Wednesday, June 4, 2014

A short summary of: Chapter 1: Conceptual Approaches to Occupational Health and Wellness: An Overview By R. J. Gatchel and N. D. Kishino In Gatchel, R.J. & Schultz, I.Z (Eds) Handbook of Occupational Health and Wellness, 2012, P.3-21.

Gatchel and Kishino start of their chapter by explaining why there has been an increase in clinical research in the field of occupational health and well-being.

Some of the reasons (which are connected to each other) are:

- The rapid worldwide economic growth
- Increases in environmental, occupational and psychological stress,

These factors have increased clinical research with different conceptual theories/models and perspectives to examine aspects within occupational health and well-being. For instance the stress-illness relationship and individual differences in resilience and productivity. In this handbook chapter, Gatchel and Kishino offer a brief overview of: a) the history that leads to the development within occupational health; b) some concepts within mediocolegal issues (i.e., medicine and legal) and occupational injuries; c) issues within occupational stress theories; and d) the nature of stress. I will here give a short overview of the chapter - mostly for myself to read later when I have forgotten everything. 

History of occupational health
First, the authors go swiftly through the history of occupational health. For someone new to this field, such as me, it is a good start and a pleasantly brief summary (consisting of just a few paragraphs) to this field. They present political occupational compensation issues throughout history, and how there were a shift from workers being seen as replaceable parts to individuals with rights around the early and middle 19th century, and how there already were differences between the systems in Europe, who started building up a federal disability system, versus the U.S, using private insurance companies as “middle men”, as a response to the demands of focusing on employee’s rights.

Also, in the 19th century, chemicals and neurotoxins (e.g., lead, mercury and asbestos) started being common in the work place, which raised concern about the unhealthy work environments this created when people started becoming sick. Later when for instance the sale of leaded gasoline was eliminated - lead levels in the blood of Americans were shown to decrease with 80%. But this was not before 1986. Gatchel and Kishino further underscores that the quantity of lead still grows today both in the U.S and worldwide. Moreover, and very unfortunate, as new science and technology is aimed to improve productivity, there might be new unhealthy hazards that we not yet know about until symptoms and diseases appear. And even more unfortunate, the authors states,  the proof has to be shown in scientifically acceptable manner with cause-effect relations, which might take several years or decades, before federal actions are implemented. All quite gloomy.....

Medicolegal issues and occupational injuries
Second, the authors briefly explain aspects/concepts within mediocolegal issues and occupational injuries such as:

·         Primary losses - e.g., the loss of employment.
·         Secondary losses - e.g., financial losses, social relationship losses, respect from family loss, and guilt of disability.
·         Primary gains - e.g., alleviation of guilt in physical symptoms.
·         Secondary gains - e.g., gain of disability-related financial rewards, social support from others.
·         Malingering, which refers to the intentional projection of psychosomatic or physical symptoms for gaining external rewards (e.g., such as financial compensation or avoidance of activities). Malingering is a described in the DSM-IV, but the current criteria have been criticized.
·         Compensation Neurosis and Litigation Neurosis, which refers to gain-related conscious or unconscious amplification of physical and psychosocial symptoms.

The issue of malingering is treated further both with regards to prevalence, compensation and assessment. For instance, the authors mention different studies where the numbers of workers that are probably malingerers range from 1.25 – 32 % - using with different samples and conditions/symptoms. However, the rate of true malingering (i.e., those with no health problems faking to be ill), is found to be low. Still, from employers’, practitioners’ or insurance providers’ perspectives, there might often be biased assumptions of the employees actual degree of disability or injury. Also, they state that malingering might be very difficult to assess in a valid manner. Also, they state that if malingering goes undetected, some individuals takes advantage of the medical, insurance and legal systems, but if malingering is wrongly diagnosed/assumed, then some individuals wrongly lose their benefits.

Occupational stress
Third, the authors introduce occupational stress issues. Much of this research started in the 1990s when researchers tried to determine the most stressful occupations, or the most vulnerable work characteristics for later coronary heart disease risks (in Karasek & Theorell, 1990). Most of this research have become recognized relatively recent.  Today, there is an acceptance for the relationship between occupational stress and health problems.  As you can see in the table, a search of publications including the terms “work stress” or “occupational stress” did indeed show a sharply increase in publications that includes these terms around the 1990s and until today (The search was conducted by me today 9.7.2013, in PubMed. It must therefore be interpreted with caution as the search was conducted fairly rapidly, and only PubMed was searched.)

The authors mention that today it is mandated by federal law to conduct research on working conditions that increase mental or physical health problems. For instance, we have The National Institute for Occupational Safety and Health (NIOSH) in the U.S., The Institute for Psychological Factors and Health, part of the Karolinska Institute in Sweden; the Finnish Institute of Occupational Health; and the Institute of Work, Health and Organizations (I-WHO) at the University of Nottingham in the UK. In Norway, we have the National Institute of Occupational Health (Stami).

The authors further mention several risk factors for coronary heart disease such as psychological demands (e.g., workload and responsibilities), autonomy (e.g., control of speed, nature and conditions) and satisfaction at work, and they give a brief description of the Karasek “job demand/control”-model (In another chapter in this handbook there is a review of research examining this model in different populations (by Theorell)). The other theories of work and stress should also have been given some words in this chapter.

Further, Gatchel and Kishino mention a study by Baum and colleagues from 1997 where working women are compared to housewives and working men. This study illustrates the importance of demands in the home, as well as at work for stress. Moreover, this study also finds that control over these demands appear to buffer stress. While working women were found to not be at higher risk of disease compared to housewives, working women with children who had high demands, and women with low supervisor/manager support were at higher risk of disease. Gatchel and Kishino also mentions that for working women, the risk of coronary heart disease increases linearly with number of children. However, be aware, as 1) this is at least 15 year old research; hopefully the circumstances for working women today have changed; and 2) this is only a summary of what I interpret that Gatchel and Kishino have interpreted of Baum et als’ findings (For the original article see the references).

For newer literature on the field of work and home relations in women, Gatchel and Kishino mentions a review by Terrill et al. from last year (2012) and from the current handbook (2012) on coronary heart disease and working women. Gatchel and Kishino briefly sum up factors suggested by Terrill and colleagues to why coronary heart disease is one of the leading causes of death in working women:

·        1.  Conflicting demands (e.g., employment, financial worries, childcare responsibilities, housework ) due to multiple roles  that results in higher levels of stress.
·         2. Sympathetic nervous system reactivity, allostatic load (i.e., effects of chronic stress) and other biological pathways.

The nature of stress
Fourth, the authors give a brief overview of stress and its impact on the individual. A review by Gatchel and Baum from 2009 is recommended by the authors, that more thoroughly goes through the nature of stress.  I will not provide a summary of these stress processes in the body.

My opinion of the chapter:
It is a good introduction which is easy to read and well-written about occupational health and wellness. Several recommended reviews are mentioned, and it is a good chapter to start off with when starting to work with occupational health.

A big plus for me (and others working at the Norwegian Institute of Public Health) is that this chapter and the entire handbook is available online as a .pdf-file here:

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