Observational stress factors and musculoskeletal disorders in urban transit operators

Exploring fascial properties in patients with depression and chronic neck pain: An observational study

BACKGROUND

Depressive disorder and chronic pain are prevalent conditions that often co-occur. The myofascial fascial continuum has been hypothesized to contribute to both conditions. However, limited research exists on the specific association between fascial properties and chronic pain and depression.

OBJECTIVE

This study aims to investigate the properties of the deep fascia of the M. trapezius and their relationship with depression, chronic neck pain, and cervical spine mobility.

METHOD

This study compared fascial properties between two groups: individuals with depression and chronic neck pain, and healthy individuals. Fascial thickness, elasticity, and stiffness were measured as primary outcomes using standardized techniques such as ultrasound imaging and compliance meter. Statistical analyses were conducted to identify potential differences and correlations in fascial properties between the two groups.

RESULT

Significant differences emerge in stiffness, tone, and fascia thickness in the deep fascia, alongside identified correlations between depression, chronic pain, and these variables.

CONCLUSION

The study highlights the impact of depression and chronic pain on fascial properties, emphasizing the need for further research in this domain to unravel the intricate connections and potential implications for treatment strategies.

Causal Relationship Between the Risk Factors and Work-Related Musculoskeletal Disorders Among Professional Drivers: A Systematic Review

OBJECTIVE

This review evaluates the evidence on the strength of causal relationship between categories of risk factors (RFs) and work-related musculoskeletal disorders (WRMSDs) among professional drivers.

BACKGROUND

A compilation of evidence on the causal relationship between RFs and WRMSDs among professional drivers is lacking.

METHODS

A systematic search of the literature was conducted in major electronic data bases that include Medline (1946 + via OvidSP), Embase (1974 + OvidSP), CINAHL (1982+), AMED, and Web of Science. The methodological quality of the studies was assessed and scored. A descriptive analysis on the categories of RFs associated with WRMSDs was conducted. The Bradford-Hill causation criteria and evidence interpretation tool were used to evaluate the causal relationship between RFs and WRMSDs in professional drivers.

RESULTS

Among the 54 studies reviewed, a strong evidence suggests a causal relationship between RFs such as whole-body vibration, awkward postures, lifting tasks, manual material handling, job stress, job demand, and previous pain episodes with WRMSDs. Moderate evidence was observed on RFs such as uncomfortable seat and low job satisfaction. The evidence on causal relationship between RFs such as years of professional driving, driving duration, and individual characteristics such as age and body mass index was inconclusive.

CONCLUSION

There is strong to moderate evidence on the causal relationship between the physical and psychosocial RFs and WRMSDs among professional drivers.

APPLICATION

Potential application of this review highlights evidence to occupational health practitioners, policy makers, and stakeholders on the strength of causal relationship between RFs and WRMSDs among professional drivers.

Understanding passenger hostility in transit: a systematic review

Passenger hostility is commonplace in the transit industry. However, research investigating this job stressor is limited in both scope and quality. This systematic review examines three questions regarding passenger hostility: (a) what is its occurrence (incidence and prevalence); (b) what are its consequences; and (c) what factors are related to its occurrence, intensity, or consequences? Six databases were searched for studies published between 2010 and 2020 reporting the occurrence, consequences, or correlates of passenger hostility directed toward transit workers. Risk of bias was categorized using the Critical Appraisal Skills Programme. Results were summarized in tables and narratively synthesized. Nineteen eligible studies (10 quantitative and nine qualitative or mixed methods) were identified. Evidence from 14 studies indicated that passenger hostility occurs frequently, and is often underreported, especially in its less severe forms. Sixteen studies reported correlates of the occurrence, intensity, or consequences of hostility, with these grouped into worker, passenger, organizational, environmental, and event categories. Immediate and long-term impacts were identified in ten studies. This review contributes to understanding the likely antecedents, correlates and consequences of passenger hostility directed at transit industry workers. It also highlights some common methodological limitations in past research and proposes solutions to them. As such, the paper provides suggestions for future explorations and intervention targets aimed at reducing this common workplace stressor.

Work-unit measures of psychosocial job stressors and onset of bullying: a 2-year follow-up study

OBJECTIVES

Numerous studies have examined the health consequences of workplace bullying, but little is known about workplace antecedents of workplace bullying. This study examines whether high psychological demands, low levels of justice at work, and low decision latitude increase the occurrence of being bullied or witnessing bullying.

METHODS

In 2007, 4489 Danish public employees answered a questionnaire with follow-ups in 2009 (72%) and 2011 (73% of 2009 respondents). We examined the longitudinal association between exposure to job stressors in 2007 and 2009 and bullying in 2009 and 2011, respectively, on an individual and work-unit level. For each working condition (psychological demands, decision latitude, procedural and relational justice), we calculated a mean value. Odds ratios were calculated by logistic regression.

RESULTS

Low levels of individual-level relational justice, compared to high levels, were associated with a higher risk of both witnessing episodes of bullying (OR 1.66, 95% CI 1.11-2.48) and perceiving oneself as a target of bullying (OR 2.21, 95% CI 1.17-4.16). Low levels of work-unit level relational justice were associated with a higher risk of witnessing bullying (OR 1.55, 95% CI 1.04-2.30) but not perceiving oneself as a target of bullying. The other workplace characteristics exhibited no or less consistent associations across the different analytical approaches.

CONCLUSION

Low levels of relational justice prospectively predicted the occurrence of workplace bullying within a 2-year period for three out of four methodological approaches, suggesting that relational justice plays a role in the prevention of workplace bullying.

The Impact of Lead Aprons on Posture of Orthopaedic Surgeons

BACKGROUND

Surgeons working in orthopedics and trauma surgery are frequently exposed to repetitive actions and non-ergonomic positions in their operative activities with the regular use of lead aprons. Musculoskeletal complaints of the neck and back among surgeons are reported in the literature as up to 80%. In this study, the effects of lead aprons on the posture of surgeons are examined using videorasterstereography, foot pressure measurement and questionnaires.

METHODOLOGY

All subjects (n = 31) were examined before and after exposure to wearing lead aprons during surgery using videorasterstereography and pedography. In addition, a survey with a separately created questionnaire and the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was carried out.

RESULTS

An average duration of lead apron use of 102.6 min showed an increase in forefoot load (p = 0.002) especially in the elderly subjects and thoracic kyphosis (p < 0.001) especially in the younger doctors with a significant lateral deviation (p = 0.006). In addition, the lateral deviation was shown to correlate with an increasing body size or a shorter period of employment (p = 0.008; r = 0.51/p = 0.026; r = - 0.44). Significantly fewer surgeons experienced back complaints on working days without lead apron use in the operating room compared to days in the OR (p = 0.011).

CONCLUSION

The impact of wearing front covered lead aprons during operations in the field of orthopaedics and trauma surgery leads to more frequent back complaints, even among young and healthy doctors. Under an average duration of surgery of 102 min a temporary postural deviation occurs that can be demonstrated by means of videorasterstereography and foot pressure measurement. The subjects showed a shifted weight distribution on the forefoot, a gain in thoracic kyphosis and an increase in lateral deviation, which also correlated with an increasing height and shorter length of employment.

Prevalence of musculoskeletal pain among professional drivers: A systematic review

OBJECTIVES

Professional drivers are at high risk of developing musculoskeletal pain (MSP) due to risk factors such as prolonged sitting, whole body vibration, awkward posture, and repetitive actions. This review investigates the reported prevalence of MSP among professional drivers.

METHODS

An electronic search of Medline (1946 + via OvidSP), Embase (1974 + OvidSP), CINAHL (1982+), AMED, PubMed, and Web of Science from 1990 to July 2019 was performed. Methodological quality of studies was assessed using three quality assessment tools for cross-sectional, case-control, and prospective cohort studies. The prevalence of MSP was reported using descriptive analysis.

RESULTS

A total of 56 studies conducted in 23 different countries across a total of 14 types of occupational transport were reviewed. Data of a total pooled population of 18 882 professional drivers were analyzed for MSP. The prevalence of MSP ranged between 43.1% and 93%. The low back was the most frequently reported body region for MSP with a meta-prevalence rate of 53% (N = 9998). Neck, shoulder, and upper back were the other common regions with high prevalence.

CONCLUSION

There is a high prevalence of MSP in professional drivers and low back was the most frequently reported body region, followed by neck, upper back, shoulder, knee, hip/thigh, wrist, ankle, and elbow. MSP is complicated in nature and therefore in-depth exploration of causal relationships between MSP and risk factors is necessary so that appropriate healthcare programs can be initiated to prevent and treat MSP effectively.

Inter-rater reliability of direct observations of the physical and psychosocial working conditions in eldercare: An evaluation in the DOSES project

The aim of the study was to develop and evaluate the reliability of the "Danish observational study of eldercare work and musculoskeletal disorders" (DOSES) observation instrument to assess physical and psychosocial risk factors for musculoskeletal disorders (MSD) in eldercare work. During 1.5 years, sixteen raters conducted 117 inter-rater observations from 11 nursing homes. Reliability was evaluated using percent agreement and Gwet's AC1 coefficient. Of the 18 examined items, inter-rater reliability was excellent for 7 items (AC1>0.75) fair to good for 7 items (AC1 0.40-0.75) and poor for 2 items (AC1 0-0.40). For 2 items there was no agreement between the raters (AC1 <0). The reliability did not differ between the first and second half of the data collection period and the inter-rater observations were representative regarding occurrence of events in eldercare work. The instrument is appropriate for assessing physical and psychosocial risk factors for MSD among eldercare workers.

Working Conditions, Job Strain, and Traffic Safety among Three Groups of Public Transport Drivers

Background

Working conditions and psychosocial work factors have acquired an important role explaining the well-being and performance of professional drivers, including those working in the field of public transport. This study aimed to examine the association between job strain and the operational performance of public transport drivers and to compare the expositions with psychosocial risk at work of three different types of transport workers: taxi drivers, city bus drivers, and interurban bus drivers.

Method

A sample of 780 professional drivers was drawn from three transport companies in Bogota (Colombia). The participants answered the Job Content Questionnaire and a set of sociodemographic and driving performance questions, including age, professional driving experience, work schedules, and accidents and penalties suffered in the last 2 years.

Results

Analyses showed significant associations between measures of socio-labor variables and key performance indicators such road traffic accidents and penalties. Furthermore, multiple linear regression analysis contributed to explain significantly suffered accidents from key variables of the Job Demand-Control model, essentially from job strain. In addition, throughout post-hoc analyses, significant differences were found in terms of perceived social support, job strain, and job insecurity.

Conclusion

Work stress is an issue that compromises the safety of professional drivers. This research provides evidence supporting a significant effect of job strain on the professional driver's performance. Moreover, the statistically significant differences between taxi drivers, city bus drivers, and interurban bus drivers in their expositions to work-related stress suggest the need for tailored occupational safety interventions on each occupational group.

Trouble in transit: Organizational barriers to workers' health

BACKGROUND

Valuable insights on the health and behavior of transit workers can be obtained from qualitative research that considers the social environment, which affects job performance and determines levels of perceived stress.

METHODS

Using a grounded theory approach, semi-structured interviews were conducted with American transit workers (n = 32). Recorded interviews were transcribed and analyzed using a constant comparative method.

RESULTS

Participants described categories related to entrenched organizational practices, particularly managements' leadership style, which created an atmosphere of distrust. High demanding work schedules, as a result of technological advances, were discussed in relation to diminished breaks, fatigue, and unhealthy diets. Transit workers also attributed increased work demands and irregular working hours to compromised time with family and friends.

CONCLUSIONS

The described barriers to positive health behaviors and social support underscore the need for interventions that ensure adequate breaks and recovery between shifts and increase safety for transit passengers. Am. J. Ind. Med. 60:350-367, 2017. © 2017 Wiley Periodicals, Inc.

Factors Associated with Cessation Activities amongst a Multiethnic Sample of Transit Workers

Introduction: Transit workers are a blue-collar occupational group with elevated rates of smoking despite access to free or low-cost cessation services available through their health insurance as a union-negotiated employee benefit. Little is known about the influences on cessation participation in this workforce.

Aims: The purpose of this study is to analyse the factors associated with past-year cessation activities amongst a multiethnic sample of transit workers.

Methods: Cross-sectional tobacco surveys were completed by 935 workers at an Oakland, California, USA-based public transit agency. Data from 190 current smokers (68% African American; 46% female) were analysed. Adjusted odds ratios were calculated to identify factors associated with past-year cessation activity.

Results: Approximately 55% of smokers stopped smoking for one day or longer during the past year in order to quit. Nearly half reported that the most common barrier to quitting was, ‘Not mentally ready to quit because I like smoking’. Workers in the contemplation/precontemplation stage for intention to quit were less likely to have engaged in cessation activities than those in the action/preparation stage (AOR = 0.34). Frequency of coworker encouragement for quitting was positively associated with past-year cessation activities (AOR = 3.25). Frequency of insomnia symptoms was negatively associated with cessation activity participation (AOR = 0.34).

Conclusions: Most transit workers who smoke made a past-year quit attempt. Gaining insight into factors associated with participation in cessation activities can aid worksite efforts to promote cessation and reduce tobacco-related disparities.

A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

OBJECTIVES

Eldercare workers in Denmark have a higher prevalence of poor psychological health than other occupational groups. We examined the association between working conditions assessed by trained observers and depressive symptoms assessed by self-report in a study of female Danish eldercare workers.

METHODS

Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work unit averaged working conditions with depressive symptoms in a sample of 95 individually observed eldercare workers. Further, we examined the association of work unit averaged working conditions with depressive symptoms in a sample of 205 care workers, including both observed and non-observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events.

RESULTS

Higher levels of regulation requirements were associated with lower depressive symptoms at the individual level (p=0.04), but not at the workplace level. Barriers were not associated with depressive symptoms at the individual level. At the workplace level, a higher number of qualitatively different barriers (p=0.04) and a higher number of barriers for equipment use (p=0.03) were associated with lower levels of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model.

CONCLUSIONS

Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both individual and workplace levels of working conditions.

Labor unions: a public health institution

Using a social-ecological framework, we drew on a targeted literature review and historical and contemporary cases from the US labor movement to illustrate how unions address physical and psychosocial conditions of work and the underlying inequalities and social determinants of health. We reviewed labor involvement in tobacco cessation, hypertension control, and asthma, limiting articles to those in English published in peer-reviewed public health or medical journals from 1970 to 2013. More rigorous research is needed on potential pathways from union membership to health outcomes and the facilitators of and barriers to union-public health collaboration. Despite occasional challenges, public health professionals should increase their efforts to engage with unions as critical partners.

Deadlines at work and sleep quality. Cross-sectional and longitudinal findings among Danish knowledge workers

BACKGROUND

Exposure to deadlines at work is increasing in several countries and may affect health. We aimed to investigate cross-sectional and longitudinal associations between frequency of difficult deadlines at work and sleep quality.

METHODS

Study participants were knowledge workers, drawn from a representative sample of Danish employees who responded to a baseline questionnaire in 2006 (n = 363) and a follow-up questionnaire in 2007 (n = 302). Frequency of difficult deadlines was measured by self-report and categorized into low, intermediate, and high. Sleep quality was measured with a Total Sleep Quality Score and two indexes (Awakening Index and Disturbed Sleep Index) derived from the Karolinska Sleep Questionnaire. Analyses on the association between frequency of deadlines and sleep quality scores were conducted with multiple linear regression models, adjusted for potential confounders. In addition, we used multiple logistic regression models to analyze whether frequency of deadlines at baseline predicted caseness of sleep problems at follow-up among participants free of sleep problems at baseline.

RESULTS

Frequent deadlines were cross-sectionally and longitudinally associated with poorer sleep quality on all three sleep quality measures. Associations in the longitudinal analyses were greatly attenuated when we adjusted for baseline sleep quality. The logistic regression analyses showed that frequent deadlines at baseline were associated with elevated odds ratios for caseness of sleep problems at follow-up, however, confidence intervals were wide in these analyses.

CONCLUSIONS

Frequent deadlines at work were associated with poorer sleep quality among Danish knowledge workers. We recommend investigating the relation between deadlines and health endpoints in large-scale epidemiologic studies.

What qualitative research has taught us about occupational stress

While many reviews of job stress and the stressor–strain relationship have been conducted, such reviews typically focus exclusively on quantitative data. In the current paper, we review qualitative studies on occupational stress that met two criteria: (1) the studies employed qualitative methods; (2) the stressors, strains and/or coping strategies were grouped into identifiable, higher-order categories. Results indicated that the nature of the stressors experienced varied by (a) occupation, (b) country, (c) seniority and (d) gender. The review further revealed that organizational constraints, work overload and interpersonal conflict were relatively universal stressors. Anger and annoyance were the most frequently reported psychological strains in the United States and the United Kingdom, while Chinese workers exhibited tension and anxiety and Indian workers exhibited acceptance. Coping strategies also varied by gender, occupation and country. Research on gender differences suggested that, compared to men, women tended to report more interpersonal stressors. Differences in the ways in which the two types of methodologies are applied, as well as their relative strengths and weaknesses, underline the value of qualitative approaches to the study of occupational stress, especially when used in conjunction with quantitative methods in mixed-methods studies.

Job strain and the risk of depression: is reporting biased?

It is unknown whether the relation between job strain and depression reflects causal characteristics of the working environment or reporting bias. The authors investigated reporting bias by analyzing individual versus work-unit measures of job strain and the risk of depressive symptoms (n = 287) and a diagnosis of depression (n = 97) among 4,291 employees within 378 work units in Aarhus, Denmark, 2007. All participants reported psychological demands and decision latitude, and the authors estimated mean values for each work unit. The odds ratios predicting depressive symptoms or a diagnosis of depression for the highest versus the lowest levels of individual, self-reported high psychological demands and low decision latitude were significantly increased above 2.5. When participants were classified by the work-unit mean levels, these associations were substantially smaller. For depressive symptoms, the odds ratios were 1.49 (95% confidence interval (CI): 0.88, 2.53) and 1.08 (95% CI: 0.84, 1.39), respectively, for psychological demands and decision latitude. For a diagnosis of depression, the odds ratios were 1.33 (95% CI: 0.57, 3.09) and 1.02 (95% CI: 0.68, 1.56), respectively, for psychological demands and decision latitude. These findings indicate that reporting bias inflates associations between job strain and the occurrence of depression, if studies rely on individual self-reports.

Upper body quadrant pain in bus drivers

The aims of this study were to evaluate the prevalence of upper body quadrant pain among Israeli professional urban bus drivers and to evaluate the association between individual, ergonomic, and psychosocial risk factors and occurrence of neck pain. Three hundred and eighty-four male urban bus drivers were consecutively enrolled in the study. Data pertaining to work-related ergonomic and psychosocial stress factors were collected. The 12-month prevalence of neck pain was 21.2%, followed by shoulder: 14.7%, upper back: 8.3%, elbow: 3.0%, and wrist: 3.0% pain. Prevalence of neck pain was associated with uncomfortable seats (odds ratio; OR [95% confidence interval; CI]: 2.2 [1.2-4.3], back support (2.3 [1.2-4.2]), and steering wheel (2.2 [1.1-4.5]). Drivers with neck pain reported significantly higher prevalence of pain in the upper back (OR [95% CI]: 5.9 [2.7-12.9]), shoulders (8.1 [4.3-15.3]), and wrists (7.0 [2.0-21.8]) compared to drivers without neck pain. Work-related organizational stress factors were not associated with neck pain prevalence.