The effect of cushioning materials on musculoskeletal discomfort and fatigue during prolonged standing at work: A systematic review

Effects of a range of 6 prefabricated orthotic insole designs on plantar pressure in a healthy population: A randomized, open-label crossover investigation

BACKGROUND

Prefabricated orthotic insoles are widely commercially available for self-selection to treat foot and lower-body musculoskeletal pain, without requiring advice from health care professionals. Although they are generally designed to mimic traditional design features of custom-made orthotics used in clinical practice, the effects of prefabricated insoles on plantar pressure distribution are poorly understood.

OBJECTIVE

This investigation aimed to evaluate and directly compare the effects of a range of 6 different commercially available prefabricated orthotic insole designs on plantar pressure in healthy individuals.

METHODS

This was a single-center, randomized, open-label, crossover investigation. In-shoe dynamic pressure (F-scan) was investigated in 24 healthy subjects with normal foot posture, wearing standard shoes alone and in combination with 6 different orthotic insoles, consecutively, measured on a single day. The biomechanical impact of each insole was determined by the statistical significance of changes from baseline measurements (standard shoe alone).

RESULTS

Insoles with heel cups and medial arch geometries consistently increased contact area at medial arch and whole-foot regions and reduced both plantar peak pressure (PP) and pressure time integral at medial arch and heel regions.

CONCLUSIONS

This investigation has aided in further understanding the mode of action of prefabricated insoles in a healthy population. The insoles in this study redistributed plantar pressure at key regions of the foot, based on design features common to prefabricated insoles. Prefabricated orthotic insoles represent an easily accessible means of reducing lower-body musculoskeletal stress for those who spend prolonged periods of time on their feet.

Overcoming Barriers: Sex Disparity in Surgeon Ergonomics

BACKGROUND

Musculoskeletal discomfort is widely experienced by surgeons across multiple surgical specialties. Developing technologies and new minimally invasive techniques add further complexity and ergonomic stressors. These stressors differentially affect male and female surgeons, but little is known about the role these sex disparities play in surgical ergonomic stress. We reviewed existing literature to better understand how ergonomic stress varies between male and female surgeons.

STUDY DESIGN

A literature search was performed via PubMed including but not limited to the following topics: ergonomics, surgeons, female surgeons, women surgeons, pregnancy, and operating room. A review of available quantitative data was performed.

RESULTS

Female surgeons endure more pronounced ergonomic discomfort than their male counterparts, with added ergonomic stress associated with pregnancy.

CONCLUSIONS

A 4-fold method is proposed to overcome ergonomic barriers, including (1) improved education on prevention and treatment of ergonomic injury for active surgeons and trainees, (2) increased departmental and institutional support for ergonomic solutions for surgeons, (3) partnerships with industry to study innovative ergonomic solutions, and (4) additional research on the nature of surgical ergonomic challenges and the differential effects of surgical ergonomics on female surgeons.

Changes in Baropodometric Evaluation and Discomfort during the Workday in Assembly-Line Workers

Prolonged standing at work is associated with health risks. The appearance of lower-limb and lower-back discomfort is one of the most prevalent factors in prolonged standing workers. The aim of this research was to evaluate the effect of an eight-hour workday on foot pressure and musculoskeletal discomfort in standing workers. Thirty-six assembly-line workers (six women) were recruited to participate in a cross-sectional study to assess foot pressure and surface, foot, knee, and lower-back discomfort before and after a real workday. Baropodometry outcomes (surface and pressure) were evaluated by the pressure platform SensorMedica and musculoskeletal discomfort was evaluated by Cornell's Musculoskeletal Discomfort Questionaire. Total foot surface (p = 0.01) and foot discomfort (p = 0.03) increased significantly at the end of the workday. Prolonged standing during 8 h workday increased the foot discomfort and total foot surface in assembly-line workers. No foot pressure variable (forefoot, rearfoot, or total) was significantly modified after the workday in assembly-line workers.

Ergonomics of bronchoscopy: good advice or a pain in the neck?

Interventional pulmonologists require a unique set of skills including precise motor abilities and physical endurance, but surprisingly the application of ergonomic principles in the field of bronchoscopy remains limited. This is particularly intriguing when considering the significant impact that poor ergonomics can have on diagnostic aptitude, income potential and overall health. It is therefore imperative to provide comprehensive education to physicians regarding the significance of ergonomics in their work, especially considering the introduction of advanced diagnostic and therapeutic procedures. By implementing simple yet effective measures (e.g. maintaining neutral positions of the wrist, neck and shoulder; adjusting the height of tables and monitors; incorporating scheduled breaks; and engaging in regular exercises), the risk of injuries can be substantially reduced. Moreover, objective tools are readily available to assess ergonomic postures and estimate the likelihood of work-related musculoskeletal injuries. This review aims to evaluate the current literature on the impact of procedure-related musculoskeletal pain on practising pulmonologists and identify modifiable factors for future research.

The humanistic and economic burden of work-related musculoskeletal pain: a cross-sectional survey of workers in the United Kingdom

OBJECTIVE

The aim of this study was to evaluate the impact of work-related musculoskeletal (MSK) lower body pain on health-related quality of life (HRQoL) and work productivity in a large sample of workers in the United Kingdom, as well as evaluating the potential economic impact of MSK pain.

METHODS

Participants with self-reported work-related MSK pain were recruited from an online panel maintained by a third party (Qualtrics LLC). Participants completed three validated instruments online: the Brief Pain Inventory (BPI), the Assessment of Quality of Life Instrument (AQoL-4D), and the 6-item Work Productivity and Activity Impairment Questionnaire (WPAI). Sociodemographic details, work patterns and healthcare resource utilisation were also reported. One-way analysis of variance (ANOVA) and t-tests were used to explore differences between variables. Linear regression was applied to determine the impact of work-related MSK pain on HRQoL.

RESULTS

All 1035 recruited participants completed the survey (57.4% female; mean age 43.4 years). Participants reported spending all (25.2%) or most (53%) of their time at work on their feet. Mean pain severity was 4.63 (standard deviation: 2.07); mean pain interference was 4.37 (2.49). There was a linear relationship between length of shift, time on feet and pain. Mean AQoL-4D scores were 0.609 (0.254). A mean of 4.12 h was lost per week due to pain. Absenteeism (last 7 days) was 9.5% (20.7%), and presenteeism 33.3% (24.9%). An average 1.55 visits were made to family practitioners (total cost: £19,866) and 1 hospital visit (£37,320) due to work-related MSK pain.

CONCLUSION

This study demonstrated that work-related lower body pain has a significant impact in terms of individual HRQoL and as an economic societal burden.

Growing pains: strategies for improving ergonomics in minimally invasive gynecologic surgery

PURPOSE OF REVIEW

To evaluate factors contributing to the development of work-related musculoskeletal disorders (WMSDs) and review strategies for mitigating ergonomic strain in minimally invasive gynecologic surgery.

RECENT FINDINGS

Factors associated with increased ergonomic strain and the development of WMSDs include increasing patient body mass index (BMI), smaller surgeon hand size, noninclusive design of instruments and energy devices and improper positioning of surgical equipment. Each type of minimally invasive surgery (laparoscopic, robotic, vaginal) confers its own ergonomic risk to the surgeon. Recommendations have been published regarding optimal ergonomic surgeon and equipment positioning. Intraoperative breaks and stretching are effective in reducing surgeon discomfort. Formal training in ergonomics has not yet been widely implemented, but educational interventions have been effective in reducing surgeon discomfort and can improve surgeon recognition of suboptimal ergonomics.

SUMMARY

Considering the serious downstream effects of WMSDs on surgeons, it is imperative to implement strategies for WMSD prevention. Optimal positioning of the surgeons and operative equipment should be routine. Intraoperative breaks and stretching should be incorporated during procedures and between every case. Formal education in ergonomics should be provided to surgeons and trainees. Additionally, more inclusive instrument design by industry partners should be prioritized.

The effect of anti-fatigue floor mat on pain and fatigue levels of surgical team members: A crossover study

As ergonomics is important to maintain comfort, this study aimed to examine the effect of anti-fatigue floor mats on pain and fatigue levels of surgical team members. Thirty-eight members participated in this crossover-designed study with no-mat and with-mat conditions, separated by a one-week washout period. They stood on the 15 mm thick rubber anti-fatigue floor mat and on the standard antistatic polyvinyl chloride flooring surface during the surgical procedures. Subjective ratings of pain and fatigue levels were measured pre and after-surgery for each experimental condition using the Visual Analogue Scale and Fatigue-Visual Analogue Scale scales. The after-surgery pain and fatigue levels for the with-mat condition were significantly lower than the no mat condition (p < .05). Consequently, anti-fatigue floor mats are effective in decreasing pain and fatigue levels of surgical team members during surgical procedures. Using anti-fatigue mats may be a practical and easy way to prevent discomfort that is often experienced by surgical teams.

Design guidelines for limiting and eliminating virtual reality-induced symptoms and effects at work: a comprehensive, factor-oriented review

Virtual reality (VR) can induce side effects known as virtual reality-induced symptoms and effects (VRISE). To address this concern, we identify a literature-based listing of these factors thought to influence VRISE with a focus on office work use. Using those, we recommend guidelines for VRISE amelioration intended for virtual environment creators and users. We identify five VRISE risks, focusing on short-term symptoms with their short-term effects. Three overall factor categories are considered: individual, hardware, and software. Over 90 factors may influence VRISE frequency and severity. We identify guidelines for each factor to help reduce VR side effects. To better reflect our confidence in those guidelines, we graded each with a level of evidence rating. Common factors occasionally influence different forms of VRISE. This can lead to confusion in the literature. General guidelines for using VR at work involve worker adaptation, such as limiting immersion times to between 20 and 30 min. These regimens involve taking regular breaks. Extra care is required for workers with special needs, neurodiversity, and gerontechnological concerns. In addition to following our guidelines, stakeholders should be aware that current head-mounted displays and virtual environments can continue to induce VRISE. While no single existing method fully alleviates VRISE, workers' health and safety must be monitored and safeguarded when VR is used at work.

Comparison of Physiological Effects Induced by Two Compression Stockings and Regular Socks During Prolonged Standing Work

OBJECTIVE

The goal of this study was to evaluate and compare lower-leg muscle fatigue, edema, and discomfort induced by the prolonged standing of security guards wearing regular socks and those wearing 15-20 or 20-30 mmHg compression stockings as intervention.

BACKGROUND

Compression stockings are sometimes used by individuals standing all day at work. However, quantitative evidence showing their potential benefits for lower-leg health issues in healthy individuals during real working conditions is lacking.

METHOD

Forty male security employees participated in the study. All were randomly assigned to the control or one of the two intervention groups (I15-20 or I20-30). Lower-leg muscle twitch force, volume, and discomfort ratings were measured before and after their regular 12-hr standing work shift.

RESULTS

Significant evidence of lower-leg long-lasting muscle fatigue, edema, and discomfort was observed after standing work for guards wearing regular socks. However, no significant changes were found for guards wearing either compression stockings.

CONCLUSION

In healthy individuals, compression stockings seem to attenuate efficiently the tested outcomes in the lower leg resulting from prolonged standing.

APPLICATION

Occupational activities requiring prolonged standing may benefit from 15-20 or 20-30 mmHg compression stockings. As similar benefits were observed for both levels of compression, the lower level may be sufficient.

Enhancing Ergonomics in Pediatric Endoscopy Training and Practice

Pediatric endoscopists are at risk of work-related injuries from overuse and repetitive motions during endoscopy. Recently, there has been increasing appreciation for the importance of ergonomics education and training to help build long-term habits that prevent injury. This article reviews the epidemiology of endoscopy-related injuries in pediatric practice, describes methods for controlling exposures in the workplace, discusses key ergonomic principles that can be used to mitigate injury risk, and outlines tips for integrating education on endoscopy ergonomics during training.

A multicomponent quasi-experimental ergonomic interventional study: long-term parallel four-groups interventions

BACKGROUND

Musculoskeletal disorders (MSDs) are known as one of the main problems affecting the health of industrial workers and can lead to lost working days, functional disability of workers and wasting the financial resources of an organization. Therefore, the present study aimed to evaluating the effect of ergonomic interventions on reducing MSDs and improving working posture in the in a foundry industry workers.

METHODS

A field multicomponent cross-interventional study was conducted on workers working in a foundry industry. In this study, 117 male workers were divided into 4 groups, including a control group, a group with specialized ergonomics training, a group with workstation intervention, and a group simultaneously undergoing training and workstation intervention. All 4 groups were evaluated during a period of baseline, 6 and 12-months follow- up. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and direct observations of working postures by using the Quick Exposure Check (QEC) method were used.

RESULTS

The results showed that the implemented interventions in the shoulder/arm, back and stress level were effective and the difference in the final score was significant among different groups (P-value > 0.05). In addition, the interventions led to a significant decrease in the QEC scores and musculoskeletal symptom scores in the neck, shoulder, lower back, knee, and lower leg regions among different groups (P-value > 0.05).

CONCLUSION

The results showed that workstation modification and training and workstation intervention simultaneously had a greater effect on MSDs and improving working posture compared to training alone.

The Effect of Standing Mats on Biomechanical Characteristics of Lower Limbs and Perceived Exertion for Healthy Individuals during Prolonged Standing

Objective

To identify the effect of standing mats on biomechanical characteristics of lower limbs and perceived exertion for healthy adult individuals during a prolonged standing task.

Methods

32 healthy college students were recruited in the randomized and cross-over designed trial according to the effect size and statistical power. After collecting the anthropometric data, each participant was asked to finish 2 sessions of 4-hour prolonged standing tasks on standing mats (MS) and hard ground (GS) in a random order and with a 72-hour interval rest. The plantar pressure distribution, foot morphology, and scores of the BESS (balance error scoring system) would be recorded pre- and posteach task. The Borg Rating of Perceived Exertion (RPE) would be collected during the whole task. Paired-samples t test was adopted to analyse the before and after difference within group and independent-samples t test was adopted to analyse the difference between groups separately.

Results

(1) A prolonged standing task on both MS and GS have a negative effect on RPE and balance performance. (2) The negative effect on RPE and balance performance induced by MS is significantly smaller than that induced by GS. (3) Compared to GS, prolonged standing on MS has a lower peak plantar pressure and an implicit decrease in navicular drop and AHI (arch index).

Conclusion

Standing mat tends to alleviate the fatigue induced by prolonged standing in lower limbs, optimize the distribution of plantar pressure, and maintain the stability.

Use of an inflatable mat to reduce body discomfort development when performing computer work at a standing desk

This study aimed to determine the effects of inflatable mat design on body discomfort, task performance, and musculoskeletal exposures during standing computer work. Twenty-seven healthy adults completed three 2-hour standing trials on different mediums (concrete floor, foam mat, and inflatable mat) on different days in an experimental laboratory. Both mats were associated with reduced discomfort in all lower-body regions and increased typing performance compared to the concrete floor. Perceived discomfort in lower extremities (except thighs) was further alleviated while standing on the inflatable mat than on the foam mat. Use of the inflatable mat led to increased lower-body muscle activity, a flexed lower back, and a wide range of sagittal knee movements. As standing time increased, body discomfort increased, typing accuracy decreased, and there were increased variations in muscle activity and postural movements in the lower body. The inflatable mat shows potential to improve the ergonomic experience during prolonged standing. Practitioner summary: Incorporating standing postures in office-based workplaces can reduce sitting time and may mitigate the health hazards associated with sedentary behaviour. With adequate weight-shifting movements, using an inflatable mat for standing could be an effective way to lessen discomfort and accumulated musculoskeletal strain due to constrained standing, without jeopardising task productivity. Abbreviations: APDF: amplitude probability distribution function. AVR: average rectified value. CI: confidence interval. CMRR: common mode rejection ratio. COP: center of pressure. CV: coefficient of variation. EA: electrical activity. EMG: electromyography. FL: fibularis longus. GM: gluteus medius. LBP: lower back pain. LES: lumbar erector spinae. MVC: maximum voluntary contraction. PD: pain developer. rANOVA: repeated-measures analysis of variance. SOL: soleus. VAS: visual analog scale. WPM: words per minute.

Influence of gender and age on musculoskeletal symptoms in white and blue-collar workers - cross-sectional study

OBJECTIVE

Identify the prevalence of musculoskeletal symptoms among blue- and white-collar workers stratified by gender and age.

METHODS

The sample was composed of 390 blue-collar and 510 white-collar workers. Musculoskeletal symptoms were evaluated using the Nordic Musculoskeletal Questionnaire. Independent t-test or Mann-Whitney test were used for the inter-group comparisons. The Chi-square (χ²) association test was applied for categorical variables. Logistic regression analysis was used to determine the influence of gender and age on musculoskeletal symptoms.

RESULTS

The prevalence of shoulder, lower back, and ankle/foot symptoms was higher among blue-collar workers compared to white-collar workers. In the analysis stratified by gender, female blue-collar workers had a higher frequency of shoulder symptoms and male blue-collar workers had a higher frequency of lower back symptoms. In the analysis stratified by age, younger blue collar-workers had a higher frequency of shoulder, lower back, and ankle/foot symptoms compared to young white-collar workers and older white-collar workers had a higher frequency of neck symptoms compared to older blue-collar workers.

CONCLUSIONS

Gender and age exerted an influence on self-reported symptoms in blue- and white-collar workers.

Garments and Footwear for Chronic Pain

In most human societies, wearing clothing and shoes, particularly in public settings, is commonplace and may even be legally required. Consequently, there is an abundance of clothing and footwear options for individuals of different ages, genders, body shapes and catering to different needs such as workwear and active-wear. However, many of the available options may not be viable for the millions and pain sufferers worldwide, indicating a need for adaptive apparel for the pain patient. In this perspective manuscript, we focus on the availability and efficacy of clothing designed to prevent pain in the general population as well as reduce or treat pain in pain patients. Furthermore, we put forth some considerations for the construction of adaptive garments. Such efforts and needed and could significantly improve well-being and quality of life in the pain patient.

Gait Characteristics and Fatigue Profiles When Standing on Surfaces with Different Hardness: Gait Analysis and Machine Learning Algorithms

Simple Summary

The purpose of this study was to explore if an anti-fatigue soft mat could improve the gait performance after standing for long periods and to examine if a machine-learning algorithm could evaluate fatigue state objectively. Compared with standing directly on the hard ground, using an anti-fatigue mat could reduce the negative effect of standing for a long time (4 h). The machine-learning algorithm demonstrated moderate accuracy in measuring fatigue. The accuracy of gait parameters used to consider a non-fatigued state following the use of an anti-fatigue mat was higher than that of the fatigue state. The results may indicate that it is beneficial to use anti-fatigue mats when standing for long periods, and it is feasible to use gait parameters and machine-learning algorithms to detect fatigue.

Abstract

Background: Longtime standing may cause fatigue and discomfort in the lower extremities, leading to an increased risk of falls and related musculoskeletal diseases. Therefore, preventive interventions and fatigue detection are crucial. This study aims to explore whether anti-fatigue mats can improve gait parameters following long periods of standing and try to use machine learning algorithms to identify the fatigue states of standing workers objectively. Methods: Eighteen healthy young subjects were recruited to stand on anti-fatigue mats and hard ground to work 4 h, including 10 min rest. The portable gait analyzer collected walking speed, stride length, gait frequency, single support time/double support time, swing work, and leg fall intensity. A Paired sample t-test was used to compare the difference of gait parameters without standing intervention and standing on two different hardness planes for 4 h. An independent sample t-test was used to analyze the difference between males and females. The K-nearest neighbor (KNN) classification algorithm was performed, the subject’s gait characteristics were divided into non-fatigued and fatigue groups. The gait parameters selection and the error rate of fatigue detection were analyzed. Results: When gender differences were not considered, the intensity of leg falling after standing on the hard ground for 4 h was significantly lower than prior to the intervention (p < 0.05). When considering the gender, the stride length and leg falling strength of female subjects standing on the ground for 4 h were significantly lower than those before the intervention (p < 0.05), and the leg falling strength after standing on the mat for 4 h was significantly lower than that recorded before the standing intervention (p < 0.05). The leg falling strength of male subjects standing on the ground for 4 h was significantly lower than before the intervention (p < 0.05). After standing on the ground for 4 h, female subjects’ walking speed and stride length were significantly lower than those of male subjects (p < 0.05). In addition, the accuracy of testing gait parameters to predict fatigue was medium (75%). After standing on the mat was divided into fatigue, the correct rate was 38.9%, and when it was divided into the non-intervention state, the correct rate was 44.4%. Conclusion: The results show that the discomfort and fatigue caused by standing for 4 h could lead to the gait parameters variation, especially in females. The use of anti-fatigue mats may improve the negative influence caused by standing for a long period. The results of the KNN classification algorithm showed that gait parameters could be identified after fatigue, and the use of an anti-fatigue mat could improve the negative effect of standing for a long time. The accuracy of the prediction results in this study was moderate. For future studies, researchers need to optimize the algorithm and include more factors to improve the prediction accuracy.

Wearing Cushioning Shoes Reduce Load Rates More Effectively in Post-Fatigue than in Pre-Fatigue during Landings

Simple Summary

Athlete experience high impact forces during landing, which is a contributing factor to injury risk potentials. As a potential factor of affecting the impact force, previous study of the effects of footwear cushioning effect on landing biomechanics were inconsistent. Furthermore, limited efforts have been exerted on the relationship between footwear cushioning and fatigue. In this study, the footwear cushioning effects on bipedal landing biomechanics before and after acute exercise-induced fatigue protocol were explored. The results of this study suggest that footwear cushioning can reduce landing-related rearfoot impact forces regardless of fatigue conditions. In a situation where the neuromuscular activity is reduced or absent, e.g., post-fatigue, wearing better cushioning shoes show superior attenuation, as indicated by low forefoot and rearfoot impacts.

Abstract

Purpose: this study aimed to investigate the footwear cushioning effects on impact forces and joint kinematics of the lower extremity during bipedal drop landings before and after acute exercise-induced fatigue protocol. Methods: in this case, 15 male collegiate basketball athletes performed drop landings from a 60 cm platform wearing highly-cushioned shoes (HS) and less cushioned shoes (control shoes, CS) before and after acute fatigue-inducing exercises (i.e., shuttle run combined with multiple vertical jumps). Force plates and motion capturing systems were synchronised to measure ground reaction forces and kinematic data during drop landings. Maximum jump height was analysed with one-way ANOVA. Two-way repeated measure ANOVAs were performed on each of the tested variables to examine if there was significant main effects of shoe and fatigue as well as the interaction. The significance level was set to 0.05. Results: rearfoot peak impact forces and loading rates significantly reduced when the participants wore HS in pre- and post-fatigue conditions. The peak loading rates in forefoot significantly reduced when HS were worn in post-fatigue. Compared with pre-fatigue, wearing HS contributed to with 24% and 13% reduction in forefoot and rearfoot peak loading rates, respectively, and the occurrence times of first and second peak impact forces and loading rates were much later. In the post-fatigue, a significant increase in the initial contact and minimum angles of the ankle were observed in HS compared with CS. Conclusion: these findings suggest that footwear cushioning can reduce landing-related rearfoot impact forces regardless of fatigue conditions. In a situation where the neuromuscular activity is reduced or absent such as post-fatigue wearing better cushioning shoes show superior attenuation, as indicated by lower forefoot and rearfoot impacts.

Enhancing occupational safety in the X-ray laboratory

Despite more than 80% of interventional operators reporting one or more orthopedic injuries attributed to the X-ray laboratory, there has been limited adoption of various strategies and equipment to minimize these injuries. A comprehensive review of these methods to reduce musculoskeletal strain is lacking in the current literature, and is essential in order to ensure a long, healthy, and productive interventional career.

Overuse-Related Injuries of the Musculoskeletal System: Systematic Review and Quantitative Synthesis of Injuries, Locations, Risk Factors and Assessment Techniques

Overuse-related musculoskeletal injuries mostly affect athletes, especially if involved in preseason conditioning, and military populations; they may also occur, however, when pathological or biological conditions render the musculoskeletal system inadequate to cope with a mechanical load, even if moderate. Within the MOVIDA (Motor function and Vitamin D: toolkit for risk Assessment and prediction) Project, funded by the Italian Ministry of Defence, a systematic review of the literature was conducted to support the development of a transportable toolkit (instrumentation, protocols and reference/risk thresholds) to help characterize the risk of overuse-related musculoskeletal injury. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to analyze Review papers indexed in PubMed and published in the period 2010 to 2020. The search focused on stress (overuse) fracture or injuries, and muscle fatigue in the lower limbs in association with functional (biomechanical) or biological biomarkers. A total of 225 Review papers were retrieved: 115 were found eligible for full text analysis and led to another 141 research papers derived from a second-level search. A total of 183 papers were finally chosen for analysis: 74 were classified as introductory to the topics, 109 were analyzed in depth. Qualitative and, wherever possible, quantitative syntheses were carried out with respect to the literature review process and quality, injury epidemiology (type and location of injuries, and investigated populations), risk factors, assessment techniques and assessment protocols.

Quality of life, lifestyle, and working environment of women in the footwear industry

Introduction:

The footwear industry uses glue and other organic solvents (such as ethyl acetate, acetone, xylene, and toluene) in its manufacturing process; these substances, when associated with an inadequate working environment, can potentialize health problems and interfere with the perception of quality of life by female workers.

Objectives:

To verify the quality of life of women working in the footwear industry and its association with the self-reported morbidities of these workers, their working environment, and lifestyle habits.

Methods:

This is a cross-sectional study, with a quantitative approach, developed with 120 women shoemakers in the city of Franca, state of São Paulo. For evaluating quality of life, we used the abbreviated version of the World Health Organization Quality of Life instrument.

Results:

The most common self-reported morbidities were anxiety (65%), stress (62.5%), irritability (49.2%), sleep alterations (35.8%), fatigue (30%), and muscle cramps (30%). The physical domain presented the highest mean score (68.0), followed by the psychological (67.1) and social relationships domains (66.4). Environment was the domain with the lowest mean score (53.5). Quality of life was associated with the following self-reported morbidities: muscle cramps (p = 0.010), breathing difficulty (p = 0.029), tingling in the upper limbs (p = 0.010), decline in manual skills and work capacity, and pain (p < 0.001); the physical domain was the most affected. We observed a statistically significant difference in mean physical domain scores (p = 0.006) of women who used personal protection equipment; noise in the workplace interfered with the social relationships domain (p = 0.019), while working position interfered with the social relationships (p = 0.021) and environment (0 = 0.047) domains.

Conclusions:

The self-reported morbidities reported here and some working conditions negatively interfered with the women’s quality of life.

Optimization of the Rubber Formulation for Footwear Applications from the Response Surface Method

Impact force remains the primary cause of foot injury and general discomfort with regard to footwear. The footwear industry traditionally relies on modified elastomers (including natural rubber) whose properties can be physically adjusted by varying the constituents in the rubber formulations. This work aims to investigate the effect of filler/plasticizer fractions on shock attenuation of natural rubber soles. The statistical response surface method (RSM) was used to optimize the loading of natural rubber, fillers (carbon black and china clay) and a plasticizer (paraffinic oil). A novel predictive equation addressing the effects of additives on the physical and mechanical properties of the shoe sole was successfully created using the RSM. Our results demonstrate how the concentrations of these components regulate final properties, such as impact force absorption and hardness, in the commercial manufacture of shoe soles. While a higher loading level of plasticizer promotes reductions in hardness and impact force, as well as energy dissipation, in these modified elastomers, these properties were improved by increasing the filler content.