A classification of components of workplace disability management programs: results from a systematic review

PURPOSE

This paper presents results from a Campbell systematic review on the nature and effectiveness of workplace disability management programs (WPDM) promoting return to work (RTW), as implemented and practiced by employers. A classification of WPDM program components, based on the review results, is proposed.

METHODS

Twelve databases were searched between 1948 to July 2010 for peer-reviewed studies of WPDM programs provided by employers to re-entering workers with occupational or non-occupational illnesses or injuries. Screening of articles, risk of bias assessment and data extraction were conducted in pairs of reviewers. Studies were clustered around various dimensions of the design and context of programs.

RESULTS

16,932 records were identified by the initial search. 599 papers were assessed for relevance. Thirteen studies met inclusion criteria. Twelve peer reviewed articles (two non-randomized studies, and ten single group experimental before and after studies), including ten different WPDM programs informed the synthesis of results. Narrative descriptions of the included program characteristics provided insight on program scope, components, procedures and human resources involved. However, there were insufficient data on the characteristics of the sample and the effect sizes were uncertain. A taxonomy classifying policies and practices around WPDM programs is proposed.

CONCLUSION

There is insufficient evidence to draw conclusions on the effectiveness of employer provided WPDM programs promoting RTW. It was not possible to determine if specific program components or specific sets of components are driving effectiveness. The proposed taxonomy may guide future WPDM program evaluation and clarify the setup of programs offered to identify gaps in existing company strategies.

Cross-cultural adaptation of the Work Role Functioning Questionnaire to Spanish spoken in Spain

PURPOSE

The Work Role Functioning Questionnaire (WRFQ) is a tool developed in the United States to measure work disability and assess the perceived impact of health problems on worker ability to perform jobs. We translated and adapted the WRFQ to Spanish spoken in Spain and assessed preservation of its psychometric properties.

METHODS

Cross-cultural adaptation of the WRFQ was performed following a systematic 5-step procedure: (1) direct translation, (2) synthesis, (3) back-translation, (4) consolidation by an expert committee and (5) pre-test. Psychometric properties were evaluated by administering the questionnaire to 40 patients with different cultural levels and health problems. Applicability, usability, readability and integrity of the WRFQ were assessed, together with its validity and reliability.

RESULTS

Questionnaire translation, back translation and consolidation were carried out without relevant difficulties. Idiomatic issues requiring reformulation were found in the instructions, response options and in 2 items. Participants appreciated the applicability, usability, readability and integrity of the questionnaire. The results indicated good face and content validity. Internal consistency was satisfactory for all subscales (Cronbach's alpha between 0.88 and 0.96), except for social demands (Cronbach's alpha = 0.56). Test-retest reliability showed good stability, with intraclass correlation coefficients between 0.77 and 0.93 for all subscales. Construct validity was considered preserved based on the comparison of median scores for each patient group and subscale.

CONCLUSIONS

Our results indicate the cross-cultural adaptation of the WRFQ to Spanish was satisfactory and preserved its psychometric properties, except for the subscale of social demands, whose internal consistency should be interpreted with caution.

Confirmatory factor analysis of the Work Limitations Questionnaire (WLQ-25) in Workers' Compensation Claimants with chronic upper-limb disorders

PURPOSE

To examine the factorial validity of the Work Limitations Questionnaire (WLQ-25) among workers' compensation claimants with chronic upper-limb disorders.

METHODS

Attendees of the WSIB Shoulder and Elbow Specialty clinic in Toronto, Ontario, Canada, completed a survey that includes the WLQ-25 [4 subscales: time-management (TM), physical demands (PD), mental-interpersonal (MI), and output demands (OD)]. Confirmatory factor analyses (n = 2262) were conducted to evaluate and compare alternative 4- and 5-factor WLQ-25 structures [MI subscale intact vs. separated into mental demands (MD) and interpersonal demands (IP) subscales]. Model fit indices, saliency of factor loadings, and convergent/divergent validity of latent factors (r = 0.4 - 0.85 expected) were concurrently assessed.

RESULTS

The 4-factor WLQ-25 showed acceptable model fit after allowing the residuals of a pair of PD items to correlate (CFI = 0.924, TLI = 0.915, RMSEA = 0.057, SRMR = 0.054); however, significantly lower-than-expected correlations between the PD factor and all other factors (r = -0.11 - -0.03) were also observed. Model fit for the 5-factor WLQ-25 was even more optimal (CFI = 0.934, TLI = 0.925, RMSEA = 0.053, SRMR = 0.051), with MD and IP factors correlating at r = 0.83.

CONCLUSIONS

Evidence of factorial validity was demonstrated by the WLQ-25; however, users should be attentive of an instrumentation issue that could be directly related to the psychometric performance of its PD subscale.

Prognostic factors for successful work functioning in the general working population

PURPOSE

To help workers to stay at work in a healthy productive and sustainable way and for the development of interventions to improve work functioning, it is important to have insight in prognostic factors for successful work functioning. The aim of this study is to identify prognostic factors for successful work functioning in a general working population.

METHODS

A longitudinal study (3 months follow-up) was conducted among the working population (N = 98). Work functioning was assessed with the Work Role Functioning Questionnaire 2.0 (WRFQ). The total score was categorized as follows: 0-90; >90 ≤95; and >95-100 (defined as 'successful work functioning'). Ordinal logistic regression analyses were performed to examine bivariate relationships between potential prognostic factors and the dependent variable (successful work functioning) to identify potential prognostic factors for the multivariate models (p < 0.10). A stepwise approach was used to introduce the variables in the multiple ordinal regression analyses.

RESULTS

Baseline work functioning and work ability were significant prognostic factors for successful work functioning at 3 months follow-up. No prospective associations were identified for psychological job demands and supervisor social support with successful work functioning.

CONCLUSION

To our knowledge this is the first longitudinal study to identify prognostic factors for successful work functioning in the general working population. High work ability is predictive for future successful work functioning, independent of baseline work functioning.

Mortality following unemployment in Canada, 1991-2001

BACKGROUND

This study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians.

METHODS

We conducted a cohort study over an 11-year period among a broadly representative 15% sample of the non-institutionalized population of Canada aged 30-69 at cohort inception in 1991 (888,000 men and 711,600 women who were occupationally active). We used cox proportional hazard models, for six cause of death categories, two consecutive multi-year periods and four age groups, to estimate mortality hazard ratios comparing unemployed to employed men and women.

RESULTS

For persons unemployed at cohort inception, the age-adjusted hazard ratio for all-cause mortality was 1.37 for men (95% confidence interval (CI): 1.32-1.41) and 1.27 for women (95% CI: 1.20-1.35). The age-adjusted hazard ratio for unemployed men and women was elevated for all six causes of death: malignant neoplasms, circulatory diseases, respiratory diseases, alcohol-related diseases, accidents and violence, and all other causes. For unemployed men and women, hazard ratios for all-cause mortality were equivalently elevated in 1991-1996 and 1997-2001. For both men and women, the mortality hazard ratio associated with unemployment attenuated with age.

CONCLUSIONS

Consistent with results reported from other long-duration cohort studies, unemployed men and women in this cohort had an elevated risk of mortality for accidents and violence, as well as for chronic diseases. The persistence of elevated mortality risks over two consecutive multi-year periods suggests that exposure to unemployment in 1991 may have marked persons at risk of cumulative socioeconomic hardship.

Response to Weinstock and Slatin's (2012) critique of IWH-NIOSH systematic review of the effectiveness of OSH training

This commentary responds to the recent critique by Weinstock and Slatin [1] of our systematic review on the effectiveness of occupational safety and health (OSH) training conducted jointly by the Institute for Work & Health (IWH) in Canada and the National Institute for Occupational Safety and Health (NIOSH) in the United States [2, 3]. We address misunderstandings of our perspectives on training, especially empowerment training, and the evaluation of such training.

The cross-cultural adaptation of the work role functioning questionnaire to Dutch

OBJECTIVE

The study objectives were to perform a cross-cultural adaptation of the Work Role Functioning Questionnaire, a health-related work outcome measure, into Dutch and to assess the questionnaire's reliability and validity in the Dutch context (WRFQ-DV).

PARTICIPANTS

40 workers with a health problem (duration > one month).

METHODS

The WRFQ translation and adaptation were conducted using a systematic approach with the following steps: forward translation, synthesis, back-translation, consolidation of translations with expert committee, and pre-testing. To evaluate the comprehensibility, usability, applicability and completeness of the translated questionnaire, a total of 40 interviews with workers with a health problem were performed.

RESULTS

The questionnaire translation was conducted without major difficulties. During the process, questionnaire instructions were modified and 5 items reformulated based on the participants' responses. Participants were positive on the comprehensibility, usability, applicability and completeness of the questionnaire, and also made suggestions for the further development of the WRFQ-DV. Furthermore, the study shows promising results concerning the psychometric properties of the WRFQ-DV (e.g. Cronbach's alphas for the subscales between 0.70 and 0.91, and good content validity).

CONCLUSIONS

The results indicate that the cross-cultural adaptation of the WRFQ-DV was successful and that the psychometric properties of the translated version are promising.

Systematic review of intervention practices for depression in the workplace

DESIGN

Systematic Review.

OBJECTIVE

To determine which intervention approaches to manage depression in the workplace have been successful and yielded value for employers in developed economies.

DATA SOURCES

We searched MEDLINE, EMBASE, CINAHL, Central, PsycINFO, and Business Source Premier up to June 2010 using search terms in four broad areas: work setting, depression, intervention, and work outcomes.

STUDY SELECTION

Two independent reviewers selected potential articles that met the following criteria: working age individuals with mild or moderate depression; interventions or programs that were workplace-based or could be implemented and/or facilitated by the employer; inclusion of a comparator group in the analysis; outcomes of prevention, management, and recurrences of work disability or sickness absence, and work functioning.

METHODS

Two reviewers independently reviewed each article for quality and extracted data using standardised forms. Following guidelines from the GRADE Working Group, the quality of evidence addressing each outcome was graded as high, moderate, low, or very low on the basis of six criteria: study design, risk of bias, consistency, generalisability, data precision, and economic benefit. Using this information and following Cochrane Collaboration guidelines, the findings for each intervention were summarised and key messages were developed.

RESULTS

We identified ten randomised trials and two non-randomised studies from various countries and jurisdictions that evaluated a wide range of intervention practices. The evidence was graded as "very low" for all outcomes identified. Therefore, no intervention could be recommended.

CONCLUSIONS

To date, there is insufficient quality of evidence to determine which interventions are effective and yield value to manage depression in the workplace.

A replicated field intervention study evaluating the impact of a highly adjustable chair and office ergonomics training on visual symptoms

OBJECTIVE

Examine the effects of two office ergonomics interventions in reducing visual symptoms at a private sector worksite.

METHODS

A quasi-experimental study design evaluated the effects of a highly adjustable chair with office ergonomics training intervention (CWT group) and the training only (TO group) compared with no intervention (CO group). Data collection occurred 2 and 1 month(s) pre-intervention and 2, 6 and 12 months post-intervention. During each data collection period, a work environment and health questionnaire (covariates) and daily health diary (outcomes) were completed. Multilevel statistical models tested hypotheses.

RESULTS

Both the training only intervention (p<0.001) and the chair with training intervention (p=0.01) reduced visual symptoms after 12 months.

CONCLUSION

The office ergonomics training alone and coupled with a highly adjustable chair reduced visual symptoms. In replicating results from a public sector worksite at a private sector worksite the external validity of the interventions is strengthened, thus broadening its generalizability.

A field intervention examining the impact of an office ergonomics training and a highly adjustable chair on visual symptoms in a public sector organization

OBJECTIVE

Examine the effect of a multi-component office ergonomics intervention on visual symptom reductions.

METHODS

Office workers were assigned to either a group receiving a highly adjustable chair with office ergonomics training (CWT), a training-only group (TO) or a control group (C). A work environment and health questionnaire was administered 2 and 1 month(s) pre-intervention and 3, 6, and 12 months post-intervention. Multi-level statistical models tested hypotheses.

RESULTS

The CWT intervention lowered daily visual symptoms (p < 0.01) post-intervention. The TO group did not significantly differ from the control group. The CWT group differed significantly from the TO group (p = 0.01) post-intervention.

CONCLUSION

Workers who received a highly adjustable chair and office ergonomics training had reduced visual symptoms and the effect was maintained through twelve months post-intervention. The lack of a training-only group effect supports implementing training in conjunction with the highly adjustable chair to reduce visual symptoms.

Attitudes towards disability management: A survey of employees returning to work and their supervisors

OBJECTIVES

Return to work after a leave on disability is a common phenomenon, but little is known about the attitudes of employees or their supervisors towards the disability management process. We report on employee and supervisor feedback from one disability management experience.

PARTICIPANTS

389 consecutive employees from the Ontario offices of a single private Canadian insurance company returning to work from short-term disability, and their supervisors.

METHODS

We surveyed employees and their supervisors about their experience with, and attitudes towards, the disability management process.

RESULTS

Of those surveyed, 88 employees and 75 supervisors provided data (response rates of 22.6% and 19.3% respectively). The majority of respondents (79.1% of employees and supervisors) endorsed positive attitudes towards their disability management experience. More than 25% of employees disagreed with the following three items: case managers contributed to recovery, case managers removed barriers to recovery, and sufficient support was provided in the return to work process. More than 25% of employees and managers reported that a commitment to modify an unhelpful work situation was not followed through.

CONCLUSION

The majority of participating employees returning to work from short-term disability, and their supervisors, reported a high level of satisfaction with the disability management process. Areas that may benefit from attention include some aspects of case manager-employee interaction and ensuring that support during the return to work process is provided, including modification to work situations when appropriate.

The 11-item workplace organizational policies and practices questionnaire (OPP-11): examination of its construct validity, factor structure, and predictive validity in injured workers with upper-limb disorders

BACKGROUND

Reliable and valid measurement of workplace organizational policies and practices (OPPs) is needed to evaluate their influences on the prevention and management of occupational injuries.

METHODS

Injured workers (n = 614) attending an upper-limb specialty clinic operated by the Workplace Safety & Insurance Board of Ontario were recruited for a 1-year study. The OPP-11, completed at baseline, was examined for scaling properties (floor/ceiling effects, internal consistency, and item-convergent/discriminant validity), construct validity, and factor structure. Predictive validity for longitudinal work disability was examined using multivariable logistic regressions.

RESULTS

Strong scaling properties were observed for the OPP-11. High internal consistency (Cronbach's alpha = 0.80-0.90) and expected associations with comparator constructs were evident. A 4-domain structure (fit statistics: CFI = 0.98, TLI = 0.97, and RMSEA = 0.06) was supported. Higher OPP-11 predicted more favorable 12-month work disability outcomes, after adjusting for demographic and health attributes.

CONCLUSIONS

The OPP-11 is valid for use in upper-limb disorders. Expanding the ergonomic practices domain could be considered.

Mechanical systems versus smoking bans for secondhand smoke control

INTRODUCTION

Despite international efforts to implement smoking bans, several national legislations still allow smoking and recommend mechanical systems, such as ventilation and air extraction, to eliminate secondhand smoke (SHS) health-related risks. We aimed to quantify the relative contribution of mechanical systems and smoking bans to SHS elimination.

METHODS

A cross-sectional study was conducted in randomly selected establishments from 4 Mexican cities (3 with no ban). SHS exposure was assessed using nicotine passive monitors. Establishment characteristics, presence of mechanical systems, and enforcement of smoking policies were obtained through direct observation and self-report. Multilevel models were used to assess relative contributions to SHS reduction.

RESULTS

Compared with Mexico City, nicotine concentrations were 3.8 times higher in Colima, 5.4 in Cuernavaca, and 6.4 in Toluca. Mechanical systems were not associated with reduced nicotine concentrations. Concentration differences between cities were largely explained by the presence of smoking bans (69.1% difference reduction) but not by mechanical systems (-5.7% difference reduction).

CONCLUSIONS

Smoking bans represent the only effective approach to reduce SHS. Tobacco control regulations should stop considering mechanical systems as advisable means for SHS reduction and opt for complete smoking bans in public places.

Preventing chronic disease in the workplace: a workshop report and recommendations

Chronic disease is the leading cause of death in the United States. Risk factors and work conditions can be addressed through health promotion aimed at improving individual health behaviors; health protection, including occupational safety and health interventions; and efforts to support the work-family interface. Responding to the need to address chronic disease at worksites, the National Institutes of Health and the Centers for Disease Control and Prevention convened a workshop to identify research priorities to advance knowledge and implementation of effective strategies to reduce chronic disease risk. Workshop participants outlined a conceptual framework and corresponding research agenda to address chronic disease prevention by integrating health promotion and health protection in the workplace.

Avoidable mortality for causes amenable to medical care, by occupation in Canada, 1991-2001

OBJECTIVE

To describe the incidence of avoidable mortality for causes amenable to medical care among occupation groups in Canada.

METHOD

A cohort study over an 11-year period among a representative 15% sample of the non-institutionalized population of Canada aged 30-69 at cohort inception. Age-standardized mortality rates for causes amenable to medical care and all other causes of death were calculated for occupationally-active men and women in five categories of skill level and 80 specific occupational groups as well as for persons not occupationally active.

RESULTS

Age-standardized mortality rates per 100,000 person-years at risk for causes amenable to medical care and for all other causes were 132.3 and 218.6, respectively, for occupationally-active women, and 216.6 and 449.3 for occupationally-active men. For causes amenable to medical care and for all other causes, for both sexes, there was a gradient in mortality relative to the five-level ranking by occupational skill level, but the gradient was less strong for women than for men. Across the 80 occupation minor groups, for both men and women, there was a linear relationship between the rates for causes amenable to medical care and the rates for all other causes.

CONCLUSIONS

For occupationally-active adults, this study found similar gradients in mortality for causes amenable to medical care and for all other causes of mortality over the period 1991-2001. Avoidable mortality is a valuable indicator of population health, providing information on outcomes pertinent to the organization and delivery of health care services.

[Perception over smoke-free policies amongst bar and restaurant representatives in central Mexico]

OBJECTIVE

To analyze the perceptions and appreciations over smoke-free environments of restaurant and bar managers from four cities in central Mexico.

MATERIAL AND METHODS

Managers from 219 restaurants and bars from Mexico City, Colima, Cuernavaca and Toluca were surveyed about smoke-free environments opinions and implementation. Simultaneously, environmental nicotine was monitored.

RESULTS

The majority of surveyed managers considered public places should be smoke-free, although more than half were concerned with potential economic loses. Implementation of smoke-free environments was more frequent in Mexico City (85.4%) than in the other cities (15.3% overall), with consequently lower environmental nicotine concentrations.

CONCLUSION

Managers acknowledge the need to create smoke-free environments. Concerns over economic negative effects derived from the prohibition could explain, at least partially, the rejection of this sector towards the implementation of this type of policy.

Musculoskeletal symptoms among mobile hand-held device users and their relationship to device use: A preliminary study in a Canadian university population

The study aims were, in a population of university students, staff, and faculty (n = 140), to: 1) determine the distribution of seven measures of mobile device use; 2) determine the distribution of musculoskeletal symptoms of the upper extremity, upper back and neck; and 3) assess the relationship between device use and symptoms. 137 of 140 participants (98%) reported using a mobile device. Most participants (84%) reported pain in at least one body part. Right hand pain was most common at the base of the thumb. Significant associations found included time spent internet browsing and pain in the base of the right thumb (odds ratio 2.21, 95% confidence interval 1.02-4.78), and total time spent using a mobile device and pain in the right shoulder (2.55, 1.25-5.21) and neck (2.72, 1.24-5.96). Although this research is preliminary, the observed associations, together with the rising use of these devices, raise concern for heavy users.

Daily self-reports resulted in information bias when assessing exposure duration to computer use

BACKGROUND

Self-reported exposure duration to computer use is widely used in exposure assessment, and this study examined the associated information bias in a repeated measures setting.

METHODS

For 3 weeks, 30 undergraduate students reported daily cumulative computer-use duration and musculoskeletal symptoms at four random times per day. Usage-monitor software installed onto participant's personal computers provided the reference measure. We compared daily self-reported and software-recorded duration, and modeled the effect of musculoskeletal symptoms on observed differences.

RESULTS

The relationships between daily self-reported and software-recorded computer-use duration varied greatly across subject with Spearman's correlations ranging from -0.22 to 0.8. Self-reports generally overestimated computer use when software-recorded durations were less than 3.6 hr, and underestimated when above 3.6 hr. Experiencing symptoms was related to a 0.15-hr increase in self-reported duration after controlling for software-recorded duration.

CONCLUSIONS

Daily self-reported computer-use duration had a weak-to-moderate correlation with software-recorded duration, and their relationship changed slightly with musculoskeletal symptoms. Self-reports resulted in both non-differential and differential information bias.

Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time

BACKGROUND

Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries.

METHODS

A systematic review used a best evidence synthesis approach to address the question: "do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?"

RESULTS

The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with "no effect" were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with "negative effects".

CONCLUSION

It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.

Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector

INTRODUCTION

Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards.

METHODS

A systematic review of the literature used a best evidence synthesis approach to address the general question "Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?" This was followed by an evaluation of the effectiveness of specific interventions.

RESULTS

The initial search identified 8,465 articles, for the period 1980-2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006-2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health.

CONCLUSIONS

The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.

Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions

INTRODUCTION

This systematic review was conducted to identify effective occupational health and safety interventions for small businesses.

METHODS

The review focused on peer-reviewed intervention studies conducted in small businesses with 100 or fewer employees, that were published in English and several other languages, and that were not limited by publication date. Multidisciplinary members of the review team identified relevant articles and assessed their quality. Studies assessed as medium or high quality had data extracted, which was then synthesized.

RESULTS

Five studies were deemed of medium or high quality, and proceeded to data extraction and evidence synthesis. The types of interventions identified: a combination of training and safety audits; and a combination of engineering, training, safety audits, and a motivational component, showed a limited amount of evidence in improving safety outcomes. Overall, this evidence synthesis found a moderate level of evidence for intervention effectiveness, and found no evidence that any intervention had adverse effects.

CONCLUSIONS

Even though there were few studies that adequately evaluated small business intervention, several studies demonstrate that well-designed evaluations are possible with small businesses. While stronger levels of evidence are required to make recommendations, these interventions noted above were associated with positive changes in safety-related attitudes and beliefs and workplace parties should be aware of them.

A systematic review of workplace ergonomic interventions with economic analyses

INTRODUCTION

This article reports on a systematic review of workplace ergonomic interventions with economic evaluations. The review sought to answer the question: "what is the credible evidence that incremental investment in ergonomic interventions is worth undertaking?" Past efforts to synthesize evidence from this literature have focused on effectiveness, whereas this study synthesizes evidence on the cost-effectiveness/financial merits of such interventions.

METHODS

Through a structured journal database search, 35 intervention studies were identified in nine industrial sectors. A qualitative synthesis approach, known as best evidence synthesis, was used rather than a quantitative approach because of the diversity of study designs and statistical analyses found across studies. Evidence on the financial merits of interventions was synthesized by industrial sector.

RESULTS

In the manufacturing and warehousing sector strong evidence was found in support of the financial merits of ergonomic interventions from a firm perspective. In the administrative support and health care sectors moderate evidence was found, in the transportation sector limited evidence, and in remaining sectors insufficient evidence.

CONCLUSIONS

Most intervention studies focus on effectiveness. Few consider their financial merits. Amongst the few that do, several had exemplary economic analyses, although more than half of the studies had low quality economic analyses. This may be due to the low priority given to economic analysis in this literature. Often only a small part of the overall evaluation of many studies focused on evaluating their cost-effectiveness.

Validity of the household and leisure time activities questionnaire (HLTA) in a multiethnic HIV-positive population

As individuals with HIV/AIDS continue to have longer life expectancies, it is vital that other health outcomes, such as functional status, be considered. The purpose of this study was to explore the psychometric properties of a new functional status measure, the Household and Leisure Time Activities (HLTA) questionnaire, in a multiethnic low-income HIV/AIDS population. The HLTA is an 11-item questionnaire consisting of two scales designed to assess an individual's ability to perform routine home activities (household functioning scale) and to participate in leisure time activities (leisure-time functioning scale). The HLTA was administered, in the form of self-report questionnaires, to 385 consecutive patients seen at a comprehensive HIV/AIDS care facility serving low-income residents of Houston, Texas. Various psychometric procedures were then performed to assess properties, including reliability, construct validity, and concurrent validity. Reliability, assessed by Cronbach's alpha, was good for both scales (0.92, household functioning; and 0.94, leisure-time functioning). Validity was supported by findings from the confirmatory factor analysis and findings from the concurrent validity analyses. Overall, the results indicated that the HLTA has satisfactory psychometric properties and is appropriate for use with multicultural low-income HIV/AIDS patients.

Association of area socioeconomic status and breast, cervical, and colorectal cancer screening: a systematic review

BACKGROUND

Although numerous studies have examined the association of area socioeconomic status (SES) and cancer screening after controlling for individual SES, findings have been inconsistent. A systematic review of existing studies is timely to identify conceptual and methodologic limitations and to provide a basis for future research directions and policy.

OBJECTIVE

The objectives were to (a) describe the study designs, constructs, methods, and measures; (b) describe the independent association of area SES and cancer screening; and (c) identify neglected areas of research.

METHODS

We searched six electronic databases and manually searched cited and citing articles. Eligible studies were published before 2008 in peer-reviewed journals in English, represented primary data on individuals ages > or = 18 years from developed countries, and measured the association of area and individual SES with breast, cervical, or colorectal cancer screening.

RESULTS

Of 19 eligible studies, most measured breast cancer screening. Studies varied widely in research design, definitions, and measures of SES, cancer screening behaviors, and covariates. Eight employed multilevel logistic regression, whereas the remainder analyzed data with standard single-level logistic regression. The majority measured one or two indicators of area and individual SES; common indicators at both levels were poverty, income, and education. There was no consistent pattern in the association between area SES and cancer screening.

DISCUSSION

The gaps and conceptual and methodologic heterogeneity in the literature to date limit definitive conclusions about an underlying association between area SES and cancer screening. We identify five areas of research deserving greater attention in the literature.

The Cultural Production of Health Inequalities: A Cross-Sectional, Multilevel Examination of 52 Countries

In a 2001 report, the U.S. National Institutes of Health called for more integration of the social sciences into health-related research, including research guided by theories and methods that take social and cultural systems into consideration. Based on a theoretical framework that integrates Hofstede's cultural dimensions with sociological theory, the authors used multilevel modeling to explore the association of culture with structural inequality and health disparities. Their results support the idea that cultural dimensions and social structure, along with economic development, may account for much of the cross-national variation in the distribution of health inequalities. Sensitivity tests also suggest that an interaction between culture and social structure may confound the relationship between income inequality and health. It is necessary to identify important cultural and social structural characteristics before we can achieve an understanding of the complex, dynamic systems that affect health, and develop culturally sensitive interventions and policies. This study takes a step toward identifying some of the relevant cultural and structural influences. More research is needed to explore the pathways leading from the sociocultural environment to health inequalities.

Upper extremity pain and computer use among engineering graduate students: a replication study

BACKGROUND

Recent literature identified upper extremity musculoskeletal symptoms at a prevalence of >40% in college populations. The study objectives were to determine weekly computer use and the prevalence of upper extremity musculoskeletal symptoms in a graduate student population, and make comparisons with previous graduate and undergraduate cohorts.

METHODS

One hundred sixty-six graduate students completed a survey on computing and musculoskeletal health. Associations between individual factors and symptom status, functional limitations, academic impact, medication use, and health services utilization were determined. Logistic regression analyses evaluated the association between symptom status and computing. Cross-study comparisons were made.

RESULTS

More symptomatic participants experienced functional limitations than asymptomatic participants (74% vs. 32%, P < 0.001) and reported medication use for computing pain (34% vs. 10%, P < 0.01). More participants who experienced symptoms within an hour of computing used health services compared to those who experienced symptoms after an hour of computer use (60% vs. 12%, P < 0.01). Years of computer use (OR = 1.59, 95% CI 1.05-2.40) and number of years in school where weekly computer use was more than 10 hr (OR = 1.56, 95% CI 1.04-2.35) were associated with pain within an hour of computing. Cross-study comparisons found college populations more similar than different.

CONCLUSION

The overall findings reinforced previous literature documenting the prevalence of upper extremity musculoskeletal symptoms in college populations, suggesting an important population for participating in public health interventions designed to support healthy computing practices and identify risk factors important to evaluate in future cohort studies. Am. J. Ind. Med. 52:113-123, 2009. (c) 2008 Wiley-Liss, Inc.

Culture and the Social Context of Health Inequalities

There is a great deal of recent interest and debate concerning the linkages between inequality and health cross-nationally. The U.S. National Institutes of Health recommended in 2001 that any new research on health disparities should include social and cultural systems as units of analysis. Nevertheless, many public health interventions and policies continue to decontextualize risk factors from the social environment. Exposures to social and health inequalities probably vary as a consequence of different cultural contexts. To identify the processes that cause social and health inequalities, it is important to understand culture's influence. Navarro's research on political institutions and inequality illustrates the role of cultural context, although indirectly. Policies reflect cultural values because politicians typically translate their constituents' dominant values into policy. Political systems and structural inequality are institutionalized manifestations of cultural differences that intervene between dominant cultural dimensions at the societal level and health. The authors present a theoretical framework that combines constructs from sociological theory and cross-cultural psychology to identify potential pathways leading from culture and social structure to social and health inequalities. Only when all levels are taken into consideration is it possible to come up with effective, sustainable policies and interventions.

The effects of an office ergonomics training and chair intervention on worker knowledge, behavior and musculoskeletal risk

A large-scale field intervention study was undertaken to examine the effects of office ergonomics training coupled with a highly adjustable chair on office workers' knowledge and musculoskeletal risks. Office workers were assigned to one of three study groups: a group receiving the training and adjustable chair (n=96), a training-only group (n=63), and a control group (n=57). The office ergonomics training program was created using an instructional systems design model. A pre/post-training knowledge test was administered to all those who attended the training. Body postures and workstation set-ups were observed before and after the intervention. Perceived control over the physical work environment was higher for both intervention groups as compared to workers in the control group. A significant increase in overall ergonomic knowledge was observed for the intervention groups. Both intervention groups exhibited higher level behavioral translation and had lower musculoskeletal risk than the control group.

Where and How College Students Use Their Laptop Computers

A pilot study classified the locations, furniture, input devices and postures associated with using laptop computers in a small cohort of college students. Data were collected from digital photographs of the students posing as using laptop computers in their usual workstation configurations. The observed configurations were assigned to descriptive categories and the Rapid Upper Limb Assessment (RULA) assessed the postural risk factors observed on the participants. We observed that 75% of the participants used the laptop computer in the traditional table and chair configuration; 25% of the participants used the laptop computer in untraditional configurations where they placed the computer on their laps while sitting on a lounge type couch or in their bed. Excessive shoulder flexion (61% of all configurations) and neck flexion (35%) were the postural risk factors observed commonly. RULA scores suggested the need for further postural investigation.

Computer use patterns associated with upper extremity musculoskeletal symptoms

INTRODUCTION

Over half of surveyed college students are experiencing pain they are attributing to computer use. The study objective was to evaluate the effect of computing patterns on upper extremity musculoskeletal symptoms.

METHODS

Symptom experiences and computing/break patterns were reported several times daily over three weeks for 30 undergraduate students over a semester. Two-level logistic regression models described the daily association between each computing pattern and both any and moderate or greater symptom experienced, adjusting for covariates.

RESULTS

The associations between most computing/break patterns and experiencing any symptoms were positive: total hours of computer use adjOR = 1.1 (90% CI 1.1-1.2), 1-2 breaks versus none adjOR = 1.3 (90% CI 0.9-1.9), 3-6 breaks versus none adjOR = 1.5 (90% CI 1.1-2.2), >15 min break versus none adjOR = 1.6 (90% CI 1.1-2.2), and number of stretch breaks adjOR = 1.3 (90% CI 1.1-1.5). However, breaks for less than 15 min were negatively associated with experiencing any symptoms: adjOR = 0.6 (90% CI 0.5-0.9). The associations between most computing/break patterns and experiencing moderate or greater symptoms were positive: total hours of computer use OR = 1.1 (90% CI 1.1-1.2), 1-2 breaks and 5-6 breaks versus none OR = 1.8 (90% CI 1.1-2.9), 7-8 breaks versus none OR = 2.0 (1.0-4.2), >15 min break versus none 1.8 (1.1-3.1), and number of stretch breaks OR = 1.3 (1.0-1.5).

CONCLUSION

Computing/break patterns were consistently associated with experiencing symptoms. Our findings suggest evaluating breaks with computing duration (computing patterns) is more informative than assessing computing duration alone and can be used to better design ergonomic training programs for student populations that incorporate break times.

Work organization and drinking: an epidemiological comparison of two psychosocial work exposure models

OBJECTIVES

To examine the relationship between two alternative psychosocial work exposure measurement frameworks (i.e., job alienation and job stress) and three drinking behaviours (frequent, heavy and drinking and work).

METHODS

A cross-sectional survey was conducted among 3,099 US drinking workers. Job stress conditions were assessed according to the Karasek's job strain model. Alienating job conditions were assessed with measures based on Kohn and Schooler's occupational self-direction concept. Multivariate logistic regression controlling for a wide range of known covariates was used.

RESULTS

High strain work showed no associations, while workers in passive jobs had an increased likelihood of heavy (OR = 1.29; 95%CI: 1.02-1.64) and lower likelihood of frequent drinking (OR = 0.71; 95%CI: 0.52-0.97). Unexpectedly, low complexity combined with low constraint related to more frequent drinking (OR = 1.60; 95%CI: 1.22-2.10). No associations with drinking at work were observed.

CONCLUSION

Our findings suggest an association between different work environment features and drinking behaviours. Our findings highlight the value of exploring the hypothesized passive pathway of the job strain model together with other theoretical perspectives, such as alienating job conditions.

Social capital, income inequality, and self-rated health in 45 countries

There has been growing interest in the relationship between the social environment and health. Among the concepts that have emerged over the past decade to examine this relationship are socio-economic inequality and social capital. Using data from the World Values Survey and the World Bank, we tested the hypothesis that self-rated health is affected by social capital and income inequality cross-nationally. The merit of our approach was that we used multilevel methods in a larger and more diverse sample of countries than used previously. Our results indicated that, for a large number of diverse countries, commonly used measures of social capital and income inequality had strong compositional effects on self-rated health, but inconsistent contextual effects, depending on the countries included. Cross-level interactions suggested that contextual measures can moderate the effect of compositional measures on self-rated health. Sensitivity tests indicated that effects varied in different subsets of countries. Future research should examine country-specific characteristics, such as differences in cultural values or norms, which may influence the relationships between social capital, income inequality, and health.

Antecedents of Work Disability Absence Among Young People: A Prospective Study

PURPOSE

This study examined the relative contribution of individual factors, job characteristics, and temporal factors to the likelihood of lost days of work due to a work-related disability or illness among Canadians 16 to 24 years old.

METHODS

Using a prospective Canadian survey with up to 6 years of follow-up, the job-based analyses included 45,125 job episodes generated from a representative sample of young workers. A hazard model on work disability absence included the following predictors: age, gender, physical demands of the job (manual, nonmanual, and mixed), hours worked, highest education achieved, multiple concurrent job, job tenure, school activity, and living in a rural or urban area.

RESULTS

The overall 1-week work disability absence rate was 0.78 per 1000 person-months. In the multivariate model, young workers holding manual jobs were 2.65 times more likely to have a work disability absence compared with young workers with nonmanual jobs. Also, those with less than a high school education were almost 3 times more likely to have a work disability absence. Other demographic factors such as gender were not independently associated with work disability absences.

CONCLUSIONS

This prospective study finds that job characteristics are the predominant risk factors for work disability absences for young workers. Young workers with less education appear to be particularly vulnerable, possibly because of inadequate job skills or particularly dangerous job tasks.

Work disability absence among young workers with respect to earnings losses in the following year

OBJECTIVES

The primary objective of this study was to evaluate the earnings losses that young workers experience in the year after a work disability absence.

METHODS

The sample consisted of workers aged 16 to 24 years from a longitudinal survey of a representative sample of Canadians. Young workers who lost > or =5 days of work due to work disability or illness (ie, work disability absence) were matched to uninjured controls on the basis of age, gender, preabsence earnings, and student status. This matching procedure resulted in 173 cases and 795 controls. The outcome measure was the difference in earnings the year after the work disability episode between injured cases and their uninjured controls.

RESULTS

An analysis of variance indicated that young workers experiencing a work disability absence had significantly fewer earnings than their controls in the year after the absence (P<0.05). This earnings loss was not due to between-group differences in school activity or workhours in the year after the work absence.

CONCLUSIONS

No study to date has estimated the impact of work-related disability on earnings trajectories among young workers. The findings of the present study indicate that earnings losses can occur among young workers even during their transition into the labor market. Documenting the economic impacts of work injuries early in one's worklife can provide information for policy debates on the allocation of resources to control workplace hazards where teenagers and young adults work and debates on the determination of fair and adequate benefits for young workers.

Daily computer usage correlated with undergraduate students' musculoskeletal symptoms

BACKGROUND

A pilot prospective study was performed to examine the relationships between daily computer usage time and musculoskeletal symptoms on undergraduate students.

METHODS

For three separate 1-week study periods distributed over a semester, 27 students reported body part-specific musculoskeletal symptoms three to five times daily. Daily computer usage time for the 24-hr period preceding each symptom report was calculated from computer input device activities measured directly by software loaded on each participant's primary computer. General Estimating Equation models tested the relationships between daily computer usage and symptom reporting.

RESULTS

Daily computer usage longer than 3 hr was significantly associated with an odds ratio 1.50 (1.01-2.25) of reporting symptoms. Odds of reporting symptoms also increased with quartiles of daily exposure.

CONCLUSIONS

These data suggest a potential dose-response relationship between daily computer usage time and musculoskeletal symptoms.

Drinking social norms and drinking behaviours: a multilevel analysis of 137 workgroups in 16 worksites

BACKGROUND

Previous studies on worksite drinking norms showed individually perceived norms were associated with drinking behaviours.

OBJECTIVE

To examine whether restrictive drinking social norms shared by workgroup membership are associated with decreased heavy drinking, frequent drinking and drinking at work at the worker level.

METHODS

The sample included 5338 workers with complete data nested in 137 supervisory workgroups from 16 American worksites. Multilevel models were fitted to examine the association between workgroup drinking norms and heavy drinking, frequent drinking and drinking at work.

RESULTS

Multivariate adjusted models showed participants working in workgroups in the most discouraging drinking norms quartile were 45% less likely to be heavy drinkers, 54% less likely to be frequent drinkers and 69% less likely to drink at work than their counterparts in the most encouraging quartile.

CONCLUSIONS

Strong associations between workgroup level restrictive drinking social norms and drinking outcomes suggest public health efforts at reducing drinking and alcohol-related injuries, illnesses and diseases should target social interventions at worksites.

Disability management practices in Ontario health care workplaces

BACKGROUND

Workplace disability management programs are important in managing injury and disability.

METHODS

A stratified random sample of 188 employers in health care workplaces (71 hospitals, 48 nursing homes, 42 private clinics, and 27 community clinics) completed a mailed Organizational Policies and Practices (OPP) questionnaire. The OPP asked questions about eight workplace disability management practices. This article compares disability management practices across the four types of health care workplaces.

RESULTS

A one-way analysis of variance for each of the eight practices demonstrated significant differences across facility types for all practices, except ergonomic practices. For unionized versus non-unionized workplaces, there were significant differences in all practices, except ergonomic practices. For workplaces with formal policies versus those without policies, there were significant differences in all practices, except people-oriented culture and safety diligence.

CONCLUSION

Variations in disability management practices in health care workplaces need to be addressed to provide more effective prevention and treatment of work-related injuries and disability.

Direct observation of computer workplace risk factors of college students

Recently, researchers have reported high musculoskeletal symptom prevalence at several US colleges. Since ergonomic interventions have been shown to prevent and reduce disability, it is important to identify the risk factors for developing symptoms among college students. A nested case-control study was completed to determine computer-related ergonomic risks associated with musculoskeletal symptoms. A trained observer completed ergonomic assessments on 52 randomly selected cases and controls. More than 75 percent (cases and controls combined) of the population was exposed to nine potential postural strains including: arms not along side during keying or mousing; lower back not supported; not having chair accessories; computer monitor not adjustable; mouse being too high or low; hand/wrist/forearm in contact with the desk edge; lack of wrist support; and keyboard not being adjustable. Cases and controls were equally likely to have substantially elevated risks but because the sample was small and lacked power, no risks were statistically significant. Since many known risk factors were prevalent in cases and controls, more research is required to evaluate and prevent injury in this population.

Undergraduate college students' upper extremity symptoms and functional limitations related to computer use: a replication study

PURPOSE

To replicate Hupert et al.'s [5] evaluation of computer-related upper extremity musculoskeletal symptoms, functional limitations, academic performance impact, medication use and health services utilization among a college student population.

SUBJECTS AND METHODS

A cross-sectional survey of undergraduate students living in a single residential dormitory at a private southwestern university who agreed to participate completed the College Computing & Health Survey in the Spring of 2001.

RESULTS

Of the 127 dormitory residents, 116 students participated and 54% reported experiencing symptoms associated with computer usage. Sixty-two percent of students surveyed experienced functional limitations. More women than men reported symptoms, functional limitations and neck and shoulder pain; those with functional limitations reported higher use of medications than other participants.

CONCLUSION

These findings, which match the general findings of the previous research study conducted with the same instrument but in a different college student population, suggest a high level of computer-use-related musculoskeletal symptoms among college students. Universities may want to consider providing ergonomic training designed for college students to: conduct workstation assessments; identify computer related problems (risk factors); and, propose ergonomic solutions.

A multi-method study evaluating computing-related risk factors among college students

PURPOSE

To characterize undergraduate computer use using different data collection methods, emphasizing computing-related postures, use patterns and upper extremity musculoskeletal symptoms.

SUBJECTS AND METHODS

In Spring, 2004, undergraduate students from a single dormitory at a private university agreed to complete a College Computing & Health Survey. For three separate data collection periods each lasting a week, we observed postures during computer once per period and continuously measured computer input device usage. During these three periods, students self-reported computer usage and symptoms 3-5 times daily.

RESULTS

Thirty students participated and all completed the study. Eighty-six percent reported ever experiencing symptoms after computer work. There were no time-related trends across data collection periods for posture, symptoms, and computing activities and patterns. Typed work and communicating (when compared with playing games) were usually the predominant computing activities throughout the semester. There was significantly greater self-reported computer use than that directly measured (p<0.05).

CONCLUSION

This is the first study that utilized several methods of exposure assessment to describe computing postures, use patterns and upper extremity musculoskeletal symptoms among a college student cohort. Epidemiological studies need to explore time-related changes such as time of day, weekday, and days into the semester to further understand symptoms, posture, and computer use changes.

Incorporating injured employee outcomes into physical and occupational therapists' practice: a controlled trial of the Worker-Based Outcomes Assessment System

BACKGROUND

Work related musculoskeletal disorders (WRMSDs) remain costly. The Worker-Based Outcomes Assessment System (WBOAS) is an injury treatment improvement tool. Its purpose is to increase treatment effectiveness and decrease the cost of care delivered in Occupational Health Service clinics.

METHODS

The study used a non-randomized (parallel cohort) control trial design to test the effects on injured employee outcomes of augmenting the standard care delivered by physical and occupational therapists (PT/OTs) with the WBOAS. The WBOAS works by putting patient-reported functional health status, pain symptom, and work role performance outcomes data into the hands of PT/OTs and their patients. Test clinic therapists were trained to incorporate WBOAS trends data into standard practice. Control clinic therapists delivered standard care alone.

RESULTS

WBOAS-augmented PT/OT care did improve (p< or =.05) physical functioning and new injury/re-injury avoidance and, on these same dimensions, cost-adjusted outcome. It did not improve (p>.05) mental health or pain symptoms or return-to-work or stay-at-work success nor, on these same dimensions, cost-adjusted outcome.

CONCLUSION

Training PT/OTs to incorporate patient-reported health status, pain symptom, and work role performance outcomes trends data into standard practice does appear to improve treatment effectiveness and cost on some (e.g. physical functioning) but not other (e.g. mental health, pain symptoms) outcomes.

Workplace interventions to prevent musculoskeletal and visual symptoms and disorders among computer users: a systematic review

BACKGROUND

The literature examining the effects of workstation, eyewear and behavioral interventions on musculoskeletal and visual symptoms among computer users is large and heterogeneous.

METHODS

A systematic review of the literature used a best evidence synthesis approach to address the general question "Do office interventions among computer users have an effect on musculoskeletal or visual health?" This was followed by an evaluation of specific interventions.

RESULTS

The initial search identified 7313 articles which were reduced to 31 studies based on content and quality. Overall, a mixed level of evidence was observed for the general question. Moderate evidence was observed for: (1) no effect of workstation adjustment, (2) no effect of rest breaks and exercise and (3) positive effect of alternative pointing devices. For all other interventions mixed or insufficient evidence of effect was observed.

CONCLUSION

Few high quality studies were found that examined the effects of interventions in the office on musculoskeletal or visual health.

The role of job strain on return to work after carpal tunnel surgery

AIMS

To examine the impact of job strain (that is, high psychological job demands and low job control) on return to work and work role functioning at two months, six months, or both, following carpal tunnel release surgery.

METHODS

A community based cohort of carpal tunnel syndrome (CTS) patients from physician practices was recruited between April 1997 and October 1998 throughout Maine (USA). 128 patients at two months and 122 at six months completed all relevant questions. A three level outcome variable indicated whether patients had: (1) returned to work functioning successfully, (2) returned to work functioning with limitations, or (3) not returned to work for health reasons. Two job strain measures were created: one, by combining psychological job demands and job control; and two, by dividing demands by control. Ordinal logistic regression was used to identify predictors of the three level work outcome variable.

RESULTS

After adjustment, workers with high demands and high control (active work) were less likely to successfully return to work (OR = 0.22; p = 0.014) at two months. Having a job with higher demands than job control (high strain) predicted not returning to work or returning to work but not successfully meeting job demands (OR = 0.14; p = 0.001), at six months.

CONCLUSIONS

The findings underscore the role of psychosocial work conditions, as defined by the Karasek demand-control model, in explaining a worker's return to work. Clinicians, researchers, and employers should consider a multidimensional and integrative model of successful work role functioning upon return to work. Moreover, since the evidence of the effects of work process changes on the reduction of CTS is very scarce, these findings point to the opportunity for collaborative workplace interventions to facilitate successful return to work.

Workplace organizational policies and practices in Ontario educational facilities

BACKGROUND

Workplace organizational policies and practices (OPPs) play a pivotal role in managing injury and disability. This study identifies the workplace OPPs in Ontario's education sector.

METHODS

OPPs were examined using a cross-sectional survey with 157 participants. The relationship among the type of school, workplace OPPs and injury and disability outcomes were investigated.

RESULTS

Mean subscale scores (potential range 1-5) varied from 3.1 (SD, 1.0) to 4.2 (SD, 0.6) for all schools. Private schools scored lowest on measures of disability prevention, disability management, and corporate culture. Ergonomic practices and return to work initiatives were achieved less frequently than other OPPs for all schools. Higher scores on safety diligence were associated with lower injury and disability incidence (proportion of variance explained ranged from 10 to 23%). Higher scores on people-oriented culture were associated with lower disability incidence and duration (proportion of variance explained ranged from 7 to 20%).

CONCLUSIONS

Public schools engage more often in workplace OPPs than private schools. Improved achievements on safety diligence and people-oriented culture practices predict reduced injury and disability outcomes.

Assessing a conceptual framework of health-related quality of life in a HIV/AIDS population

With the recognition of health-related quality of life (HRQOL) as an important outcome in the course of HIV-disease, it is important to gain a better understanding of the complex relationships among the various factors that influence it. This study assesses a conceptual framework of HRQOL, consisting of disease status, socio-economic status (SES), behavioral variables, symptom status, role-specific functional status and HRQOL, among a multiethnic, economically disadvantaged population of individuals living with HIV/AIDS. Self-report data were collected from 348 patients receiving care at a large HIV/AIDS care center, serving residents of a large metropolitan area. The relationships between the study variables were examined using structural equation modeling. Results indicated that the hypothesized framework provided a well-fitted solution to the data, chi2(44df) = 57.62], p = 0.08 and root mean square error of approximation = 0.03, 90% confidence interval 0.01; 0.05. This framework suggests that health-related variables fall along a continuum, beginning with disease status and ending in generic HRQOL. In addition, the framework suggests that behavioral factors (i.e., smoking status, alcohol consumption, and illicit drug use) and SES exert significant effects along this continuum and should be carefully considered when analyzing and interpreting HRQOL data.