Job Stress and High-Sensitivity C-Reactive Protein as an Indicator of Chronic Inflammation among LG Electronics Company Workers in Ismailia City

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1 Med. J. Cairo Univ., Vol. 82, No. 1, March: , Job Stress and High-Sensitivity C-Reactive Protein as an Indicator of Chronic Inflammation among LG Electronics Company Workers in Ismailia City BASSMA A. IBRAHIM, M.Sc.*; RASHA F. ABDELLAH, M.D.*; SOHA E. YOUNIS, M.D.** and AMANI W. EL-DIN, M.D.* The Departments of Community & Occupational Medicine* and Clinical Pathology**, Faculty of Medicine, Suez Canal University Abstract Background: Occupational stress has become issue of great concern over the last decade, both internationally and nationally. Objectives: The current study was conducted to determine the prevalence of the job stress among LG Electronics Company workers in Ismailia city, Egypt. Furthermore, it explored the relationship between job stress and high-sensitivity C- reactive protein concentrations as indicator of chronic inflammation. Methods: A cross-sectional study was carried out in LG Electronics Company in Ismailia city. A total of 264 workers were included. All of them were males. A structured interview questionnaire measuring the sociodemographic characteristics, work characteristics, assessment of the job stress using Job Content Questionnaire was used. C-reactive protein (CRP) concentration was measured as an indicator of chronic inflammation. Results: The prevalence of high job strain in Electronics Company workers was 33.7%. Electronics workers in high strain group were significantly younger in age (28.74±4.87 years) compared to those in non high strain group (30.43±5.42 years), (p<0.05). Workers in high strain group had significantly shorter duration of employment (5.94±2.43 years) as compared to those in non high strain group (7.75±4.96 years) with p<0.05. There was statistically significant association between social support and high job stress (p<0.01) with 65% of high strain workers got low social support from others. In current study, high-sensitivity C-reactive protein concentrations were increased in high strain workers (median= mg/dl); but this increase was not statistically significant (p=0.056) compared to non high strain workers (median=0.95mg/dl). Conclusion: A high proportion of electronics workers experienced high job strain and several factors in the workplace posed significant relationships with job strain in these workers. Key Words: Job stress High-sensitivity C-reactive protein (hs CRP) Social support. Correspondence to: Dr. Rasha F. Abdellah, Department of Community & Occupational Medicine, Suez Canal University, Ismailia, Egypt Introduction JOB stress is becoming an increasingly important occupational health problem [1]. Job stress can be defined as the harmful physical and emotionally responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker [2]. The electronics industry workers are one of several occupational groups who report disproportionately high levels of job stress. Several characteristics of electronics work contribute to the development of a stress reaction such as the fast and unvarying pace of work in assembly lines, the repetitive and monotonous nature of work [3]. The results of a study of work stress and well-being in electronics workers in Taiwan showed that 27.5% of the workers were under stress in the workplace [4].The National Institute on Occupational Safety and Health (1999) linked stress with physiological conditions such as cardiovascular diseases, stroke, increased susceptibility to infections, gastrointestinal tract problems, stomach ulcer, diabetes, sleeping disorders, asthma, immune system disease, concentration problems, burnout and depression [5]. The association of both acute and chronic stress with the pathogenesis and exacerbation of common disease such as atherosclerosis, diabetes mellitus and asthma appears to be mediated, at least in part, by an enhanced inflammatory reaction, with a corresponding raise in the inflammatory markers such as (fibrinogen, C-reactive protein) increase in association with both acute and chronic stress [6]. 157

2 158 Job Stress & High-Sensitivity C-Reactive Protein as an Indicator In a study of psychosocial and behavioral predictors of inflammation in middle-aged and older Adults, there was a positive association between perceived stress and CRP [7]. Also a study of allostatic load and work conditions showed that elevated concentrations of CRP had been found in people with higher job demands [8]. The present study was conducted to determine the prevalence of the job stress among LG Electronics Company workers in Ismailia city and to describe extend of job stress (job demand, job control and social support) among them. Furthermore, it explored the relationships between job stress and high-sensitivity C-reactive protein concentrations as indicator of chronic inflammation. Subjects and Methods A cross-sectional study was carried out in LG Electronics Company in Ismailia City, Egypt. Two hundred and sixty four workers with at least one year experience in their position were included using systematic random sample technique. Subjects were admitted to the study after excluding who known to have certain medical problems such as inflammatory, cardiovascular, rheumatic or peripheral blood diseases, previous stroke or cancer, and mental crisis and diabetes. With exclusion of subjects who reported regularly taking of medications such as antipsychotic medications, statins (for the lowering of blood cholesterol), aspirin, steroids or antibiotics, because these medications have an impact on the levels C-reactive protein. A structured interview questionnaire measuring the sociodemographic characteristics, work characteristics, and assessment of the job stress using Job Content Questionnaire was used including job demands scale, job control scale and social support scale [9]. The quantitative determination of C- reactive protein (CRP) concentration in Participants' blood samples was done by a microplate immuneenzymometric assay. Data were collected during the period from May to August Results Table (1) illustrates the distribution of sociodemographic characteristics and occupational characteristics among the studied electronics company workers. All were males. The mean age of the studied workers was 29.86±5.29 years, and 69.7% of them were married. Moreover, majority of workers (83%) had completed secondary education. Their work history revealed that the mean duration of employment was 7.14±4.36 years. Furthermore, the mean working hours was of was 40.59±1.1 hours per week. Table (1): Distribution of sociodemographic characteristics and occupational characteristics among the studied electronics company workers (n=264). Sociodemographic characteristics Range Marital status: Single Married Widowed and divorced Educational status: Primary and preparatory Secondary High education Occupational characteristics Duration of employment in years: Hours worked/week: n=89 (33.7%) No. of workers (n=264) ±5.29 The prevalence of job strain in Electronics Company workers is shown in Fig. (1). A proportion (33.7%) of workers was classified under the high strain group while 66.3% of workers classified under the non high strain group including the active job strain, passive job strain, low job strain categories. Non high job strain High job strain n=175 (66.3%) Fig. (1): Prevalence of job strain among the studied electronics company workers (n=264). Differences in sociodemographic characteristics and occupational characteristics in high strain and non high strain workers are shown in Table (2). It shows that electronics workers in high strain group were significantly younger in age (28.74±4.87 years) compared to those in non high strain group (30.43±5.42 years). With respect to marital status, 73% of high strain workers were married while 68% of non high strain workers were married, with no statistically significant difference. Secondary education represented the main educational level in both groups. Furthermore, workers in high strain group had significantly shorter duration of employment (5.94±2.43 years) as compared to those in non high strain group (7.75±4.96 years). % ± ±1.10

3 Bassma A. Ibrahim, et al. 159 Table (2): Distribution of sociodemographic characteristics and occupational characteristics among workers with high job strain and non high job strain. Sociodemographic characteristics High job strain (n=89) N (%) Non high job strain (n=175) N (%) Statistical test value p value Age in years: 28.74± ±5.42 Mann-whitney test= * Marital status: Single 21 (23.6) 54 (30.9) Fisher's exact test= Married 65 (73.0) 119 (68.0) Widowed & divorced 3 (3.4) 2 (1.1) Occupational characteristics Duration of employment in years: 5.94± ±4.96 Median 6 7 Mann-whitney test= * Hours worked/week: 40.60± ±1.21 Median Mann-whitney test= * = Statistically significant at p<0.05. Table (3) displays the association between job strain and social support. It shows that there was statistically significant association between social support and high job stress with 65% of high strain workers got low social support from others. Table (3): Social support among workers with high job strain and non high job strain. High job Non high job Social strain strain Statistical p support (n=89) (n=175) test value value N (%) N (%) High 31 (34.8) 105 (60.0) Low 58 (65.2) 70 (40.0) * = Statistically significant at p<0.05. x 2 = * Table (4) displays the association between high job strain and high-sensitivity C-reactive protein level. It shows that high-sensitivity C-reactive protein concentrations among high job strain workers (median= mg/dl) was higher than non high job strain workers (median=0.95mg/dl) with statistically insignificant difference (p=0.056). Table (4): High-sensitivity C-reactive protein concentrations among workers with high job strain and non high job strain. High job Non high job Hs CRP strain strain Statistical p (mg/dl) (n=89) (n=175) test value value N (%) N (%) Mann-whitney Median 1.10 (1.49) 0.95 (0.86) test= (IQ Range) Hs CRP = High-sensitivity C-reactive protein. IQ = Interquartile. Predictors for high job strain as detected by logistic regression analysis are represented in Table (5). The table shows that short duration of employment in years was a predictor for high job strain (ß= 0.161) In addition, the low social support was a predictor for high job strain (ß= 1.045). Also the marital status (ß=1.208), educational status (ß= 1.547), exposure to noise (ß=1.841), and exposure to metal fumes (ß=2.809) were predictors for high job strain. Table (5): Logistic regression analysis of independent predictors of high job strain among electronics workers. Predictor ß p value OR (95% CI) Marital status ( ) Educational status ( ) Duration of ( ) employment in years Social support ( ) Exposure to noise ( ) Exposure to metal ( ) fumes Constant Model χ 2 = <0.001 Discussion Based on Karasek's job strain model, the prevalence of high job strain among the current participant workers in the Electronics Company was found to be 33.7%. On the other hand, there was a lower prevalence of job strain among workers in a Thai electronic factory; Jirachewee mentioned that the prevalence of job strain was 23.6% [10].

4 160 Job Stress & High-Sensitivity C-Reactive Protein as an Indicator Moreover, Gonzalez et al., found that 26.3% of the electronics workers were under stress in the workplace [11]. Furthermore, the prevalence of work stress in Taiwan electronics workers was found to be 27.5% [12]. Shams and El-Masry assessed the prevalence of job stress and burnout among a group of Egyptian university career anesthesiologists, they found that more than two-thirds of the respondents (69.4%) were encountering job stress [13]. The variation in the prevalence of job strain may be attributed to the differing circumstances of workers and attitudes that could be unique for these workplaces and their workers. Furthermore, the findings of the current study showed that participating electronics workers suffering from high strain were significantly younger in age (28.74±4.87 years) compared to those in non high strain group (30.43±5.42 years), (p=0.048). This may be because age is a dynamic variable, which influences the factor of learning, development of skills, potentiality, working efficiency and effectiveness [14]. This finding also is in consistent with that of Cheng et al., who found that, younger age is a risk factor for perceived occupational stress [15]. Yeh et al., [16] concluded that younger workers had higher levels of job stress. Moreover, Wang et al., [17] found that occupational stress decreased significantly with increased age of university teachers. The results of the current study indicated that workers in high strain group had significantly shorter duration of employment (5.94±2.43 years) as compared to those in non high strain group (7.75±4.96 years). This finding was supported by Zukri and Hassim [18] who observed that stress group, had significantly less duration of service compared to no stress group. Furthermore, Aziah et al., [19] found that the high strain group of laboratory technicians had significantly shorter total duration of employment compared to those in non-high strain group. The current study revealed that there was statistically significant association between social support and high job stress (p<0.001). Near two thirds of participants with high strain (65%) got low social support from others. In the conceptualization of coping patterns, social support is one method of emotion management. The finding of the current study was supported by that of a crosssectional study conducted in a central province of Thailand. It revealed that workers with low supervisor social support were more likely to develop job strain than those with high supervisor social support [20]. In current study, high-sensitivity C-reactive protein concentrations were increased in high strain workers (median=1.10mg/dl); but this increase was not statistically significant (p=0.056) compared to non high strain workers (median=0.95mg/dl). Repeated episodes of acute or chronic psychological stress can lead to a chronic inflammatory process [21]. The association of both acute and chronic stress with the pathogenesis and exacerbation of common disease states such as atherosclerosis and asthma appears to be mediated, at least in part, by an enhanced inflammatory response. Inflammation as a potential mediating mechanism in the relation between stress and CVD has been extensively elaborated [22,23]. Finding of the present study is consistent with that of McDade et al., [7], who found that perceived stress was positively associated with CRP. This agrees with Janszky et al., [24] study which indicated that participants having stress showed higher levels of hs CRP (2.79 vs. 1.83mg/l). Conclusion: This study found a high prevalence of high job strain among Electronics Company workers (33.7%). Electronics workers in high job strain group were significantly younger in age compared to those in non high job strain group. Moreover, workers in high job strain group had significantly shorter duration of employment as compared to those in non high job strain group. In addition, there was statistically significant association between social support and high job stress. The current study showed that highsensitivity C-reactive protein concentrations were higher in high strain workers; but this increase was not statistically significant compared to non high strain workers. Recommendations: Based on the findings of the present study, the following recommendations are proposed: 1- Organizing an occupational stress committee in the company. The committee should meet on an ongoing basis. The objectives of the committee can include: Improving the work environment, organizing a stress management program about: Stress and its associated health effects; and coping and stress reduction skills, such as relaxation exercise and cognitive techniques. 2- Increasing employees sense of control through: Involving employees in planning and sharing of performance information of the work place.

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