Organisational downsizing and musculoskeletal problems in employees: a prospective study

Do psychosocial work factors and social relations exert independent effects on sickness absence? A six year prospective study of the GAZEL cohort

STUDY OBJECTIVES

The objective of this prospective cohort study was to determine whether psychosocial work characteristics and social relations exert independent effects on the incidence of sickness absence in a population of middle aged French employees over six years of follow up.

DESIGN

This study included 9631 men and 3595 women participating in the French GAZEL cohort. Social relations (social networks, personal social support, and social relations satisfaction) were measured in 1994 by self report. Psychosocial work characteristics (decision latitude, psychological demands, and social support at work) were ascertained in 1995. Sickness absence data were collected independently. The authors studied the incidence of short (>7 days), intermediate (7-21 days), and long (>21 days) spells of absence from 1995 to 31 December 2001. Rate ratios associated with psychosocial exposures, adjusted on sociodemographic characteristics, and health behaviours, were calculated by means of log-linear Poisson regression.

SETTING

A cohort of 20000 employees of France's national gas and electricity company (the GAZEL study).

MAIN RESULTS

Among men and women, levels of decision latitude and personal social support below the median predicted 17% to 24% increases in absence rates. Low satisfaction with social relations and low social support at work lead to a 10% to 26% excess in sick leaves among men. No interactive effects were found between the variables under study.

CONCLUSIONS

The quality of the work environment and of social relations affect sickness absence over an extended period of follow up. This study supports the hypothesis of independent, not interactive effects.

Clinical examination as a tool for identifying the origin of regional musculoskeletal pain

A knowledge of the physiopathology of the processing of noxious stimuli in regional musculoskeletal disorders is useful for an understanding of the clinical history. In regional musculoskeletal pain (RMP) the physiopathology of the pain may be separated into two main features. First, the nociceptive pain which results from the activation of nociceptors diffusely distributed among the anatomical structures in and around the joint, apart from the cartilage; the nociceptive pain has a protective role. Second, the abnormal impulses from a nervous tissue lesion give rise to a neuropathic pain which offers no biological advantage and is a maladaptive pain. This chapter describes the main physiological characteristics of these two kinds of pain. From these, in the majority of cases, the clinical history and the physical examination must specify the diagnosis of the RMP and localize the source of pain. Furthermore, the clinical characteristics permit diagnosis of different complex situations where these two types of pain are associated.

A review of functional status measures for workers with upper extremity disorders

In order to identify functional status measures for epidemiological studies among workers with mild to moderate disorders of the neck and upper extremity, a literature search was conducted for the years 1966 to 2001. Inclusion criteria were: (1) relevance to neck and upper extremity; (2) assessment among workers; and (3) relevance to mild to moderate disorders. Of 13 instruments reviewed, six measures were tested among workers. The three best measures, depending on the purpose of research, included the standardised Nordic Musculoskeletal Questionnaire, the Upper Extremity Questionnaire, and the Neck and Upper Limb Instrument. Development of a functional protocol is regarded as a realistic enhancement for research of neck and upper extremity disorders in the workplace. For research and clinical practice, measures of functional status, sensitive enough to measure the subtle conditions in mild to moderate disorders, may provide prognostic information about the risk of developing musculoskeletal disorders in apparently healthy patients. Appropriate use of functional status questionnaires is imperative for a meaningful portrayal of health.