observed while a decrease in the prevalence of these adverse factors was observed in organisations more exposed to Management practices interventions. Moreover, a more important decrease in high psychological distress was observed in organisations more exposed compared to those less exposed to interventions in this area. Discussion These results suggest that organisational psychosocial interventions implemented in the context of this standard may be effective in reducing both adverse psychosocial work factors as well as high psychological distress and may therefore be an effective means to improve the mental health of workers.

Introduction Work-related musculoskeletal problems (WMSP) are amongst the most frequent and costly health problems experienced by the working population. Both adverse physical and psychosocial work factors can lead to WMSP. The Healthy Enterprise Standard (HES) targets four intervention areas, including the Workplace environment and the Management practices areas. The aim of this study was to determine the impact of HES interventions targeting both these areas simultaneously on the prevalence of adverse physical and psychosocial work factors and of WMSP. Methods This was an intervention study with a before-after design derived from secondary data. Organisations adopted the standard of their own initiative and were responsible for implementing interventions. All active employees were solicited to participate before (T1=2849) and 24–38 months (T2=2560) following the standard’s implementation. At both time points, participants completed a questionnaire. Physical work factors were measured with five items. Psychosocial work factors were assessed with the validated demand-control-support and effort-reward imbalance models. WMSP were measured with four items adapted from the Nordic Questionnaire. Intervention exposure was measured by questionnaire and complemented by qualitative analyses. Result There was an increase from T1 to T2 in adverse physical and psychosocial work factors as well as the prevalence of WMSP. The rate of adverse physical work factors at T2 was lower amongst participants exposed to interventions in the Workplace environment area of the HES. The prevalence of adverse psychosocial work factors at T2 was lower amongst participants exposed to interventions in the Management practices . However, the T2 prevalence of WMSP was similar between participants simultaneously exposed to interventions in both areas of interest and those not exposed to these interventions. Discussion These results suggest that this type of intervention may be effective in reducing workers’ occupational exposure to risk factors associated with WMSP and therefore be an effective strategy to prevent WMSP.

Introduction The Healthy Enterprise Standard (HES) is related to a certification program in Quebec (Canada) and targets four areas: Lifestyle, Work-life balance, Workplace environment and Management practices. The aim of this study was to open the black box of intervention and analyse the implementation process in order to interpret effects of HES on health and workplace risk factors, and cost-benefit results from the employer’s perspective. Methods We used a before-after design for a two-case analysis with a mixed-method approach. In two organisations from different sectors, quantitative data were collected with a questionnaire among all active workers before the standard’s implementation (T1 organisation A=186, organisation B=1081) and 25–31 months after (T2 A=190, B=975). Psychosocial work factors (demand-control-support and effort-reward imbalance validated scales), psychological distress (validated Kessler-6), and work-related musculoskeletal problems (WMSP, 4 items from the Nordic Questionnaire) were measured as well as intervention exposure. Intervention costs data, presenteeism and absences data were collected. Qualitative data through interviews and focus groups in both organisations were recorded, transcribed and coded in order to perform thematic analysis a posteriori. Results The prevalence of psychosocial work factors (low social support, low reward) at T2 was lower amongst participants exposed to intervention in the Management practices area in both organisations. WMSP was lower for those exposed to the Workplace environment area in B. The average cost per worker per year was very similar for A and B whereas distribution of cost categories differed. The net benefit was highly positive in B and negative in A. Implementation analysis showed that each area of HES was associated to different types of facilitators and obstacles. Cyclical factors, communication and management involvement differed between A and B. Discussion These results show that the implementation process analysis provides interesting insights into understanding effect and cost-benefit results and improving OSH interventions.

Adverse psychosocial work factors are recognized as a significant source of psychological distress, resulting in a considerable socioeconomic burden. The impact of occupational health standards that aim to reduce these adverse work factors, such as the Quebec Healthy Enterprise Standard (QHES), is of great interest for public health. The aim of this study was to evaluate, for the first time, the effect of QHES interventions targeting adverse psychosocial work factors on the prevalence of these factors and of psychological distress among ten Quebec organizations. These outcomes were assessed by questionnaire using validated instruments before (T1, n = 2849) and 2–3 years following (T2, n = 2560) QHES implementation. Beneficial effects of interventions were observed for two adverse psychosocial work factors: low rewards (ratio of prevalence ratios (PRs) = 0.77, 95% CI = 0.66–0.91) and low social support at work (ratio of PRs = 0.89, 95% CI = 0.77–1.03). Moreover, beneficial effects of interventions were also observed on the prevalence of high psychological distress (ratio of PRs = 0.86, 95% CI = 0.75–0.998). Psychosocial interventions implemented in the context of this standard improved the psychosocial work environment and had beneficial effects on workers’ mental health.

Aim Our study objectives were as follows: assess exposure to psychosocial work demands among working pregnant women and women on preventive withdrawal from work; and measure the association between psychosocial work demands and major depressive symptoms, according to time of withdrawal from work. Methodology Karasek's abbreviated scale was used to measure psychosocial work demands (Job strain and “Iso-strain”) and CES-D scale (Center for Epidemiological Studies Depression Scale) was used to measure major depressive symptoms (CES-D score ≥ 23), at 24–26 weeks of pregnancy, among 3043 pregnant women in Montreal (Quebec) who worked at paid jobs at least 15 h/week and at least four consecutive weeks since the beginning of their pregnancy. Multivariate logistic regression models were built. Results At 24–26 weeks of pregnancy, 31.4% (956/3043) of pregnant women were on preventive withdrawal from work. They were more in “high-strain” (31.1% vs. 21.1%) and “Iso-strain” groups (21.0% vs. 14.2%) than those who continued to work (P Conclusion Psychosocial work demands are an important risk factor for the mental health of pregnant workers and require that preventive actions be put forward.

OBJECTIVES To describe the changes implemented as part of a workplace psychosocial intervention. METHODS The intervention was conducted in a public organization employing 1630 white-collar workers. The intervention was defined as all changes implemented to reduce adverse psychosocial work factors. A logbook was held to describe the changes implemented in the intervention group and in a comparable control group (N = 1282). RESULTS Social support and reward were the psychosocial factors most targeted (41% to 83%). In comparison with the control group, the intervention group implemented four times more major changes and implemented changes, improving the employees' workload. CONCLUSIONS Changes mainly targeted social support and reward. The intervention group implemented four times more major changes than the control group. The intervention group implemented changes targeting the workload, whereas no such changes were implemented in the control group.