Regional pattern of physical inactivity in Croatia [Regionalizam fizičke neaktivnosti u Hrvatskoj]

The aim of this paper was to analyze the regional pattern of physical inactivity in Croatia based on the Croatian Adult Health Survey 2003 data. A total of 9,070 adult respondents were included in this study. In men, the highest prevalence of physical inactivity was recorded in the City of Zagreb (39.6%), and it was significantly higher than in Central (25.6%), Coastal (25.6%) and Mountainous region (14.1%). Mountainous region had significantly lower prevalence of physical inactivity compared to any other region, except the Central region. The highest prevalence of physical inactivity in women was also recorded in the City of Zagreb (43.6%), and it was also significantly higher than in all other regions. The lowest prevalence of physical inactivity was recorded in Eastern Region (24.7%). The highest levels of physical inactivity in both in both genders were recorded in urban regions, suggesting that intervention measures in terms of health promotion should be undertaken, with strong emphasis on the people living in urban settings

Shift Work, Quality of Life and Work Ability among Croatian Hospital Nurses

This paper is a report of a study of the associations of shift work with work ability and quality of life (QoL) among clinical nurses. A cross-sectional study was conducted in 2007–2008 on 1124 nurses using the Work Ability Index Questionnaire and the Quality of Life Questionnaire (WHOQOL-BREF). Lower education was a predictor for low level of work ability and low physical health domain of QoL. Older age and having no partner were statistically significantly related to lower social interaction. Predictors significantly related to low environment domain of QoL were low education and shift work. Shift workers had higher level of level of work ability, but clinically insignificant. The study provides no evidence of a significant association between shift work and work ability or quality of life. Education has a positive association with nurses’ work ability and quality of life

Peripheral Regional Analgesia with Femoral Catheter versus Intravenous Patient Controlled Analgesia after Total Knee Arthroplasty: A Prospective Randomized Study

The aim of this study is to compare the effects of femoral analgesia (FA) with 0.25% levobupivacain and intravenous patient controlled analgesia (PCA) with morphine on postoperative pain assessed by a visual-analog scale (VAS) score and their complications during the first 24 postoperative hours after the a total knee arthroplasty in a prospective randomized study. Secondary outcomes included: morphine use, patient satisfaction, complication of analgesia and duration of hospital stay. We analyzed 71 patients with an ASA score of II or III. The patients were randomized into two groups: group PCA (n=36) was given the PCA pump, which contained morphine; and group FA (n=35) was given first a bolus dose, then a continuous infusion 0.25% levobupivacain via a femoral catheter. The assessment of VAS was performed every 2 hours. There were no differences between the PCA and FA groups regarding demographic characteristics, operation duration, ASA score distribution, duration of hospital stay and satisfaction with analgesia (although there were more satisfied patients in the FA group). Significant differences were noted in the quantity of morphine used (higher values were in the PCA group; p<0.001). More complications were recorded in PCA group (p<0.001). The VAS score was lower in the FA group (p<0.001). The highest difference occurred 4 hours after the operation, with the PCA group having significantly higher VAS score values compared to the FA group. Femoral analgesia leads to a stronger pain relief with less side effects, less morphine use and more patient satisfaction than intravenous PCA with morphine

Shift Work, Quality of Life and Work Ability among Croatian Hospital Nurses

This paper is a report of a study of the associations of shift work with work ability and quality of life (QoL) among clinical nurses. A cross-sectional study was conducted in 2007–2008 on 1124 nurses using the Work Ability Index Questionnaire and the Quality of Life Questionnaire (WHOQOL-BREF). Lower education was a predictor for low level of work ability and low physical health domain of QoL. Older age and having no partner were statistically significantly related to lower social interaction. Predictors significantly related to low environment domain of QoL were low education and shift work. Shift workers had higher level of level of work ability, but clinically insignificant. The study provides no evidence of a significant association between shift work and work ability or quality of life. Education has a positive association with nurses’ work ability and quality of life

MAINTENANCE OF WORK ABILITY AMONG HOSPITAL HEALTH CARE PROFESSIONALS

Cilj rada bio je istražiti vrijednosti pokazatelja radne sposobnosti (Work Ability Index -WAI) kod bolničkih zdravstvenih djelatnika i analizirati čimbenike koji mogu utjecati na radnu sposobnost. U istraživanju je sudjelovalo 1856 zdravstvenih djelatnika zaposlenih u zagrebačkim bolnicama. Korišteni su upitnici za određivanje pokazatelja radne sposobnosti i stresora na radnom mjestu bolničkih zdravstvenih djelatnika. Prosječni pokazatelj radne sposobnosti (WAI) svih ispitanika je 38,68±6,28 što ukazuje na vrlo dobru radnu sposobnost. Analizirajući kategorije WAI-a (loš, dobar, vrlo dobar, izvrstan), vidljivo je da mali broj djelatnika ima loš WAI. Između liječnika i medicinskih sestara dobivena je značajna razlika u učestalosti pojedinih kategorija. Iako su liječnici značajnije stariji od medicinskih sestara, u liječnika je pokazatelj radne sposobnosti češće izvrstan, a u medicinskih sestara dobar i vrlo dobar. Dobivena je značajna razlika između pojedinih dobnih skupina. Analizom podataka identificirani su spol, dob, radni staž i stresori na radu kao značajni prediktori pokazatelja radne sposobnosti. Radna sposobnost zdravstvenih djelatnika značajno je negativno povezana sa svim stresorima. Rezultati ovog istraživanja pokazali su da zdravstveni djelatnici u zagrebačkim bolnicama imaju prosječno vrlo dobru radnu sposobnost, ali da manji broj djelatnika ima niske vrijednosti pokazatelja radne sposobnosti. Temeljem rezultata predlažu se preventivne mjere za očuvanje radne sposobnosti.Aim: The aim of this study was to investigate the values of the Work Ability Index (WAI) and to analyze the factors that may be associated with work ability among hospital health care professionals. Methods: A total of 1856 health care professionals employed at 5 Zagreb hospitals participated in this cross-sectional study. Data were collected using the Work Ability Index Questionnaire and Occupational Stress Assessment Questionnaire for hospital health care professionals. Results: The average WAI of all participants was 38.68±6.28, indicating very good work ability. WAI was significantly higher in men than in women, 40.43±5.81 and 38.27±6.32, respectively (p<0.001). Younger participants had greater WAI compared with those of older age groups (p<0.001). There was a substantial difference in the proportions of participants in the categories of WAI (poor, good, very good and excellent) between physicians and nurses (p<0.001). Although physicians were considerably older than nurses (p<0.001), the proportion of those with excellent WAI was greater among physicians than among nurses, suggesting that the jobs of highly educated participants, which are characterized by broad decision-making latitude and promotion possibilities maintain work ability better in comparison with low decision-making latitude jobs and low control jobs. About 5 percent of all participants had poor WAI. We identified the following significant predictors of suboptimal WAI among health care professionals: female sex, age, service accrual, and stressors related to organization and financial issues (p<0.001), risks and hazards (p=0.040), and shift work (p=0.001). Conclusion: The average WAI of all participants indicated very good work ability, but small percent of them had poor WAI. Our results suggest the need of preventive measures that would target maintenance of work ability at an organizational and individual level. The organizational level should include the provision of a sufficient number of workers, adequate financial resources for work and adequate salaries, less paperwork, positive collaboration with the public, especially media, and education of medical staff on the risks and hazards at work. The individual level should include individual assessment of sensitivity to night work and shift work considering age and health status, and training in stress management techniques

WORK STRESS: RECOGNITION, PREVENTION AND SOLUTION

Budući da je stres na radnom mjestu postao jedan od vodećih problema u radnoj zajednici i da je rizik obolijevanja od kardiovaskularnih bolesti veći kod ljudi izloženih raznim stresorima, bitno je ukazati na mogućnosti njegovog prepoznavanja, rješavanja i prevencije. Stres na radnom mjestu je rezultat niza okolnosti koje uzrokuju pojavu štetnih fizioloških, psiholoških i bihevioralnih reakcija radnika, pri čemu njegove sposobnosti nisu u skladu s njegovim potrebama. Mjerama prepoznavanja stresa pripada i prepoznavanje štetnih učinaka kako na samog radnika, tako i na cijelu tvrtku. Štetni učinci su ponekad lako prepoznatljivi, a katkad je potrebno upotrebljavati posebne upitnike o stresnim uvjetima na radu kako bi se dobila cjelovita slika o zaposlenima. Potrebno je redovito organizirati zdravstvene preglede zaposlenih, ukazati im na mogućnost obraćanja stručnoj osobi, kao i osigurati interdisciplinarni pristup koji uključuje psihologe, doktore medicine rada i stručnjake za zaštitu na radu. Različiti su načini kojima se stres na radu može smanjiti, a uključuju primarnu, sekundarnu i tercijarnu prevenciju. U današnjem svijetu sve se više ističe važnost tercijarne prevencije čiji je jedan od ciljeva smanjiti razvoj daljnjih štetnih posljedica za pojedinca ili skupinu ljudi izloženih stresorima. Pojam prevencija uključuje dva pristupa: mijenjanje pojedinca s pomoću treninga za upravljanje stresom i smanjenje stresa promjenom organizacije posla. Faze programa za prevenciju stresa su sljedeće: faza pripreme, identificiranje problema, oblikovanje i primjena intervencija i evaluacija primijenjenih metoda intervencije. Rješavanje stresa na radnom mjestu je složen interdisciplinarni postupak kojim se u budućnosti smanjuju negativne posljedice za zajednicu i samog radnika.SUMMARY: Since the work stress has become a major problem in work organization and the risk of morbidity of cardiovascular diseases is greater among the ones exposed to variety of stressors, it is important to point out the methods for its recognition, solution and prevention. Work stress presents a series of circumstances that lead to harmful physiological, psychological and behavioural reactions in employees whose capacities do not match work demands. Assessing the risk at work includes identification of harmful effects both on employees and on the entire organization. Stress is not always easily detectable, and sometimes it is necessary to use special work stress related questionnaires in order to get a full view of the employees’ stress level. It is necessary to schedule regular check-ups, interview employees about their health and tell them whom to address about the problems, and to ensure interdisciplinary approach that includes psychologists, occupational medicine specialists and experts on protection at work. There are a number of methods by which the risk of work stress can be reduced. These include primary, secondary and tertiary prevention. Contemporary work stress management should cover tertiary prevention that includes reduction of further harmful effects on individual or on people who are exposed to stressors. The term prevention comprises two approaches: changing individuals through work stress related training, and reduction of work stress through changing work organization. Steps toward prevention include: preparation phase, identification of the problem, designing and implementing interventions and evaluation of the interventions. Solving work stress problems is a complex, interdisciplinary task which reduces future negative consequences on the organization and on the employee

HOSPITAL HEALTHCARE WORKERS AND STRESS AT WORK: STUDY IN ZAGREB

Stres na radu je specifična vrsta stresa čiji je izvor u radnom okolišu. Individualna procjena objektivnog stanja ili događaja uvelike utječe na pojavu stresnog odgovora u pojedinca. Cilj istraživanja bio je u skupini zdravstvenih djelatnika u bolnici ispitati koje čimbenike stresa (stresore) na radu doživljavaju kao stresne i/ili izrazito stresne te postoje li razlike u doživljavanju stresa na radu između liječnika i medicinskih sestara/tehničara. U istraživanje je bilo uključeno 1.900 ispitanika. Ankete je ispunilo 1.477 zdravstvenih djelatnika sa stopom odgovora 78%. Rezultati su pokazali da zdravstveni djelatnici u bolnicama doživljavaju više različitih stresora s velikim intenzitetom. Među najčešćim stresorima koji su obje skupine ispitanika prepoznale su financijski i organizacijski čimbenici. Liječnici u odnosu na medicinske sestre/tehničare doživljavaju neke od tih čimbenika stresa s većim intenzitetom. Na vrhu hijerarhijske ljestvice u većine liječnika prvenstveno su stresori vezani uz financijske mogućnosti, organizaciju i neadekvatan prostor dok su medicinske sestre i tehničari uz stresore financijske prirode naveli i mali broj djelatnika. Medicinske sestre i tehničari češće od liječnika doživljavaju kao izvor stresa na radu strah od specifičnih opasnosti i štetnosti u zdravstvu, što ukazuje na potrebu poboljšanja edukacije i mjera zaštite i sigurnosti na radu. S druge strane, liječnici uz neprimjerenu javnu kritiku svojeg rada kao izraziti stres navode i psihološki pritisak pacijenata povezan s pogrešnom informiranošću i nerealnim očekivanjima, što ukazuje na potrebu unapređenja komunikacije na relaciji liječnik-pacijent.Stress at work is a specific type of stress arising from the work environment. The individual’s estimate of the objective situation or event greatly affects the level of stress in the individual’s response. It was the aim of the study to test the sample of hospital healthcare workers on the stressors at work which they find stressful and/or greatly stressful and to establish whether there are differences in the experience of stress between physicians and nurses/lab technicians. The study was based on a sample of 1,900 participants. Of the total number of participants, 1,477 healthcare workers completed the questionnaire and the response rate was 78%. Results indicated that hospital healthcare workers experience great intensity of stress from several stressors. Among the most common for both groups were the financial and organisational factors. Physicians, as opposed to nurses and technicians, experience some of these stressors with greater intensity. At the top of the scale for most physicians are the stressors related to financial aspects of their work, organisation and inadequate workspace, whereas nurses and technicians listed inadequate (insufficient) number of workers as a stressor alongside the inappropriate financial remuneration. Nurses and technicians, more frequently than physicians, experience as stressful the fear of specific work-related dangers and harms in healthcare, indicating a need to improve education and safety measures at work. On the other hand, physicians find stressful the exposure to unjust public criticism and, much more so, the psychological pressure from the patients poorly informed and labouring under unrealistic expectations, indicating a need to improve physician-patient communication

VALIDATION OF THE QUESTIONNAIRE ON WORKPLACE STRESSORS FOR HOSPITAL WORKERS

Rad prikazuje faktorsku strukturu i pouzdanost upitnika o stresorima na radnom mjestu bolničkih zdravstvenih djelatnika i time pridonosi daljnjoj validaciji i standardizaciji mjernog instrumenta stresa u zdravstvenih djelatnika, čime bi se direktno utjecalo na sigurnost pacijenata i zdravstvenih djelatnika u radnoj okolini bolnica. U istraživanje je uključeno 1.900 ispitanika između 18 i 65 godina starosti koji rade na radnom mjestu zdravstvenih djelatnika (medicinske sestre i tehničari srednje i više stručne spreme, te liječnici) u KB Dubrava, KBC Zagreb, KB Sestre milosrdnice, OB „Sveti Duh“ i koji su dobrovoljno pristali na istraživanje. Stopa odgovora bila je 78% te je na kraju dobiven uzorak od 1.481 ispitanika (1.086 medicinskih sestara/tehničara i 395 liječnika). U upitniku je pored osnovnih sociodemografskih pitanja ponuđeno 37 stresora na radu koji se odnose na organizaciju rada, smjenski rad, napredovanje u struci, edukaciju, profesionalne zahtjeve, međuljudsku komunikaciju, komunikaciju zdravstvenih djelatnika s pacijentima te na strah od opasnosti i štetnosti u zdravstvu. Ispitanici su svoj doživljaj ispravnosti odgovora ocijenili na Likertovoj ljestvici ocjenama od 1 = “nije uopće stresno” do 5 = “izrazito stresno”. Faktorska analiza je izlučila šest faktora relativno visoke pouzdanosti tipa unutarnje konzistencije (sve vrijednosti Crombach α su bile veće od 0,7): Organizacija radnog mjesta i financijska pitanja, Javna kritika, Opasnosti i štetnosti na poslu, Sukobi i komunikacija na poslu, Smjenski rad, Profesionalni i intelektualni zahtjevi. Pojedine čestice logično objašnjavaju strukturu odgovarajućih faktora te daju dobar oslonac daljnjoj izradi mjernog instrumenta stresa na radnom mjestu bolničkih zdravstvenih djelatnika. Ovim istraživanjem pridonijelo se daljnjem razvoju odgovarajućeg mjernog instrumenta, njegovoj praktičnoj primjeni, a time boljem prepoznavanju, rješavanju te prevenciji stresa i očuvanju sigurnosti u radnoj okolini bolnica u sklopu cjelokupnog očuvanja zdravlja na radnom mjestu zdravstvenih djelatnika.The paper presents factor structure and reliability of the workplace stressor questionnaire for hospital healthcare workers and hopes to further validate and standardise the stress measuring instrument for healthcare workers and thus directly affect the safety of patients and healthcare workers in hospital environments. The study was based on a sample of 1,900 participants aged between 18 and 65, employed in healthcare (nurses, lab technicians and physicians) in the hospitals Dubrava, Zagreb, Sestre milosrdnice and Sveti Duh. All participants voluntarily joined the study. Rate of response was 78%, from the actual sample of 1,481 participants (1,086 nurses and technicians and 395 physicians). In addition to general socio-demographic questions, the questionnaire included 37 workplace stressors referring to work organisation, shift work, opportunities for promotion, education, professional demands, interpersonal communication, communication between the healthcare workers and patients, and fear of dangers and potential harms in healthcare. The participants assessed their experience on the Likert scale (1-5) from 1 = \u27\u27no stress\u27\u27 to 5 = \u27\u27great stress\u27\u27. Factor analysis yielded six factors of relatively high reliability of inner consistency (all values of Crombach α exceeded 0.7): Workplace Organisation and Financial Issues, Public Criticism, Dangers and Harms at Workplace, Conflicts and Communication at Work, Shift Work, Professional and Intellectual Demands. Individual particles logically explain the structure of the corresponding factors and provide good foundation for further development of the stress measuring instrument at the workplace for hospital healthcare workers. The study contributes to the improvement of a suitable measuring instrument and its implementation in practice, and assists in better recognition and better solutions in the prevention of stress and preservation of safety in hospitals which should help to protect the health of healthcare workers

Regional Pattrn of Physical Inactivity in Croatia

The aim of this paper was to analyze the regional pattern of physical inactivity in Croatia based on the Croatian Adult Health Survey 2003 data. A total of 9,070 adult respondents were included in this study. In men, the highest prevalence of physical inactivity was recorded in the City of Zagreb (39.6%), and it was significantly higher than in Central (25.6%), Coastal (25.6%) and Mountainous region (14.1%). Mountainous region had significantly lower prevalence of physical inactivity compared to any other region, except the Central region. The highest prevalence of physical inactivity in women was also recorded in the City of Zagreb (43.6%), and it was also significantly higher than in all other regions. The lowest prevalence of physical inactivity was recorded in Eastern Region (24.7%) The highest levels of physical inactivity in both in both genders were recorded in urban regions, suggesting that intervention measures in terms of health promotion should be undertaken, with strong emphasis on the people living in urban settings

Domene kvalitete života kao prediktori radne sposobnosti bolničkih zdravstvenih djelatnika

This dissertation analyzes work ability, quality of life and salutogenic productivity of hospital health care workers employed in seven hospitals in Croatia. A cross-sectional study was conducted. The study population consisted of 1633 participants (267 men, 1363 women and 3 with no information on sex), aged 19-64 years. Different types of hospitals were included: 2 clinical, 4 general and 1 specialized hospital. The study was carried out in 2007 and 2008. The study was anonymous and voluntary with a response rate of 57,08%. The study included a wide range of health care workers: physicians, nurses/medical technicians, physiotherapists, pharmacists and other health care professionals. Three questionnaires were used: Work Ability Index Questionnaire, World Health Organization Quality of Life-Brief Version questionnaire, which measures quality of life in 4 domains (physical health, psychological health, social interaction and environment), and Human Work Index Questionnaire (HWI). Mann-Whitney U-test, Kruskal-Wallis analysis of variance by ranks and χ2-test were used for descriptive analyses. Binary logistic regression models were used to assess the association between the domains of quality of life and work ability, with work ability index being the dependent variable. The participants had satisfactory values of quality of life (QoL) in all its domains, with exception of environment which consistently showed borderline values in all hospitals. The values of all QoL-domains significantly differed according to hospital, with exception of psychological domain. Furthermore, Work Ability Index (WAI) was satisfactory in all hospitals, with exception of a specialized hospital, where its values were borderline. There was a substantial difference in WAI with respect to hospital. Only 32% of all participants had sustainable work ability. Analysis of HWI among all participants revealed that the value of the total HWI was moderate (68% of scale maximum, SM). The values of the components of HWI were as follows: work interest and cooperation showed moderate values, with 65% SM and 57% SM, respectively, while work ability component was good (81% SM). Analysis of the association between QoL-domains and work ability showed that good physical and psychological health were significant predictors of good work ability, whereby health care workers with good physical health had 6,8 greater likelihood of having good work ability compared with those without good physical health. Also, participants with good psychological health were 1,8 times more likely to have good work ability than their counterparts without good psychological health. Other factors that were considerably associated with good work ability were age (inverse association) and education level (positive association). Despite the methodological limitations, this study clearly shows the descriptive details of work ability, QoL and salutogenic productivity of hospital health care workers and points to the need to formulate and implement a workplace health promotion program that aims at maintaining work ability