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PubMed2004

Emotional labor: relevant theory for occupational health practice in post-industrial America.

The occupational experience of workers in service-oriented jobs can have profound effects on their health and well being, such as burnout, inauthenticity, and job dissatisfaction. The growing service economy and resultant proliferation of service-oriented jobs in current times and in the future must be acknowledged and investigated. The move from an economy driven by manufacturing industries to one dominated by service industries has taken place and currently prevails in the United States. In recognizing this shift in the "work" experience of the American work force, the changing nature of work related hazards must also be considered. Emotional labor has come to be known as an appreciable aspect of work involving direct interactions with clients and customers that can lead to adverse psychosocial outcomes. These relationships reveal the potential unpleasantness of service employment in which the performance of emotional labor is unavoidable. Although worker attributes can influence the emotional experience on the job, emotional labor is also likely to threaten the well being of workers through significantly high demands to express organizationally desired emotions and low control over what emotions can be felt and displayed. Recognition and investigation of emotional labor is necessary to understand its effects on worker populations. Conceptual models featuring emotional labor are available to guide research. However, discrimination among them based on utility and application in relation to identified study objectives and needs is essential.

Burnout, Professional↗
PubMed2005

[Clinical analysis of continuous electronic fetal heart rate monitoring for preterm small for gestational age during labor].

OBJECTIVE: To investigate the clinical value of continuous electronic fetal heart rate (FHR) monitoring for preterm small for gestational age (PSGA) during labor. METHODS: Three hundred and three pregnant women who had inevitable preterm labor at 32 - 36 weeks' gestation because of premature rupture of membrane or unknown cause underwent continuous electronic FHR monitoring during labor from Jan 2002 to May 2004. In total, 78 newborns were preterm small for gestational age (PSGA, PSGA group) and 225 newborns were preterm appropriate for gestational age (PAGA, PAGA group). The cardiotocography (CTG), outcome of labor, and cases with combined umbilical cord abnormality of both groups were analysed retrospectively. RESULTS: The number of cases with pure U type variable deceleration of PSGA group and PAGA group was respectively 24 (30.8%) and 10 (4.4%) (P < 0.01). The number of cases of U type variable deceleration accompanied with other abnormal CTG of both groups was respectively 10 (12.8%) and 1 (0.4%) (P < 0.01). Of PSGA group, the rate of cesarean section and forceps among cases of pure U type variable deceleration was lower than that of cases with U type variable deceleration accompanied with other abnormal CTG (20.8% vs 60.0%, P < 0.05. While, the rate of umbilical cord abnormality (44.1%) among 34 cases with U type variable deceleration was higher compared with that (20.5%) among 44 cases without U type variable deceleration (P < 0.05). CONCLUSIONS: U type variable deceleration is the characteristic FHR graph of PSGA during labor and is not the sign of fetal distress when not accompanied with other abnormal CTG.

Adult↗
PubMed2006

Labor characteristics and program costs of a successful diabetes disease management program.

BACKGROUND: Organizations have invested in disease management programs to improve quality and to reduce costs, but little is known about the labor characteristics and the program costs necessary to implement a program. OBJECTIVE: To examine the labor characteristics and the program costs of a successful diabetes disease management program. STUDY DESIGN: We performed a labor and cost analysis within a randomized controlled trial of a primary care-based diabetes disease management intervention. METHODS: Participants included 217 patients with type 2 diabetes mellitus and poor glycemic control (glycosylated hemoglobin levels, > or = 8.0%). The intervention group received 12 months of intensive management from clinical pharmacists and a diabetes care coordinator who provided education, applied algorithms for medication management, and addressed barriers to care. The control group attended a single session led by pharmacists, followed by usual care from their primary providers. The process outcomes included the number of patient care-related activities, time spent per patient, and number of drug titrations or additions. The program costs were calculated based on Bureau of Labor Statistics wage data using a sensitivity analysis. RESULTS: The disease management team performed a mean of 4.0 care-related activities for a mean of 38.6 minutes per patient per month for intervention patients and performed a mean of 1.1 care-related activities for a mean of 10.7 minutes per patient per month for control patients (P < .001). Intervention patients had a median of 7 drug titrations or additions during the study. The incremental program cost for the intervention was 36.97 dollars (sensitivity analysis, 6.22 dollars-88.56 dollars) per patient per month. CONCLUSION: A successful diabetes disease management program can be integrated into an academic clinic for modest labor and cost.

Adolescent↗
PubMed2006

[Molecular mechanisms of regulation uterine contractile activity during pregnancy and labor in mammals].

Main purpose of the investigation was to study basic mechanisms of regulation uterine contractile activity on various stages of gestation, labor and to determine nature of substances activating, inhibiting and modulating myometrium contractility. The study was carried out on 115 pregnant and not pregnant women, and women in labor, and on 45 newborns. The experiments analyzed hypothalamus and uterus of 100 white rats and brain of 45 newborn rats. Dynamics of neuropeptides and catecholamine contents was investigated in maternal and fetal blood and tissues on various levels of gestation, labor and delivery. The level of neiropeptide in the blood was determined by the method of high pressure liquid chromatography. In the myometrium functional indexes of adrenal receptors (affinity and sensitivity) and especially isometric contractions under influence of investigated substances were examined. Interaction of the neuropeptide with catecholamine was analyzed by means of radioligand binding. It was established that along with steroid hormones, monoamines and prostaglandins, neiropeptide systems play important part in contractile mechanisms during gestation, labor and adaptation of fetus to the out-of-uterine life, particularly influencing the functions of organs-effectors, as well as modulating biochemical processes in the cells. Based on the results of our investigation and existing literary data we have suggested protocols of neuroendocrine, paracrine and autocrine regulation of cell biochemical processes during gestation, labor and delivery.

Adrenocorticotropic Hormone↗
PubMed2006

[Study on the occupational stress norm and it's application for the marketing group, public service/safety group and production laborer group].

OBJECTIVE: A study of the occupational stress norm and it's application for the marketing group, public service/safety group and production laborer group. METHODS: In this study, cross-sectional study method is used, and a synthetic way of sorting and randomized sampling is adopted to deal with research targets (36 marketing group, 331 public service/safety group, 903 production laborer group). RESULTS: Descriptive statistics for OSI-R scale scores for the marketing group, public service/safety group and production laborer group were modulated. Scale raw score to T-score conversion tables derived from the OSI-R normative sample for marketing group public service/safety group and production laborer group were established. OSI-R profile from for marketing group, public service/safety group and production laborer group were established. For the ORQ and PSQ scales, scores at or above 70 indicate a strong levels of maladaptive stress and strain. Score in the range of 60 to 69 suggest middle levels of maladaptive stress and strain. Score in the range of 40 to 59 indicate normal levels of stress and strain. Score below 40 indicate a relative absence of occupational stress and strain. For the PRQ scales, score below 30 indicate a significant lack of coping resources. Score in the range of 30 to 39 suggest middle deficits in coping resources. Score in the range of 40 to 59 indicate average coping resources. Scores at or above 60 indicate a strong levels of coping resources. CONCLUSION: The authors combined subjective and objective environment match model of occupational stress. Different intervention measure should be take to reduce the occupational stress so as to improve the work ability.

Adolescent↗
PubMed1987

Testing local level labor force and unemployment projections.

The labor force projections perform well, even for small areas, which suggests that changes in local labor force participation rates can be approximated by national changes. In fact, the mean absolute percent errors are low even when the previously calculated population projections are used. The unemployment projections do not do as well, and using 1980 census labor force data instead of previously calculated labor force projections offers no improvement in the results. A two-step study is needed to determine why the errors are so large. First, the state level changes from 1970 to 1980 should be compared with national changes to determine the difference in unemployment rate changes by race and sex. Second, state level data on the occupational mix should be examined for the relationship between this and the changes in state level unemployment rates by race and sex. It is hypothesized that the first step will show that even state level changes in unemployment rates by race and sex cannot be well approximated by the national changes and the second step will show that some of the variation can be explained by state differences in occupational mix. Further studies should be made to determine how the calculation of national changes affects the results. Changes in labor force participation rates seem to follow trends, and therefore extrapolation may not have much effect on the results. Although using the actual changes in unemployment from 1970 to the latest year available as a proxy for the changes from 1970 to the target year may have a serious detrimental effect on the unemployment projections, if some of the variation in the national changes in race and sex can be explained and some adjustments made, the actual changes may be the best proxy to use.

Black or African American↗
PubMed1986

Labor time spent in foodservice activities in one hospital: a 12-year profile.

Labor minutes per meal equivalent and percentage of time spent in direct work, indirect work, delay time, and total time were determined in an annual study of foodservice workers in a community hospital. Twelve activity sampling studies (from 1973 through 1984) were conducted for 7 days (Monday through Sunday), usually during the second week of February. The conventional foodservice, with the cook/hot-hold method of food production and service, averaged about 10 minutes for direct work, 1 minute for indirect work, 2 minutes for delay time, and 13 total labor minutes per meal equivalent for the 12 years. The data were similar to those of the study in the 1960s, of conventional hospital foodservices, with high productivity, which averaged about 11 minutes for direct work, 1 minute for indirect work, 2 minutes for delay time, and 14 total labor minutes per meal equivalent. Data averaged from the 1973 through 1984 studies compared with the data from the 1960s study showed that transportation, cleaning, and service required the most labor time (total of 58% in this study and total of 62% in the 1960s study). Methods reported in this article may be applied in other foodservices to identify labor time spent in work and delay activities to establish productivity guidelines for a foodservice department.

Efficiency↗
PubMedDate not supplied

Labor force participation among registered nurses and women in comparable occupations.

Comparison of labor force participation of female nurses with women in comparable occupations showed no difference in overall participation rates. However, analysis by family life cycle did show differences: married nurses of all ages with young children were more likely to be in the labor force than those over age 35 without young children, while the reverse was true for married women in the comparison groups. Data were obtained from a pooled national sample survey of adult noninstitutionalized persons residing in the continental United States from 1972 through 1978 and 1980. Separate discriminant function analyses on nurses, teachers, and a composite group of other women using independent variables derived from a conceptual model of pushes and pulls into the labor force and labor force status as the dichotomous dependent variable were compared. Findings indicated that the presence of young children at home keeps married teachers and others out of the labor force but has no effect on married nurses.

Adolescent↗
PubMed1984

Labor time code for assembling and microwave heating menu items in a hospital galley.

Labor times for microwave-heating activities were developed by using Master Standard Data (MSD). Step 1 involved defining the layout of the actual hospital galley , dividing into small motions the labor activities involved in assembling menu items that would be microwave heated, and identifying basic elements for each motion. Step 2 was the development of seven macro elements under simulated conditions in the laboratory. In step 3, a stopwatch time study in the laboratory was used to verify MSD-predicted times for the seven macro elements. For the final step, a stopwatch time study was conducted under actual operating conditions in a hospital galley . Predicted time derived from laboratory simulation of microwave-heating activities indicated that it should take a foodservice employee 1.71 minutes to assemble menu items from two trays and heat the items by using two microwave ovens . Total labor time for assembling and microwave heating menu items under actual conditions in the hospital galley was similar to MSD-predicted times. Although labor times reported are specific for the cook/chill foodservice system used in this study, the methods and the code may be applied in other hospital foodservices to develop specific labor times for those facilities.

Food Handling↗
PubMed1983

An analysis of variations in U.S. fertility and female labor force participation trends.

This study is based on time series data from 1947-1977 on fertility and female labor force participation, and examines (a) the effects of male relative income and female earnings on the level and timing of fertility and female labor force participation, and (b) the relative importance of variations in relative income and female wage rates in explaining the fluctuations in both fertility and female labor supply. The results suggest that relative income exerts a significant positive effect on fertility and a negative effect on female work effort. However, female wage rates appear to be the dominant factor in explaining variations in fertility and female labor force participation over the past two decades, with increases in female earnings leading to both depressed fertility and increased labor force participation of women.

Age Factors↗
PubMed1980

Labor-force participation patterns of older self-employed workers.

Self-employed persons work in a less constrained environment than do most wage-and-salary employees. Generally they are not subject to compulsory retirement nor are they affected by institutional rules concerning labor supply. Data from the 1969 and 1971 interviews of the Retirement History Study show that the labor supply and retirement patterns of the self-employed are distinct from those of other workers. The self-employed (espeically "career" self-employed) nearing retirement age are less likely to be out of the labor force, and those who continue in the labor force have a wider variation in the number of hours worked per year. Downward flexibility in hours (the option for gradual retirement) may be an extremely valuable aspect of self-employed status, and one wonders whether other older workers would also choose this pattern if more flexible opportunities were available. Despite these differences, labor-supply decisions of the self-employed are found to be influenced by many of the same factors that affect the rest of the workforce--health, eligibility for social security and pension benefits, the wage rate, and the flow of asset.

Cross-Sectional Studies↗
PubMed1980

Mandatory retirement and labor-force participation of respondents in the Retirement History Study.

The Age Discrimination in Employment Act (ADEA) was amended in 1978 to prohibit mandatory retirement before age 70 in most occupations. The impact of this legislation on the probability of older persons remaining in the labor force is the primary concern of this article. Specifically, questions concerning which older workers are affected by mandatory-retirement provisions and the extent to which they are forced to retire and leave the labor force are examined. Tabular analysis of data from the Retirement History Study on persons aged 62-63 in 1969 shows significant variation in mandatory-retirement coverage between the public and private sectors and across industries, occupations, and demographic groups. Until age 65, the labor-force participation rate of those facing compulsory retirement is higher than or equal to that of those not covered but it drops significantly below the noncovered rate after 65. Logit analysis of the labor-force participation of persons before and after age 65 indicates that mandatory retirement at that age reduces the probability of retirement by approximately 16.7 percentage points for white men wage earners. This results in a decline in the labor-force participation rate of all men aged 66-67 of approximately 4 percentage points.

Age Factors↗
PubMedDate not supplied

Intravenous glucose infusion in labor does not affect maternal and fetal acid-base balance.

OBJECTIVE: This prospective randomized trial compares the effects of a 5% glucose solution or no infusion during labor on glucose levels, pH, pO2, pCO2, and base excess (BE) of normal pregnant women in early labor and at delivery, and on fetal cord blood. METHODS: Forty-three women were randomized to glucose infusion and 38 were controls. RESULTS: Starting glucose levels were independent from the fasting state. When no glucose supplementation was given, the labor itself was associated with a reduction of mean pH (from 7.42 to 7.36, P = 0.00001), mean pCO2 (from 25.7 to 24.4 mm Hg, P = 0.04), and mean BE (from -6.3 to -9.8 mEq/L, P = 0.00001), and an increase of capillary glucose (from a mean of 83 to 105 mg/dL, P = 0.00001). Infusions of glucose did not significantly alter maternal acid-base balance at delivery. pH, PO2, pCO2, and BE were similar in arterial and venous cord blood of both groups. No variables correlated with cord blood glucose levels or with glucose vein-artery difference. CONCLUSIONS: We conclude that a 5% glucose infusion does not significantly reduce maternal acidemia associated with vaginal delivery and therefore its use cannot be recommended, since maternal glucose is largely available during labor. Intrapartum glucose infusions do not alter the acid-base balance, when the fetus is well oxygenated.

Acid-Base Equilibrium↗
PubMed1989

5-Hydroxyeicosatetraenoic acid, leukotriene C4, and prostaglandin F2 alpha in amniotic fluid before and during term and preterm labor.

Arachidonic acid is metabolized by cyclooxygenase leading to prostaglandins and by lipoxygenases leading to hydroxyeicosatetraenoic acids (HETE) and leukotrienes (LT). Prostaglandins are potent uterine constrictors. 5-HETE and LTC4 also stimulate uterine contractions but their role in labor is not known. To estimate the activities of these pathways before parturition and their relationship to uterine contractility, amniotic fluid concentrations of 5-HETE, LTC4, and prostaglandin F2 alpha (PGF2 alpha) were determined in five chronically catheterized rhesus monkeys. Uterine contractility was continually assessed by recording changes in amniotic fluid pressure. The results obtained indicate the following conclusions: (1) 5-HETE and LTC4, but not PGF2 alpha, are associated with uterine contractility after preterm intrauterine surgery. Surprisingly, amniotic fluid PGF2 alpha, levels were nondetectable for 1 to 2 weeks after surgery. (2) 5-HETE and LTC4 are present in higher concentrations than PGF2 alpha in amniotic fluid. (3) 5-HETE, LTC4, and PGF2 alpha all increase with the onset of labor. Amniotic fluid concentrations of 5-HETE and LTC4 are significantly higher than those of PGF2 alpha before and during term and preterm labor. (4) Labor can occur with suppressed PGF2 alpha levels but with increasing 5-HETE and LTC4 levels. (5) These data suggest that 5-HETE and LTC4 are important components of the parturitional process.

Amniotic Fluid↗
PubMed1993

The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial.

OBJECTIVE: Our purpose was to determine the effect of epidural analgesia on nulliparous labor and delivery. STUDY DESIGN: Normal term nulliparous women in early spontaneous labor were randomized to receive either narcotic or epidural analgesia. RESULTS: When compared with the group receiving narcotic analgesia (n = 45), the group receiving epidural analgesia (n = 48) had a significant prolongation in the first and second stages of labor, an increased requirement for oxytocin augmentation, and a significant slowing in the rate of cervical dilatation. Epidural analgesia was associated with a significant increase in malposition (4.4% vs 18.8%, p < 0.05). Cesarean delivery occurred more frequently in the epidural group (2.2% vs 25%, p < 0.05), primarily related to an increase in cesarean section for dystocia (2.2% vs 16.7%, p < 0.05). CONCLUSIONS: In a randomized, controlled, prospective trial epidural analgesia resulted in a significant prolongation in the first and second stages of labor and a significant increase in the frequency of cesarean delivery, primarily related to dystocia.

Adult↗
PubMed1995

Salivary estriol as risk assessment for preterm labor: a prospective trial.

OBJECTIVE: Increased understanding of human parturition allows for novel approaches to (1) identification of women at increased risk for preterm birth and (2) development and controlled testing of etiology-based strategies to prevent preterm birth. STUDY DESIGN: Five hundred forty-two women were enrolled at five study sites in a prospective evaluation of salivary estriol in samples obtained weekly beginning at 22 weeks' gestation (Salest, Biex, Inc., Boulder, Colo.). Estriol concentrations were determined with a well-characterized enzyme-linked immunoassay. Women adjudged at either high risk or low risk for prematurity were evaluated through to delivery. RESULTS: A total of 267 women submitted serial samples that were analyzed; 241 women with singleton pregnancies submitted sufficient samples. Twenty-three women with singleton fetuses went into idiopathic preterm labor (without prior rupture of membranes) and were delivered preterm (mean 35 weeks' gestation); 182 were delivered at term (> or = 37 weeks' gestation). Mean (geometric) estriol concentrations were higher from 24 to 34 weeks in women with singleton pregnancies delivering preterm (p < 0.05). A surge in estriol concentrations occurred approximately 3 weeks before the onset of labor in both women delivering at term and those delivering preterm. This increase occurred approximately 4 weeks earlier in women delivered preterm versus term. Receiver-operator curve analyses showed that exceeding a 2.3 ng/ml saliva estriol level was associated with occurrence of preterm labor (71% sensitivity, 77% specificity, 23% false-positive rate). CONCLUSION: Detection of an early estriol surge or increased level (> or = 2.3 ng/ml) may be clinically helpful in identifying women at elevated risk for preterm labor and birth, allowing for evaluation of biologically based interventions in controlled trials.

Adult↗
PubMed1989

Initiation of labor with a moderately favorable cervix: a comparison between prostaglandin E2 gel and oxytocin.

This study compares prostaglandin E2 (PGE2) gel and oxytocin for the initiation of labor in term pregnancies with a moderately favorable cervix (Bishop score 5-8). Compared with a matched group, 48 cases treated with PGE2 gel (2.5 mg intravaginally) required significantly less or no oxytocin, had shorter first stages of active labor, and had no increased risk of uterine hyperstimulation or cesarean section. Initiation of labor with low dose PGE2 when the cervix is moderately favorable is less labor intensive and meets with more patient satisfaction.

Adult↗
PubMed1996

Latent labor with an unknown uterine scar.

OBJECTIVE: To determine if avoiding the augmentation of ineffective contractions in women with unknown uterine scars would decrease the risk of cesarean for protraction disorders, compared with awaiting the onset of spontaneous labor. METHODS: Term gravidas with one or two unknown uterine scars in early labor were randomized to nonintervention (N = 101) and intervention (N = 96) groups. Nonintervention subjects were discharged if cervical change did not occur within 4 hours. Intervention subjects were admitted. Contractions that persisted for 4 hours without cervical change were augmented with oxytocin. RESULTS: Intervention subjects received oxytocin significantly more often (82 versus 55%, P < .001) and had a statistically significantly higher rate of uterine scar separation (5 versus 0%, P = .03). There was no difference between the two groups in length of active labor (4.0 versus 4.25 hours) or incidence of cesarean delivery (16 versus 17%). CONCLUSION: The augmentation of ineffective contractions during latent labor in gravidas with an unknown uterine scar does not increase the rate of cesarean delivery, but it is significantly more likely to result in uterine scar separations.

Adult↗