Association between Psychosocial Working Conditions and Perceived Physical Exertion among Eldercare Workers:A Cross-Sectional Multilevel Analysis of Nursing Homes, Wards and Workers

This cross-sectional multilevel study aims at investigating the associations between psychosocial working conditions of different workplace levels and perceived physical exertion among eldercare workers. Data were obtained from the ‘Danish Observational Study of Eldercare work and musculoskeletal disorderS’ (DOSES) study, including 536 eldercare workers, nested in 126 wards and 20 nursing homes. Psychosocial working conditions were measured by the Copenhagen Psychosocial Questionnaire (COPSOQ). The physical workload was measured with a self-administered scale (0–10) rating perceived physical exertion. Multilevel linear mixed models were used to determine associations of psychosocial conditions between nursing homes, wards, and workers with physical exertion. Most of the variance in the perceived physical exertion was explained by differences between workers (83%), but some variance was explained by wards (11%) and nursing homes (6%). Workers employed in nursing homes with low influence (p = 0.01) and poor leadership (p = 0.02), and in wards with high quantitative demands (p = 0.03), high work pace (p < 0.001), and low justice (p = 0.01) were at increased risk of reporting higher physical exertion. The strongest associations were found for low influence, low quality of leadership, and high work pace at nursing homes and ward levels. In conclusion, improving specific psychosocial working conditions at nursing home and ward levels may be of particular importance to reduce excessive physical workload in eldercare workers

Asymmetric Catalysis : Ligand Design and Conformational Studies.

This thesis deals with the design of ligands for efficientasymmetric catalysis and studies of the conformation of theligands in the catalytically active complexes. All ligandsdeveloped contain chiral oxazoline heterocycles. The conformations of hydroxy- and methoxy-substitutedpyridinooxazolines and bis(oxazolines) during Pd-catalysedallylic alkylations were investigated using crystallography,2D-NMR techniques and DFT calculations. A stabilising OH-Pdinteraction was discovered which might explain the differencein reactivity between the hydroxy- and methoxy-containingligands. The conformational change in the ligands due to thisinteraction may explain the different selectivities observed inthe catalytic reaction. Polymer-bound pyridinooxazolines and bis(oxazolines) weresynthesised and employed in Pd-catalysed allylic alkylationswith results similar to those of monomeric analogues;enantioselectivities up to 95% were obtained. One polymer-boundligand could be re-used several times after removal of Pd(0).The polymer-bound bis(oxazoline) was also used in Zn-catalysedDiels-Alder reactions, but the heterogenised catalyst gavelower selectivities than a monomeric analogue. A series of chiral dendron-containing pyridinooxazolines andbis(oxazolines) were synthesised and evaluated in Pd-catalysedallylic alkylations. The dendrons did not seem to have anyinfluence on the selectivity and little influence on the yieldwhen introduced in the pyridinooxazoline ligands. In thebis(oxazoline) series lower generation dendrimers had a postiveon the selectivity, but the selectivity and the activitydecreased with increasing generation. Crown ether-containing ligands were investigated inpalladium-catalysed alkylations. No evidence of a possibleinteraction between the metal in the crown ether and thenucleophile was discovered. A new type of catalyst, an oxazoline-containing palladacyclewas found to be very active in oxidations of secondary alcoholsto the corresponding aldehydes or ketones. The reactions wereperformed with air as the re-oxidant. Therefore, this is anenviromentally friendly oxidation method. Keywords:asymmetric catalysis, chiral ligand,oxazolines, conformational study, allylic substitution,polymer-bound ligands, dendritic ligands, crown ether,oxidations, palladacycle.NR 2014080

Combined effects of physical behavior compositions and psychosocial resources on perceived exertion among eldercare workers

High perceived physical exertion is common in eldercare workers and a strong predictor for impaired health. However, little is known on how physical behaviors at work associate with physical exertion in this group. The aim of this study was to determine the extent to which the composition of physical behaviors at work is associated with perceived physical exertion in nursing home eldercare workers, and the extent to which these associations are modified by psychosocial resources. Methods Our population consisted of 399 female eldercare workers from 126 wards in 20 different nursing homes. We evaluated time spent in physical behaviors at work [sitting, standing still, light activities (LAs), and moderate to vigorous activities (MVAs)] using triaxial accelerometers worn, on average, for three working days. We accounted for inherent codependency between the behaviors using compositional data analysis. We used multilevel linear mixed regression models to determine associations between the behaviors and perceived exertion, measured on a numeric rating scale (0–10), and included interactions between each behavior and psychosocial resources (influence at work, social support, and quality of leadership) to determine a possible moderating effect of resources. Regression results were illustrated using isotemporal substitution. Results Sitting was negatively (β: −0.64; P < 0.01) while MVA was positively (β: 0.95; P = 0.02) associated with perceived exertion. According to isotemporal substitution, replacing 30 min of MVA by sitting would, for an average worker, be associated with a decrease in physical exertion by −0.14 on the 0–10 scale. Job resources marginally moderated the association between LA and exertion. Thus, among workers with low influence and low social support, we found a positive association between LA and exertion, while that was not found for workers with medium or high influence and support (interactions for influence and support: P = 0.08 and P = 0.10). Conclusions Our findings suggest that reallocating time from MVA to sitting can mitigate perceived physical exertion in eldercare workers. More time in LA increased physical exertion only for workers with low psychosocial resources, supporting a positive effect of a better psychosocial work environment in elderly care

What determines step-rate at work? An investigation of factors at the shift, worker, ward and nursing home levels in eldercare

Objectives. Current knowledge on the determinants of step-rate at different organisational levels is limited. Thus, our aim was to identify, in eldercare, at what workplace level differences in step-rate occur and to identify determinants of workers’ step-rate at these levels. Methods. Participants were 420 eldercare workers from 17 nursing homes (126 wards) in Denmark. Accelerometry was used to assess step-rate (steps/hour) of workers over multiple shifts. We assessed various determinants at different levels of the workplace, i.e., at the 1) shift, 2) worker, 3) ward and 4) nursing home levels. Variance components analysis identified the percentage contribution to total variance in step-rate from each respective level. Multi-level linear regression modelling was used to investigate the association between candidate determinants at each level and step-rate. Results. Differences in eldercare workers’ step-rate occurred primarily between shifts (within workers; 44.9%) and between workers (within wards; 49.1%). A higher step-rate was associated with: 1) weekend and evening shifts (vs. weekday/day); 2) job as a care helper (vs. care aide) and an increased proportion of time spent on direct care tasks; 3) working in a somatic ward (vs. dementia), an increased resident-staff ratio and permission to take unscheduled breaks; and 4) lack of elevators. Conclusion. We found that nearly all variability in step-rate in eldercare work occurs between shifts (within workers) and between workers (within wards). The main determinants of step-rate were related to the type of shift, type of work tasks, staffing ratio, break policy and availability of elevators.

Nursing home, ward and worker level determinants of perceived quantitative work demands: a multi-level cross-sectional analysis in elderly care

Introduction Perceived quantitative demands at work have been associated with poor mental and physical health, long-term sickness absence and subsequent early retirement. Identifying modifiable predictors of perceived quantitative demands at different levels of the organization is key to developing effective interventions. The aim of the study was to identify predictors of perceived quantitative demands at work and examine the extent to which they occur at different levels of the eldercare organisation (i.e., the worker, ward and nursing home levels). Methods We collected data on 383 eldercare workers in 95 wards at 20 nursing homes in Denmark using workplace observations and questionnaires to workers and their managers. Perceived quantitative work demands were assessed using two items from the Copenhagen Psychosocial Questionnaire, II (COPSOQ-II). We identified contributions to overall variability from the three organisational levels using variance components analysis, and examined associations between predictors at these three levels and quantitative demands. Results Almost all (90.9%) the variability in perceived quantitative demands occurred between eldercare workers (within wards). Predictors significantly associated with lower quantitative demands were: having a job as a care helper, working fixed evening shifts, being born outside Denmark, having lower influence at work, higher quality of leadership and lower emotional demands. None of the investigated physical factors (e.g. resident handlings, push/pull tasks, step-count) were associated with perceived quantitative demands. Conclusion We found that the variability in perceived quantitative demands occurred primarily between eldercare workers within wards. Our study indicates that psychosocial work environment factors are the strongest modifiable predictors of perceived quantitative demands in eldercare, while organisational factors related to job position, shift, and resident-staff ratio also play a role. Interventions should test if changes in these predictors can reduce perceived quantitative demands at work in eldercare. 

Associations between perceived quantitative work demands at different organisational levels and pain and sickness absence in eldercare workers: A multilevel longitudinal analysis

Purpose Eldercare work is characterised by high quantitative work demands and high occurrence of musculoskeletal pain and sickness absence. Our aim was to investigate the association between quantitative demands aggregated at the different organizational levels of eldercare and low back pain (LBP) and sickness absence due to pain among workers. Methods This study was conducted in 527 eldercare workers from 105 wards across 20 nursing homes in Denmark. We collected workers’ perceived quantitative demands at baseline and workers’ LBP and sickness absence repeatedly over the following year. We aggregated worker-level quantitative demands to the ward and nursing home-levels, and used mixed-effects regression models to investigate the associations between quantitative demands at different organizational levels and LBP and sickness absence over 1 year. Results Across all models, increased quantitative demands (0-100 scale) at the worker-level was associated with an increased likelihood (OR = 1.02) and intensity of LBP (β = 0.01). We did not identify any associations between quantitative demands at the wardlevel and either of our outcomes. Across all models, increased quantitative demands at the nursing home-level was associated with increased days with sickness absence due to pain (β = 0.03 to 0.06). Conclusion In eldercare, workers’ perceived quantitative demands are associated with the presence and intensity of LBP. Further, quantitative demands across the overall nursing home-level are associated with sickness absence due to pain among eldercare workers. These results are of relevance to developing organisational interventions targeting quantitative demands to reduce sickness absence in eldercare.