天津职业大学文本 Working conditions, visual fatigue, and mental health among systems analysts in Sao Paulo, Brazil_眼屈光学

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ORIGINAL ARTICLE Working conditions, visual fatigue, and mental health among systems analysts in Sa˜o Paulo, Brazil L E Rocha, M Debert-Ribeiro .............................................................................................................................. . See end of article for authors’ affiliations ....................... Correspondence to: Prof. L E Rocha, Rua Alvaro Neto 168, Sa˜o Paulo 04112-070, Brazil; lysrocha@usp.br Accepted 13 January 2003 ....................... Occup Environ Med 2004;61:24–32 Aims: To evaluate the association between working conditions and visual fatigue and mental health among systems analysts living in Sa˜o Paulo, Brazil. Methods: A cross sectional study was carried out by a multidisciplinary team. It included: ergonomic analysis of work, individual and group interviews, and 553 self applied questionnaires in two enterprises. The comparison population numbered 136 workers in different occupations. Results: The study population mainly comprised young males. Among systems analysts, visual fatigue was associated with mental workload, inadequate equipment and workstation, low level of worker participation, being a woman, and subject’s attitude of fascination by the computer. Nervousness and intellectual performance were associated with mental workload, inadequate equipment, work environment, and tools. Continuing education and leisure were protective factors. Work interfering in family life was associated with mental workload, difficulties with clients, strict deadlines, subject’s attitude of fascination by the computer, and finding solutions of work problems outside work. Family support, satisfaction in life and work, and adequate work environment and tools were protective factors. Work interfering in personal life was associated with subject’s attitude of fascination by the computer, strict deadlines, inadequate equipment, and high level of work participation. Satisfaction in life and work and continuing education were protective factors. The comparison population did not share common working factors with the systems analysts in the regression analysis. Conclusions: The main health effects of systems analysts’ work were expressed by machine anthropomorphism, being very demanding, mental acceleration, mental absorption, and difficulty in dealing with emotions. Use of computers in Brazil started during the 1970s. Since then there has been a large increase of workers whose major task is computer related. Among professions that have grown in importance and number in the past decade is systems analysis, which involves continuously transforming existing languages into other more modern ones, as well as turning manual operations into computer systems. Programming the machine has lead to the development of a specific relationship between the professional and the equipment. Few studies1–3 have focused on the health consequences of analysts’ work. The study carried out by the National Institute of Occupational Safety and Health1 involved supervisors and systems analysts. Positive aspects found were: worker satisfaction; feeling that the machine was not only a tool but also a source of amusement; time flexibility; and the dynamic nature of the work. Negative aspects included troubled interpersonal relationships with superiors and quality of the equipment. Lack of availability of the terminal and slow response time of the system made it difficult meeting deadlines. Fugikaky2 pointed out the importance of mental workload among software engineers, mainly in the phase of system implementation; at that time professionals declared themselves as physically and mentally exhausted. Kawakami and colleagues3 studied the effects of work stressors on software engineers and programmers, observing that work overload and working conflicts were associated with depression and anxiety. Support from colleagues and ability in using the computer acted as protective factors. In Brazil, Merlo4 studied systems analysts of a data processing enterprise, observing that these professionals are under severe pressure from meeting strict production deadlines, management of the relationship with clients, and the fast changes undergone by computing products. The present study was requested from the Ministry of Labor by the Processing Data Enterprises Employees’ Union because of the lack of information on systems analysts’ working conditions in Brazil. It provided elements for the collective agreement between systems analysts and employers.5 The study aimed to evaluate possible associations between working conditions and visual fatigue, mental and psychosocial health of systems analysts. The study was intended to contribute to the understanding of mental health and psychosocial dimension of systems analysts as well as to clarify possible relationships between work and life outside work. METHODOLOGY The present investigation was a cross sectional study integrating qualitative and quantitative approaches designed and undertaken by a multidisciplinary team. Qualitative assessment The script of the semi-structured interview included life and work history, life conditions, leisure time and family organisation, detailed description of current work, health status, and workers’ expectations. The collective interviews were undertaken at the worksite. Individual interviews were carried out at the interviewee’s home, aiming to determine the relationship of the worker to his family. The interviewer was a social scientist trained in occupational health. Seventeen workers were interviewed. Median duration of the interview was three to four hours. 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The assessment of working conditions was based on the ergonomic analysis of the workplace including the observation of the workstation, environment, equipment, and work organisation. It was carried out by a professional trained in ergonomics according to Guerin’s methodology.6 Quantitative evaluation Study population The study was carried out in two data processing enterprises, one state owned with 347 professionals and one belonging to a private bank with 398 employees. In the latter, 341 (85.6%) analysts participated, whereas in the state agency 295 (85.0%) were included. Non-participation was due to vacation time, meetings with clients outside the worksite, training abroad, maternity leave, and absences. There were nine cases of explicit refusal. The total sample comprised 636 systems analysts in the two enterprises. A comparison population was selected among professionals of the same enterprise with similar wages. The objective of the procedure was to have a group for which life conditions were very similar to those of systems analysts. The comparison group was selected only in enterprise one, which graded occupations according to wage categories. The need to ensure salary comparability precluded the selection of a comparison group in enterprise two, as systems analysts’ salary level would only match those of managers from other enterprises pertaining to the financial group. Programmers, data entry operators, and computer operators were excluded from the comparison population due to their specific relationship with the computer. The comparison population comprised 215 workers, of which 147 (68.4%) participated in the study. Reasons for non-participation of subjects in the comparison population were the same as for systems analysts. There were 15 cases of refusal. Questionnaire A careful literature review of questionnaires related to video display terminal work,7 stress8 and hypertension research9 was carried out. Elements of semi-structured interviews and the assessment of working conditions, were also incorporated in the questionnaire. The questionnaire was tested with 10 systems analysts to evaluate understanding, and adequacy of contents. Due to the long time spent in filling out the questionnaire, the decision was made to split the original instrument into two forms. Self administered questionnaires were used; non-identification of subjects was guaranteed. The worksites were initially visited by the research team. At that time workers were informed of the objectives of the study and informed consent was requested. The questionnaires were filled in during working hours and with managers’ consent. Form one addressed social and demographic information such as gender, schooling, marital status, number of children, leisure activities, health, and morbidity. The required time for filling in was 15–20 minutes. On that occasion three consecutive blood pressure measurements were taken with a mercury manometer after a 10 minute rest in the sitting position. The second form, distributed on the following day, contained information on occupational history, working conditions that might generate distress and fatigue as well as work satisfaction, and personal and family life. The questionnaire items are given in the results section. Items were coded as always, frequently, sometimes, seldom, and never. Job satisfaction was given by self attribution. Filling in of this form took 30–40 minutes. Splitting the questionnaire in two forms reduced the amount of time spent in filling it in each day. On the other hand, it increased the number of non-respondents to one of the forms. A total of 636 participants answered at least one of the forms and 553 filled in both forms: 306 (90%) were in the private owned firm and 247 (84%) in the state owned. For the comparison population 136 (92%) filled in both forms. Data analysis Three sets of data were considered: working conditions, health aspects, and correlates of work and health. The latter ones were variables that were neither part of working conditions nor of health aspects. Family support, satisfaction in life, social and demographic characteristics were among them. Factor analysis was carried out to reduce the number of variables and determine the basic dimensions by selecting factors based on their importance in the explanation of phenomena. Factor rotation was based on the Varimax method and only variables with factor loads greater than 0.40 were considered. The analysis was carried out with subprogram Factor of the SPSS (Statistical Package for the Social Sciences) Program.10 Factors were extracted by means of the principal components method, with values higher than 1. In the factor analysis for the systems analysts, working conditions put together 87 variables from which 27 factors were extracted. Percentage of the total common variance was accounted for by 61.5%. From these, 13 were selected for the regression analysis. The second group of health aspects totalled 84 variables, from which 27 factors were extracted (total variance 63.3%), 12 factors being used in the Main messages N Visual fatigue was associated with mental workload, inadequate equipment and workstation, and low level of worker participation at work. N Mental and psychosocial health aspects were associated with mental workload, difficulties with clients, strict deadlines, inadequate equipment, and work environment. N The main health effects were expressed by machine anthropomorphism, being very demanding, mental acceleration, mental absorption, and difficulty in dealing with emotions. N Psychosocial aspects identified as specific by systems analysts were related to the kind of relationship with the computer. N Satisfaction in life and work was an important protective factor against mental and psychosocial health effects of systems’ analysts work. Policy implications N Occupational guidelines for systems analysts should incorporate not only environmental conditions, workroom, and equipment issues but also work organisation and psychosocial aspects. N As computer programming is extended it becomes important to acknowledge mental and psychosocial health issues for these professionals. N Systems analysts should be involved in elaboration and implementation of occupational health policies. 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regression. The third group corresponded to correlates of work and health variables; it grouped 63 variables into 24 factors (total variance 62.1%), 13 factors being selected for the regression analysis. For the comparison population, for working conditions there were 78 variables, resulting in 26 extracted factors (total variance 76.2%); 13 factors were selected for regression analysis. The second group included 80 variables on health aspects; 22 factors were extracted (total variance 75.2%), 12 factors being selected for regression analysis. Correlates of work and health factors grouped 62 variables, resulting in the extraction of 23 factors (total variance 72.6%), 14 of which were selected for regression analysis. For the presentation of results of factor analysis, factors selected for each group of variables are shown. Moreover, proportion of variance explained by the given factor, the proportion of variance regarding the chosen factors, and the sum of squares are presented. Variables included in each factor as well as their loads, or the weight associated with the factor will only be provided for those selected for the multiple regression analysis. Independent variables of regression analysis were factors regarding working conditions and correlates of work and health. Dependent variables were health aspects factors. Stepwise multiple regression11 was used with a forward strategy. According to this technique variables were introduced one by one until a predefined significance level of 0.05. Factors were selected for presentation on the basis of the amount of variance explained by them for systems analysts factor analysis. In regard to the comparison population the same health aspects were considered. Regression tables provided the degree of explanation (R), B values, their standard errors, and F values. The fit of the model was checked via case wise diagnostic statistics by Stata v. 6.0 software.12 RESULTS Social and demographic characteristics Table 1 shows that the sample of systems analysts included a larger number of subjects that were younger, more educated, and with less children when compared to the comparison population. Working conditions The production process in computing services is made up of information treatment on customers’ demands. The systems analyst is the one to whom the customer will request a given product, and who will also be in charge of the follow up of the services and their operational detailing. This means that the systems analysts are the link between the customer and the data processing enterprise. The task of the analyst was described by one of them as ‘‘an invisible work’’, taking the shape of documents and reports as final products. The comparison population included managers (32.1%), human resources analysts (23.7%), finance analysts (25.2%), and technicians (19.0%). Table 2 shows the factors related to systems analysts’ working conditions. Factors selected for presentation are: W3–7, W9, W11–12. The third factor (W3) grouped variables related to distress associated with time demands: deadlines (0.53), work overload (0.58), and irregular work schedules (0.44). Deadlines were related to the political and social impact of the product (0.57), work intensity (0.48), and pressure from clients (0.44). The fourth (W4) put together variables of distress associated with mental workload: constant work of the mind (0.85), thinking in detail (0.84), and high level of responsibility (0.63). The fifth factor (W5) was represented by workers’ participation in technical (0.70) and administrative (0.69) decisions, as well as in work planning (0.67). Table 1 Systems analysts and comparison population: gender, age group, schooling, marital status, and number of children Social and demographic characteristics Systems analysts Comparison population n% n% p Gender NS Males 328 (59.3) 71 (52.2) Females 225 (40.7) 65 (47.8) Age (years) ** ,0.001 18–24 60 (10.8) 1 (0.7) 25–34 262 (47.4) 62 (45.6) 35–44 184 (33.2) 56 (41.1) 45–56 47 (8.5) 17 (12.5) Schooling *** College (complete) 465 (84.1) 92 (67.7) College (incomplete) 72 (13.0) 25 (18.4) High school (complete) 16 (2.9) 14 (10.3) Elementary school 2 2 5 (3.7) Marital status NS Single 201 (36.3) 37 (27.2) Married 330 (59.7) 90 (66.2) Divorced/widow 22 (4.0) 9 (6.6) Number of children *** None 287 (51.9) 52 (38.2) One 60 (10.8) 41 (30.1) Two 127 (23.0) 34 (25.0) Three or more 79 (14.3) 9 (6.6) Total 553 (100) 136 (100) x2 . NS, not significant. **p,0.001, ***p,0.0001. 26 Rocha, Debert-Ribeiro www.occenvmed.com Downloaded from oem.bmjjournals.com on 4 August 2005

The sixth factor (W6) characterised the good quality of furniture, such as chairs (0.77) and table (0.65), leading to less fatigue due to uncomfortable posture (0.63). Work environment factor (W7) comprised adequate lighting (0.69), temperature (0.71), and noise (0.53) as well as good quality of working tools (0.41) and of the video terminal display image (0.48). Equipment (W9) was rated as a distress factor due to insufficient number of terminals (0.64), presence of obsolete equipment (0.65), and the frequency of breakdowns (0.47). Factor W11 included continuing technical education (0.71), human relationships education (0.67), and extra job dates (0.47). Relationship with clients (W12) was evaluated as negative because the latter were not able to inform their needs clearly (0.80) and did not acknowledge the difficulty involved in the systems analysts’ work (0.75). Table 3 shows the factors related to comparison populations’ working conditions. Factors selected for presentation were: Wc1, Wc7, Wc12. The first factor (Wc1) joined together variables related to the workstation perceived as positive by the comparison population: furniture, including table (0.82), chair (0.71), and layout (0.67); environmental conditions: temperature (0.76), noise (0.75), and lighting (0.67); working instruments (0.76) and the quality of video displays (0.62). Factor 7 (Wc7) gathered variables related to the equipment. Longer working periods at the computer (0.69) corresponded to higher frequency of complaints that the equipment is a factor of distress (0.78), the presence of filter screen (0.59), and uncomfortable posture (0.57). Factor 12 (Wc12) involved resolution of work problems while having a shower (0.73) and not in transportation (0.60). Table 4 shows the factors related to health aspects of systems analysts. Factors selected for presentation were: H1, H2, H4, H5. The first factor was visual fatigue (H1), including the following symptoms: eye tiredness (0.77), sensation of weight in the eyes (0.72), reduced visual acuity (0.72), eye burning (0.66), and visual fatigue (0.56). Factor 2 (H2) contained variables such as nervousness and intellectual performance: difficulty to focus (0.80), unstable attention (0.72), memory problems (0.69), irritability and nervousness (0.48). Factor 4 (H4) included work interfering in family life: getting home and wishing for nothing else than watching TV (0.79), not being able to ‘‘turn off’’ the mind from work (0.59), feeling that subject’s family does not follow his/her reasoning (0.74), and getting home very tired (0.69). Table 3 Factors related to working conditions: comparison population Factors (Wc) Proportion of variance explained (%)* Proportion of factors chosen Sum of squares Furniture, environment and equipment: good (Wc1) 10.02 18.32 4.599 Distress: work overload, client and colleagues (Wc2) 18.22 14.99 2.833 Relationship with superiors and colleagues: support (Wc3) 24.70 11.85 2.805 Workers’ participation (Wc4) 28.77 7.44 2.765 Work requirements: decision and responsibility (Wc5) 32.83 7.42 2.601 Continuing education: sufficient (Wc6) 36.32 6.38 2.424 Distress: equipment (Wc7) 39.42 5.67 2.372 Work satisfaction: enterprise capacity (Wc8) 42.39 5.43 2.194 Work satisfaction: acknowledgement, no routine work (Wc9) 45.08 4.92 2.077 Work requirements: memory, planning (Wc10) 47.67 4.73 2.061 Expectation to change of professional area (Wc11) 50.14 4.51 2.029 Solution of work problems outside work (Wc12) 52.50 4.31 1.955 Career: lack of satisfaction (Wc13) 54.70 4.02 1.954 Total 99.99 *Cumulated frequency. Table 2 Factors related to working conditions: systems analysts Factors (W) Proportion of variance explained (%)* Proportion of factors chosen Sum of squares Work satisfaction: capacity of enterprise, acknowledgement, no routine work, creativity (W1) 9.39 22.27 2.957 Relationship with superiors: support (W2) 16.51 16.88 2.680 Distress: deadlines, work overload, irregular work schedules (W3) 20.42 9.27 2.474 Distress: mental workload, responsibility (W4) 23.65 7.66 2.446 Workers’ participation (W5) 26.34 6.38 2.255 Workstation: good (W6) 28.71 5.62 2.155 Work environment and tools: good (W7) 30.99 5.41 2.065 Career: adequate in private firm and not adequate in public firm (W8) 33.06 4.91 2.005 Distress: equipment (W9) 34.99 4.58 1.960 Job requirements: initiative, decision, plans (W10) 36.85 4.41 1.944 Continuing education: sufficient (W11) 38.66 4.29 1.912 Relationship with clients: difficult (W12) 40.44 4.22 1.813 Relationship with colleagues: support (W13) 42.16 4.08 1.784 Total 99.98 *Cumulated frequency. Table 4 Factors related to health aspects: systems analysts Factors (H) Proportion of variance explained (%)* Proportion of factors chosen Sum of squares Visual fatigue (H1) 14.59 35.31 2.902 Symptoms: nervousness and intellectual performance (H2) 17.81 7.79 2.758 Search for medical care in the last 15 days (H3) 20.94 7.57 2.363 Work interfering in family life (H4) 23.77 6.85 2.347 Work interfering in personal life (H5) 26.45 6.48 2.208 Mental fatigue and exhaustion (H6) 28.93 6.00 2.182 Sleep disorders and work (H7) 31.39 5.95 2.077 Backache and neck ache (H8) 33.61 5.37 2.014 Symptoms: palpitation/chest pain (H9) 35.68 5.01 1.993 Appetite disturbance (H10) 37.67 4.82 1.847 Normal blood pressure (H11) 39.56 4.57 1.833 Fatigue (H12) 41.32 4.26 1.748 Total 100 *Cumulated frequency. Working conditions, visual fatigue, and mental health in systems analysts 27 www.occenvmed.com Downloaded from oem.bmjjournals.com on 4 August 2005

Factor 5 (H5) included work interfering in personal life: systems analyst being very demanding and expecting everything to be correct (0.83), being rigid and meticulous (0.78), expecting people to act as accurately as does a computer (0.52), and being annoyed at any sort of delay (0.40). Table 5 shows the factors related to health aspects of comparison population. Factors selected for presentation were: Hc1, Hc3, Hc8, Hc10. Factor 1 (Hc1) put together psychosomatic symptoms: palpitation (0.87), chest pain (0.80), trembling (0.79), sweating (0.76), irritability (0.79), anxiety (0.76), depressive states (0.75), memory problems (0.76), difficulty to focus (0.80), unstable attention (0.73), lack of orientation in time (0.71) and space (0.79), nausea and vomiting (0.84), stomach overloading (0.78), constipation and diarrhoea (0.81), dreams about work (0.80), stormy nights (0.79), sleeplessness (0.74), and lack of sexual interest (0.74). Factor 3 (Hc3) showed work interfering in family life: getting home and wishing nothing else than watching TV (0.79), not being able to ‘‘turn off’’ the mind from work (0.68), feeling that subject’s family does not follow his/her reasoning (0.63), and getting home very tired (0.61). Factor 8 (Hc8) included work interfering in personal life: being very demanding and expecting everything to be correct (0.79); being rigid and meticulous (0.73), and being annoyed at any sort of delay (0.45). Factor 10 (Hc10) showed visual fatigue (0.84) and eye tiredness (0.60). Table 6 shows the correlates of work and health factors of systems analysts. Factors selected for presentation were: I4–6, I8, I10, I13. The fourth factor (I4) included satisfaction with work (0.70), satisfaction with life (0.72), and renewed option for the same work (0.42). The fifth factor (I5) was associated with being a female (0.70) and having lower body mass index (0.75). Factor 6 included dedication to hobbies (0.74), sports (0.66), and arts (0.47). Factor 8 (I8) included resolution of work problems while having a shower (0.65) and during sleep (0.53). The family as a factor of emotional support for facing difficulties at work (0.75), and little time spent with the family (0.60) were included in factor 10 (I10). Factor 13 (I13) included variables concerning the relationship with the computer: fascination for the constant challenges it provides (0.75) and interpersonal relationships seen as easier with people of the same professional area (0.44). Table 7 shows the correlates of work and health factors of the comparison population. Factors selected for presentation were: I3, I5, I7, I8, I10. Table 5 Factors related health aspects: comparison population Factors Proportion of variance explained (%)* Proportion of factors chosen Sum of squares Psychosomatic symptoms: nervousness, digestive and sleep disorders (Hc1) 21.34 36.29 13.392 Backache, neck ache, and mental fatigue (Hc2) 27.97 11.28 2.595 Work interfering in family life (Hc3) 33.07 8.67 2.579 Search for medical care in the last 15 days (Hc4) 37.55 7.62 2.553 Relationship with the computer (Hc5) 40.92 5.73 2.548 Symptoms: cramp, dizziness (Hc6) 43.92 5.10 2.430 Physical Fatigue (Hc7) 46.87 5.02 2.399 Work interfering in personal life (Hc8) 49.57 4.59 2.331 Hospitalisation and sick leave due to stress (Hc9) 52.04 4.20 2.151 Visual fatigue (Hc10) 54.37 3.96 2.138 Normal blood pressure (Hc11) 56.65 3.88 2.033 Sleep disorder and work (Hc12) 58.80 3.66 2.015 Total 100 *Cumulated frequency. Table 6 Correlates of work and health factors: systems analysts Factors Proportion of variance explained (%)* Proportion of chosen factors (%) Sum of squares Family situation: married with children (I1) 8.01 19.10 3.383 Professional experience: young (I2) 12.32 10.28 2.190 Expectations as to professional change (I3) 16.03 8.85 1.969 Satisfaction in life and work (I4) 19.24 7.65 1.781 Women/lower body mass index (I5) 22.20 7.06 1.727 Leisure: hobby, sports, arts (I6) 24.98 6.63 1.725 Leisure: shopping; travel; TV/video; sleep (I7) 27.71 6.51 1.708 Solution of work problems outside work (I8) 30.31 6.20 1.595 Sleep and time commuting for work (I9) 32.87 6.10 1.499 Family as support (I10) 35.22 5.60 1.488 Leisure: reading and video/ no household fixing (I11) 37.51 5.46 1.487 Reason for choice profession (I12) 39.76 5.37 1.459 Relationship with computers: challenge (I13) 41.93 5.17 1.440 Total 100 *Cumulated frequency. Table 7 Correlates of work and health factors: comparison population Factors Proportion of variance explained (%)* Proportion of factors chosen (%) Sum of squares Family situation: married with children (Ic1) 7.40 13.63 3.351 Expectation of professional change (Ic2) 13.54 11.31 2.659 Computer at home (Ic3) 19.10 10.24 2.288 Professional choice (Ic4) 23.33 7.79 2.095 Relationship with computer (Ic5) 27.52 7.72 2.051 Solution of work problems outside work (Ic6) 31.12 6.63 1.932 Leisure: shopping, travel (Ic7) 34.64 6.49 1.927 Short time in the job (Ic8) 37.80 5.82 1.914 Young professionals (Ic9) 40.88 5.67 1.891 Leisure: TV, video (Ic10) 43.81 5.40 1.825 Satisfaction in life and work (Ic11) 46.60 5.14 1.812 Leisure: hobby/sports (Ic12) 49.33 5.03 1.802 Lower schooling (Ic13) 51.88 4.70 1.790 Male boss (Ic14) 54.27 4.40 1.783 Total 100 *Cumulated frequency. 28 Rocha, Debert-Ribeiro www.occenvmed.com Downloaded from oem.bmjjournals.com on 4 August 2005

Downloaded from oem.bmjjournals.com on 4 August 2005 Working conditions,visual fatigue,and mental health in systems analysts 29 Table 8 Regression on visual fatigue Variables (factors) SE B SigT R2 Systems analysts:visual fatigue(H) Distress:mental workload (W) +0.2106 0.0414 0.0000 0.0525 Workstation:good (We) -0.1773 0.0407 00000 00898 Women/lower body mass index (ls) +0.1519 0.0406 0.0002 0.1195 Distress:equipment [W) 40.1333 0.0412 0.0013 0.1360 Workers'participation (Ws) -0.1106 0.0412 0.0075 0.1457 Relationship with computers (3] +0.0889 0.0404 0.0279 0.1534 F=16.07 n=538df=6p<0.0001 A (constant)=+0.0003504 Co mparison population:visual fatigue (Hc Relationship with computer (lcs) +0.2252 0.1073 0.0381 0.0388 F=4.40n=109 d=1 P<00381 A(constant)=-0.02558 Factor 3 (Ic3)included having a computer at home for environment,and having a computer at home.Factors that extra work (0.93)or because of the children (0.92) reduced symptoms were leisure factors such as:shopping, Factor 5(Ics)was related to the computer:fascination by travelling,watching TV,and video. the constant challenges it provided (0.84)and its predict- Table 10 shows that among systems analysts,work ability (0.82). interfering in family life was associated with mental work- Leisure activities in factor 7(Ic)included travelling (0.77) load,strict deadlines,difficulty when dealing with clients, and going shopping (0.65).Factor 10 (Icio)encompassed inadequate work environment and tools,finding out solution watching TV (0.74),video (0.42),and other activities (0.47) of work problems outside,and the fascination exerted by the Factor 8 (Ics)is made out of short time both in current job computer.Family's emotional support,work and life satis- (0.76)and enterprise (0.42)and being born in Sao Paulo faction provided protection against the influence of work on (0.55) family life.For the comparison population work interfering in family life was associated with having a computer at home Regression analysis and short time both in the job and enterprise. Table 8 shows that among systems analysts,visual fatigue Among systems analysts,work interfering in personal life was associated with mental workload,inadequate equip- was associated with strict deadlines,inadequate equipment, ment,and being a woman.Lower occurrence of visual difficulty when dealing with clients,greater workers' symptoms was associated with adequate furniture and participation at work,and the fascination exerted by the greater workers'participation at work.The only factor computer.Factors that reduce the interference of work in associated with visual fatigue for both systems analysts and personal life were work and life satisfaction and continuing the comparison population was subjects'attitude of fascina- education seen as sufficient.For the comparison population tion in the face of the constant challenges provided by the work interfering in personal life was associated with short computer. time both in the job and enterprise,and finding out solutions Regression analysis for systems analysts in table 9 showed of work problems outside work (table 11). higher frequency of nervous symptoms and change in intellectual performance as associated with distress factors: DISCUSSION mental workload and equipment features.Factors that The present study detected associations between systems reduce the frequency of those symptoms were:work and life analysts'work with visual fatigue,mental,and psychosocial satisfaction,hobbies,sports and artistic activity;continuing health.The comparison population was important because it education felt as sufficient,adequate work environment,and showed that work factors associated with health aspects were tools.Among the comparison population,the symptoms of different for both groups.In the comparison population,only psychosomatic disorders were associated with the presence of psychosomatic symptoms were associated with working equipment as distress factor,adequate furniture and work conditions. Table 9 Regression analysis on nervousness and intellectual performance Variables (factors) SE B SigT Systems analysts(H2:nervousness and intellectual performance Satisfaction in life and work (l4) -0.2340 0.0401 0.0000 0.0851 Distress:mental worklood (W) +0.1959 0.0407 0.0000 0.1394 Distress:equipment (Wo) +0.1425 0.0400 0.0004 0.1604 Continuing education:adequate(W) -01222 00409 0.0029 0.1782 Work environment/tools:good [Wz) -0.1063 0.0399 0.0079 0.1884 Leisure:hobby,sports,ts( -00876 0.0394 00267 0.1958 F=21.59n=538 df=6p<0.0001 A (consiant)= -0.0000202 Comparison population (H):psychosomatic symptoms Distress:equipment (WCz) 0.3961 006.68 0.0000 0.2135 Furniture,environment:good (WC) +0.1755 0.0642 0.0074 0.2768 Computer at home(IC3) +0.1626 0.0639 0.025 0.3119 Leisure:shopping travel (IC,) -01A54 0.0648 00269 0.3422 Leisure:TV and video (IC1o) -0.1412 0.0654 0.0330 0.3702 F=12.34n=105d=5 p<0.0001 A(constant)= -016391 www.occenvmed.com

Factor 3 (Ic3) included having a computer at home for extra work (0.93) or because of the children (0.92). Factor 5 (Ic5) was related to the computer: fascination by the constant challenges it provided (0.84) and its predictability (0.82). Leisure activities in factor 7 (Ic7) included travelling (0.77) and going shopping (0.65). Factor 10 (Ic10) encompassed watching TV (0.74), video (0.42), and other activities (0.47). Factor 8 (Ic8) is made out of short time both in current job (0.76) and enterprise (0.42) and being born in Sa˜o Paulo (0.55). Regression analysis Table 8 shows that among systems analysts, visual fatigue was associated with mental workload, inadequate equipment, and being a woman. Lower occurrence of visual symptoms was associated with adequate furniture and greater workers’ participation at work. The only factor associated with visual fatigue for both systems analysts and the comparison population was subjects’ attitude of fascination in the face of the constant challenges provided by the computer. Regression analysis for systems analysts in table 9 showed higher frequency of nervous symptoms and change in intellectual performance as associated with distress factors: mental workload and equipment features. Factors that reduce the frequency of those symptoms were: work and life satisfaction, hobbies, sports and artistic activity; continuing education felt as sufficient, adequate work environment, and tools. Among the comparison population, the symptoms of psychosomatic disorders were associated with the presence of equipment as distress factor, adequate furniture and work environment, and having a computer at home. Factors that reduced symptoms were leisure factors such as: shopping, travelling, watching TV, and video. Table 10 shows that among systems analysts, work interfering in family life was associated with mental workload, strict deadlines, difficulty when dealing with clients, inadequate work environment and tools, finding out solution of work problems outside, and the fascination exerted by the computer. Family’s emotional support, work and life satisfaction provided protection against the influence of work on family life. For the comparison population work interfering in family life was associated with having a computer at home and short time both in the job and enterprise. Among systems analysts, work interfering in personal life was associated with strict deadlines, inadequate equipment, difficulty when dealing with clients, greater workers’ participation at work, and the fascination exerted by the computer. Factors that reduce the interference of work in personal life were work and life satisfaction and continuing education seen as sufficient. For the comparison population work interfering in personal life was associated with short time both in the job and enterprise, and finding out solutions of work problems outside work (table 11). DISCUSSION The present study detected associations between systems analysts’ work with visual fatigue, mental, and psychosocial health. The comparison population was important because it showed that work factors associated with health aspects were different for both groups. In the comparison population, only psychosomatic symptoms were associated with working conditions. Table 8 Regression on visual fatigue Variables (factors) B SE B Sig T R2 Systems analysts: visual fatigue (H1) Distress: mental workload (W4) +0.2106 0.0414 0.0000 0.0525 Workstation: good (W6) 20.1773 0.0407 0.0000 0.0898 Women/lower body mass index (I5) +0.1519 0.0406 0.0002 0.1195 Distress: equipment (W9) +0.1333 0.0412 0.0013 0.1360 Workers’ participation (W5) 20.1106 0.0412 0.0075 0.1457 Relationship with computers (I13) +0.0889 0.0404 0.0279 0.1534 F = 16.07 n = 538 df = 6 p,0.0001 A (constant) = +0.0003504 Comparison population: visual fatigue (Hc10) Relationship with computer (Ic5) +0.2252 0.1073 0.0381 0.0388 F = 4.40 n = 109 df = 1 p,00381 A(constant) = 20.02558 Table 9 Regression analysis on nervousness and intellectual performance Variables (factors) B SE B Sig T R2 Systems analysts (H2): nervousness and intellectual performance Satisfaction in life and work (I4) 20.2340 0.0401 0.0000 0.0851 Distress: mental workload (W4) +0.1959 0.0407 0.0000 0.1394 Distress: equipment (W9) +0.1425 0.0400 0.0004 0.1604 Continuing education: adequate (W11) 20.1222 0.0409 0.0029 0.1782 Work environment/tools: good (W7) 20.1063 0.0399 0.0079 0.1884 Leisure: hobby, sports, arts (I6) 20.0876 0.0394 0.0267 0.1958 F = 21.59 n = 538 df = 6 p,0.0001 A (constant) = 20.0000202 Comparison population (Hc1): psychosomatic symptoms Distress: equipment (WC7) +0.3961 0.0668 0.0000 0.2135 Furniture, environment: good (WC1) +0.1755 0.0642 0.0074 0.2768 Computer at home (IC3) +0.1626 0.0639 0.0125 0.3119 Leisure: shopping, travel (IC7) 20.1454 0.0648 0.0269 0.3422 Leisure: TV and video (IC10) 20.1412 0.0654 0.0330 0.3702 F = 12.34 n = 105 df = 5 p,0.0001 A(constant) = 20.16391 Working conditions, visual fatigue, and mental health in systems analysts 29 www.occenvmed.com Downloaded from oem.bmjjournals.com on 4 August 2005

Downloaded from oem.bmjjournals.com on 4 August 2005 30 Rocha,Debert-Ribeiro Table 10 Regression:work interfering in family life Variables (factors) SE B Sig T Systems analysts(H4):work interfering in family life Family as support (l1o) -0.3681 0.0394 00000 0.0860 Distress:mental workload (W,) +0.1590 00401 00001 0.1345 Relation with clients:difficult (W2) +0.1415 0.0394 0.0004 0.1611 Satisfaction in life and work (la) -0.1527 0.0387 00001 01870 Distress:deadlines/work overlood (W3l +0.1276 0.0405 0.0017 0.2029 Relationship with computer(Ia) 40.1248 0.0385 0003 0.264 Work environment/tools:good (Wz) -0.0974 0.0397 0.0144 0.2269 Solution of work problems outside [le) +0.0852 0.0389 0.0290 0.2338 F=20.22n=538df=8p<0.0001 A(constant)=+0.0002947 Comparison population (:work interfering in family life Computer at home (lca) +0.2764 0.0884 0.0023 0.0859 Short time in the job (lcal 40.2163 0.0926 0.0213 0.1299 F=8.06n=108df=2 p<0.0005A(constant)=-0.06917 Visual fatigue was common among systems analysts and psychological problems such as irritability,depression,ten- was also the most frequent complaint among video display sion,and severe fatigue.An investigation by Gredilla and terminal (VDT)users,according to Bergqvist and Knave'and Gonzalez"detected anxiety,sleep disorders,and poor mental Nishiyama. focus among systems analysts and computer programmers. This study also revealed a positive association between In the present study,behavioural changes identified visual complaints and reports of obsolete equipment and bad among systems analysts were sleep disorders and the conditions of furniture.Similar results were reported by difficulty of turning the mind off work problems. Jaschinski and colleagues"s and Hunting and colleagues. Reviewing sleep disorders,Wisner"reported that an intense Characteristics of the task and of work organisation were cognitive effort in the period that precedes night rest induced also associated with visual fatigue among systems analysts sleep difficulties and were also found by Villanueva and colleagues"and Work was viewed as interfering with family life in the Mocci and colleagues. present study as a result of the extension of work related Visual fatigue was shown by Rocha and Debert to be more intense mental absorption to extra-job life.Psychosocial frequent among female systems analysts,and was also aspects identified as specific by systems analysts were related observed by Knave and colleagues2 among computer user to the kind of relationship with the computer-an absorbing workers. one in which,by posing constant challenges to the profes- Computer work was associated with the presence of sional,the machine was viewed as inducing a search for musculoskeletal symptoms in different studies" and was perfection,either due to subject identification with the present in the activity of the systems analysts. computer or to a need for avoiding the consequences of Mental and psychosocial health among systems analysts errors.This kind of behaviour spilled over from work and deserved special attention.According to the World Health determined a search for perfectionism at home as well, Organisation,"associations between work and mental health leading to family conflicts observed in individual interviews. of VDT workers were defined as "stress related disorders" Some psychosocial aspects related to the contents of the and involved physiological,psychological,and behavioural work performed by systems analysts such as impatience and aspects.In the present study,stress related physiological mental acceleration also expressed themselves in personal disorders included among systems analysts were symptoms and family life.Feelings such as impatience and irritation, such as palpitation,chest pain,and appetite problems. reported by these workers in a wide range of situations as The psychological symptoms more frequently seen among "delay in being served",seem to fit to Rebecchi's"observa- systems analysts in the present study were irritability. tion of a"psychological dilation of the waiting time and a anxiety,and depression as well as mental and physical strong condensation of the working time,the former being a fatigue.By interviewing systems analysts,Cohen'observed consequence of the latter".According to the author,this was Table 11 Regression analysis on work interfering in personal life Variable(factors) B SE B Sig T R2 Systems analysts(Hs):work interfering in personal life Relafionship with computer (3) +0.2009 0.0416 0.0000 0.0402 Distress:deadlines/work overload [Wa) +0.1256 0042 0.00X0 0.0633 Satisfaction in work and life ( -0.1153 0.0430 0.0076 0.0762 Workers'participation (Ws) +0.1230 0.0429 0.0043 00892 Distess:equipment (W) +0.0953 00417 00727 00980 Confinuing education:adequate [W -0.0901 0.0428 0.0358 0.1055 F=10.45n=538df=6p<0.0001 A (constant)=+0.0000555 Comparison population(Hca):work interfering in personal life Solution of work problems outside [Wc2) +0.2764 0.0822 0.0011 0.0863 Short time in the job (lce) +0.2377 0.0863 00069 0.1464 F=9.26n=108d=2 p<0.0002A(constant)=-0.02213 www.occenvmed.com

Visual fatigue was common among systems analysts and was also the most frequent complaint among video display terminal (VDT) users, according to Bergqvist and Knave13 and Nishiyama.14 This study also revealed a positive association between visual complaints and reports of obsolete equipment and bad conditions of furniture. Similar results were reported by Jaschinski and colleagues15 and Hunting and colleagues.16 Characteristics of the task and of work organisation were also associated with visual fatigue among systems analysts and were also found by Villanueva and colleagues17 and Mocci and colleagues.18 Visual fatigue was shown by Rocha and Debert to be more frequent among female systems analysts,19 and was also observed by Knave and colleagues20 among computer user workers. Computer work was associated with the presence of musculoskeletal symptoms in different studies21–23 and was present in the activity of the systems analysts. Mental and psychosocial health among systems analysts deserved special attention. According to the World Health Organisation,24 associations between work and mental health of VDT workers were defined as ‘‘stress related disorders’’ and involved physiological, psychological, and behavioural aspects. In the present study, stress related physiological disorders included among systems analysts were symptoms such as palpitation, chest pain, and appetite problems. The psychological symptoms more frequently seen among systems analysts in the present study were irritability, anxiety, and depression as well as mental and physical fatigue. By interviewing systems analysts, Cohen1 observed psychological problems such as irritability, depression, tension, and severe fatigue. An investigation by Gredilla and Gonzalez25 detected anxiety, sleep disorders, and poor mental focus among systems analysts and computer programmers. In the present study, behavioural changes identified among systems analysts were sleep disorders and the difficulty of turning the mind off work problems. Reviewing sleep disorders, Wisner26 reported that an intense cognitive effort in the period that precedes night rest induced sleep difficulties. Work was viewed as interfering with family life in the present study as a result of the extension of work related intense mental absorption to extra-job life. Psychosocial aspects identified as specific by systems analysts were related to the kind of relationship with the computer—an absorbing one in which, by posing constant challenges to the professional, the machine was viewed as inducing a search for perfection, either due to subject identification with the computer or to a need for avoiding the consequences of errors. This kind of behaviour spilled over from work and determined a search for perfectionism at home as well, leading to family conflicts observed in individual interviews. Some psychosocial aspects related to the contents of the work performed by systems analysts such as impatience and mental acceleration also expressed themselves in personal and family life. Feelings such as impatience and irritation, reported by these workers in a wide range of situations as ‘‘delay in being served’’, seem to fit to Rebecchi’s27 observation of a ‘‘psychological dilation of the waiting time and a strong condensation of the working time, the former being a consequence of the latter’’. According to the author, this was Table 10 Regression: work interfering in family life Variables (factors) B SE B Sig T R2 Systems analysts (H4): work interfering in family life Family as support (I10) 20.3681 0.0394 0.0000 0.0860 Distress: mental workload (W4) +0.1590 0.0401 0.0001 0.1345 Relation with clients: difficult (W12) +0.1415 0.0394 0.0004 0.1611 Satisfaction in life and work (I4) 20.1527 0.0387 0.0001 0.1870 Distress: deadlines/work overload (W3) +0.1276 0.0405 0.0017 0.2029 Relationship with computer (I13) +0.1248 0.0385 0.0013 0.2164 Work environment/tools: good (W7) 20.0974 0.0397 0.0144 0.2269 Solution of work problems outside (I8) +0.0852 0.0389 0.0290 0.2338 F = 20.22 n = 538 df = 8 p,0.0001 A (constant) = +0.0002947 Comparison population (Hc3): work interfering in family life Computer at home (Ic3) +0.2764 0.0884 0.0023 0.0859 Short time in the job (Ic8) +0.2163 0.0926 0.0213 0.1299 F = 8.06 n = 108 df = 2 p,0.0005 A (constant) = 20.06917 Table 11 Regression analysis on work interfering in personal life Variable (factors) B SE B Sig T R2 Systems analysts (H5): work interfering in personal life Relationship with computer (I13) +0.2009 0.0416 0.0000 0.0402 Distress: deadlines/work overload (W3) +0.1256 0.0421 0.0030 0.0633 Satisfaction in work and life (I4) 20.1153 0.0430 0.0076 0.0762 Workers’ participation (W5) +0.1230 0.0429 0.0043 0.0892 Distress: equipment (W9) +0.0953 0.0417 0.0227 0.0980 Continuing education: adequate (W11) 20.0901 0.0428 0.0358 0.1055 F = 10.45 n = 538 df = 6 p,0.0001 A (constant) = +0.0000555 Comparison population (Hc8): work interfering in personal life Solution of work problems outside (Wc12) +0.2764 0.0822 0.0011 0.0863 Short time in the job (Ic8) +0.2377 0.0863 0.0069 0.1464 F = 9.26 n = 108 df = 2 p,0.0002 A (constant) = 20.02213 30 Rocha, Debert-Ribeiro www.occenvmed.com Downloaded from oem.bmjjournals.com on 4 August 2005

Downloaded from oem.bmjjournals.com on 4 August 2005 Working conditions,visual fatigue,and mental health in systems analysts 31 an"absolutely decisive"aspect of computerised work,which, On the other hand,this study also analysed protective by increasing quantitatively the workload,also increased the factors that help professionals cope with stress:work consumption of psychic energy impressively. satisfaction and leisure activities.Work satisfaction was Software program design imposed logical reasoning. reported as an important element by system analysts and was formal,binary,detailed thinking and the need to predict associated with fewer symptoms of nervousness and less the possible results of every single computer operation.This interference of work in personal and family life.The type of reasoning was referred by Rebecchi's discussion on association between lower frequency of symptoms and higher language:""questions and sequences of operations formu- level of work satisfaction was also observed by Fraser and lated by the machine have little in common with everyday Elias and Cail. use of our cognitive abilities.Interactive conversation is Despite the complexity of the concept of work satisfaction, reduced to a simple exchange of information suppressing all it was related among systems analysts,to the meaning of aspects of informality and redundancy that are necessary in work and to professional acknowledgement,especially in human interaction". terms of the significance attributed to the final product, One of the aspects described by both systems analysts and which is sometimes referred to as "a son'. the comparison population relates to the "anthropomorphi- Leisure activities were reported as being part of the sation"also discussed by Rebecchi:""the man is alone in workers'individual strategies to facilitate "turning the mind front of the machine,in a position of dependence and, off"work,to reduce mental strain at work and to improve the mainly,in a situation in which he sort of 'anthropomor- relationship within the family sphere. phises'the machine.At first an electronic brain,the After the discussion of the results at the light of world computer is turned into a brain and slowly,subtly,almost literature we turn now to the identification of the theoretical unconsciously,into a person" framework of the present study.Despite the many different With regard to the association of work and mental health, approaches with which stress research has been carried out, the findings of this study showed similarities with we chose the one by Kalimo,"who considers stress as a Seligmann-Silva's"description of mental acceleration which unbalance between the subjects and his environment. consists in conditioning the mind to work in such a rhythm, According to this concept,stress is not only seen as a result and with the same reasoning of the machines,that the of exogenous factors,but as a dynamic product of a particular operator becomes more and more accelerated,working faster combination between,on the one hand,the social and and faster. physical environment and the individual,his personality,his In this study,one important aspect of the psychosocial behaviour pattern and life history,on the other hand. dimension was the difficulty expressed by the systems This theoretical framework was shown to be broad enough analysts in dealing with emotions associated with attitudes for the evaluation of psychosocial factors involved in the such as being "demanding,critical,perfectionist,and metho- dical"with themselves and others (family members,collea- complex reality of systems analysts'work.A new methodo- logical approach included interviews which allowed the gues,boss).This kind of interference of work on personal and disclosure of individuals'subjective dimension and the family life has been described under different denominations, incorporation to the questionnaire of elements that would such as “emotional erosion”(Frankenhaeuser) and "alexithimia"(Karasek and Theorell).30 otherwise remain unnoticed. Frankenhaeuser"stated,with regard to "emotional ero- One limitation of the present study was the small size of the comparison population and the fact that it was recruited sion'',that special attention should be given to risks involved from only one enterprise.Some of the differences found in overstimulation,as they may lead to important con- sequences on the emotional sphere:"When we are exces- between the two groups might be organisation specific. sively bombarded with strong and frequent stimuli the Heterogeneity of the comparison population lead to the response of the nervous system gradually weakens;the gathering,through factor analysis,of different dimensions in stimuli lose their impact,and reactions diminish.The phy- the same factor.On the other hand,greater homogeneity of siological effect of stress becomes less intense and the feeling the systems analysts'sample allowed the grouping in of discomfort decreases.The same happens with the feelings different factors of specific aspects of each theme. of involvement,empathy and consideration for others.The The cross sectional design was chosen because it is a process is an 'invisible'one,and the gradual wear and tear of suitable method for symptom survey."Limitations of the the subject's capacity of psychological involvement may be study include its narrow scope (two data processing unnoticed." enterprises),the inclusion of active professionals only,and Karasek and Theorell described "alexithimia"as a the difficulties around the time sequence of events in the difficulty in expressing and distinguishing one's own feelings cross sectional design. and the inability to express emotions.These authors also Inferences based on cross sectional studies may be limited reported the inhibition of emotional expressions as associated The associations found in the present study between systems with heart disease,especially coronary disease. analysts'work with visual fatigue,mental health,and the All the aspects of mental and psychosocial health among work interfering with personal and family life,must be systems analysts were associated with time pressure, confirmed in a prospective study. constant and intense mental effort,and the specific relation- ship with the computer.These aspects varied according to the ACKNOWLEDGEMENTS personality,nature of activities,characteristics of work We are grateful to Antonio de Castro Bruni for statistical assistance organisation,as well as organisational culture.Smith' the Safety and Health Department of the Ministry of Labour of Brazil explored how psychosocial aspects of video display terminal and the Medical Research Laboratory (LIM 40)of the Medical School work were related to job stress and their consequences for of the University of Sao Paulo for financial support.We are grateful for the valuable comments of the reviewers:David Hosmer,Deborah mental and physical health. Salerno,and Philip Tucker. This study points out several aspects on mental and psychosocial health associated with the work of systems analysts that may be extended to professionals responsible Authors'affiliations for designing web pages or those involved in computer L E Rocha,Faculdade de Medicina,University of Sao Paulo,Brazil programming. M Debert-Ribeiro,Federal University of Sao Paulo,Brazil www.occenvmed.com

an ‘‘absolutely decisive’’ aspect of computerised work, which, by increasing quantitatively the workload, also increased the consumption of psychic energy impressively. Software program design imposed logical reasoning, formal, binary, detailed thinking and the need to predict the possible results of every single computer operation. This type of reasoning was referred by Rebecchi’s discussion on language:27 ‘‘questions and sequences of operations formulated by the machine have little in common with everyday use of our cognitive abilities. Interactive conversation is reduced to a simple exchange of information suppressing all aspects of informality and redundancy that are necessary in human interaction’’. One of the aspects described by both systems analysts and the comparison population relates to the ‘‘anthropomorphisation’’ also discussed by Rebecchi:27 ‘‘the man is alone in front of the machine, in a position of dependence and, mainly, in a situation in which he sort of ‘anthropomorphises’ the machine. At first an electronic brain, the computer is turned into a brain and slowly, subtly, almost unconsciously, into a person’’. With regard to the association of work and mental health, the findings of this study showed similarities with Seligmann-Silva’s28 description of mental acceleration which consists in conditioning the mind to work in such a rhythm, and with the same reasoning of the machines, that the operator becomes more and more accelerated, working faster and faster. In this study, one important aspect of the psychosocial dimension was the difficulty expressed by the systems analysts in dealing with emotions associated with attitudes such as being ‘‘demanding, critical, perfectionist, and methodical’’ with themselves and others (family members, colleagues, boss). This kind of interference of work on personal and family life has been described under different denominations, such as ‘‘emotional erosion’’ (Frankenhaeuser29) and ‘‘alexithimia’’ (Karasek and Theorell).30 Frankenhaeuser29 stated, with regard to ‘‘emotional erosion’’, that special attention should be given to risks involved in overstimulation, as they may lead to important consequences on the emotional sphere: ‘‘When we are excessively bombarded with strong and frequent stimuli the response of the nervous system gradually weakens; the stimuli lose their impact, and reactions diminish. The physiological effect of stress becomes less intense and the feeling of discomfort decreases. The same happens with the feelings of involvement, empathy and consideration for others. The process is an ‘invisible’ one, and the gradual wear and tear of the subject’s capacity of psychological involvement may be unnoticed.’’ Karasek and Theorell30 described ‘‘alexithimia’’ as a difficulty in expressing and distinguishing one’s own feelings and the inability to express emotions. These authors also reported the inhibition of emotional expressions as associated with heart disease, especially coronary disease. All the aspects of mental and psychosocial health among systems analysts were associated with time pressure, constant and intense mental effort, and the specific relationship with the computer. These aspects varied according to the personality, nature of activities, characteristics of work organisation, as well as organisational culture. Smith31 explored how psychosocial aspects of video display terminal work were related to job stress and their consequences for mental and physical health. This study points out several aspects on mental and psychosocial health associated with the work of systems analysts that may be extended to professionals responsible for designing web pages or those involved in computer programming. On the other hand, this study also analysed protective factors that help professionals cope with stress: work satisfaction and leisure activities. Work satisfaction was reported as an important element by system analysts and was associated with fewer symptoms of nervousness and less interference of work in personal and family life. The association between lower frequency of symptoms and higher level of work satisfaction was also observed by Fraser32 and Elias and Cail.33 Despite the complexity of the concept of work satisfaction, it was related among systems analysts, to the meaning of work and to professional acknowledgement, especially in terms of the significance attributed to the final product, which is sometimes referred to as ‘‘a son’’. Leisure activities were reported as being part of the workers’ individual strategies to facilitate ‘‘turning the mind off’’ work, to reduce mental strain at work and to improve the relationship within the family sphere. After the discussion of the results at the light of world literature we turn now to the identification of the theoretical framework of the present study. Despite the many different approaches with which stress research has been carried out, we chose the one by Kalimo,34 who considers stress as a unbalance between the subjects and his environment. According to this concept, stress is not only seen as a result of exogenous factors, but as a dynamic product of a particular combination between, on the one hand, the social and physical environment and the individual, his personality, his behaviour pattern and life history, on the other hand. This theoretical framework was shown to be broad enough for the evaluation of psychosocial factors involved in the complex reality of systems analysts’ work. A new methodological approach included interviews which allowed the disclosure of individuals’ subjective dimension and the incorporation to the questionnaire of elements that would otherwise remain unnoticed. One limitation of the present study was the small size of the comparison population and the fact that it was recruited from only one enterprise. Some of the differences found between the two groups might be organisation specific. Heterogeneity of the comparison population lead to the gathering, through factor analysis, of different dimensions in the same factor. On the other hand, greater homogeneity of the systems analysts’ sample allowed the grouping in different factors of specific aspects of each theme. The cross sectional design was chosen because it is a suitable method for symptom survey.35 Limitations of the study include its narrow scope (two data processing enterprises), the inclusion of active professionals only, and the difficulties around the time sequence of events in the cross sectional design. Inferences based on cross sectional studies may be limited. The associations found in the present study between systems analysts’ work with visual fatigue, mental health, and the work interfering with personal and family life, must be confirmed in a prospective study. ACKNOWLEDGEMENTS We are grateful to Antonio de Castro Bruni for statistical assistance, the Safety and Health Department of the Ministry of Labour of Brazil, and the Medical Research Laboratory (LIM 40) of the Medical School of the University of Sa˜o Paulo for financial support. We are grateful for the valuable comments of the reviewers: David Hosmer, Deborah Salerno, and Philip Tucker. Authors’ affiliations ..................... L E Rocha, Faculdade de Medicina, University of Sa˜o Paulo, Brazil M Debert-Ribeiro, Federal University of Sa˜o Paulo, Brazil Working conditions, visual fatigue, and mental health in systems analysts 31 www.occenvmed.com Downloaded from oem.bmjjournals.com on 4 August 2005

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天津职业大学文本 Working conditions, visual fatigue, and mental health among systems analysts in Sao Paulo, Brazil_眼屈光学

天津职业大学 文本 Working conditions, visual fatigue, and mental health among systems analysts in Sao Paulo, Brazil_眼屈光学

天津职业大学文本 Working conditions, visual fatigue, and mental health among systems analysts in Sao Paulo, Brazil_眼屈光学