Psychosocial risk factors for work-related musculoskeletal disorders of the lower-back among long-haul international female flight attendants

Organizational Risk Factors for Aircrew Health: A Systematic Review of Observational Studies

Addressing the field of health and safety at work, the primary objective of the present systematic review was to analyze the organizational risk factors for aircrew health according to professional category (flight attendants and pilots/co-pilots) and their consequences. The secondary objective was to identify the countries in which studies were carried out, focusing on the quality of content of the publications. The Medline/Pubmed, Cochrane, Web of Science, and Scopus databases were searched for eligible studies according to PRISMA statements. The risk of bias and the methodological quality of the studies were assessed using the Newcastle-Ottawa scale and Loney tools. Of the 3230 abstracts of articles screened, 36 studies met the inclusion criteria. Most of the research conducted on risk factors for the work organization of aircrew was carried out in the United States and the European Union and had moderate or low-quality methodology and evidence. However, the findings are homogeneous and allow the most prevalent organizational risk factors for the health of aircrew to be determined, namely, high work demand, long hours, and night work. Consequently, the most pervasive health problems were sleep disturbances, mental health disorders, musculoskeletal disorders, and fatigue. Thus, the regulation of the aircrew profession must prioritize measures that minimize these risk factors to promote better health and sleep for these professionals and, consequently, to provide excellent safety for workers and passengers.

'What a Pretty Assistant You Have': Addressing Sex-Based Harassment by Patient Offenders in Undergraduate Medical Training

Sex-based harassment remains a concern in the medical workplace environment and is negatively associated with physical and mental health complications. Presently, undergraduate medical education fails to provide students with the appropriate toolset to successfully handle sex-based harassment by patient offenders. Through peer discussion and personal experience from a medical student perspective, herein we suggest strategies for individuals at all levels of medical training to help mitigate these uncomfortable situations. Simulation-based training and implementation of frameworks regarding microaggressions are crucial components of the medical curricula which must be incorporated expediently to create cultural change and help combat pre-existing historical precedents.

Approach for Assessing the Prevalence of Psychosocial Risks of Workers in the Greenhouse Construction Industry in South-Eastern Spain

This paper shows the prevalence of psychosocial risks for workers in the greenhouse construction industry in south-eastern Spain. Method: The assessment of the workers' psychosocial risks was carried out through simple random sampling, which uses a questionnaire containing 13 variables characterizing the companies, 14 variables characterizing the workers, and 15 questions proposed by the Mini Psychosocial Factors (MPFs) risk assessment method. A descriptive analysis and multiple correspondence analysis were performed on the sample data. Results: Greenhouse construction businesses in south-eastern Spain can generally be classified as small companies with an average annual turnover below EUR 2.0 million (69.3%), an average of 22.8 workers with an average age of 39.84 years old, most of whom are married, with an average of 1.76 children. The prevalence of workers at high risk was 2.9%, while 45.1% were at medium-high risk. Of the 12 psychosocial factors assessed using the MPF method, 7 of them presented a high level of worker risk: Mobbing (3.2%), Relationships (1.6%), Recognition (1.6%), Autonomy (12.9%), Emotional (8.0%), Control (4.8%), and Demands (3.2%). Lastly, the variables were grouped into four clusters, showing that larger companies are correlated with a medium (workers over 40 years of age or less than 25 years of age) to high (workers under 25 years of age) risk level in several of the psychosocial factors assessed for workers who are Spanish nationals, while in smaller companies, the workers are usually middle aged (between 25 and 40 years old) and from Eastern Europe or Africa, presenting either a low or high level of risk depending on the psychosocial factors and tasks performed. Impact of the results: The study reveals a lack of prevention management regarding psychosocial risks. Therefore, it is necessary to carry out new prevention programmes that optimise the psychosocial conditions of the workers, involving the workers, employers, and other social agents.

General and passenger-relevant factors of work-related musculoskeletal disorders (WMSDs) among Chinese female flight attendants

BACKGROUND

A high prevalence of work-related musculoskeletal disorders (WMSDs) has been reported among flight attendants. Identifying the root causes of these disorders may improve the health conditions of flight attendants and further improve flight safety and service quality.

OBJECTIVE

In this study, we aimed to identify WMSD risk factors for a specific population, namely Chinese female flight attendants.

METHODS

A two-stage survey including an online questionnaire (46 flight attendants) and a semi-structured interview (16 flight attendants) was used to assess the WMSDs of Chinese female flight attendants. Text analysis tools in NVivo 11 were used to identify the main concerns and risk factors for WMSDs of Chinese flight attendants.

RESULTS

In the online questionnaire, more than 86% of the participants reported discomfort in at least one body part. Biomechanical factors, work organizational factors, and psychosocial factors were reported by participants in this study. Chinese passengers were found to have an effect on WMSD development in Chinese flight attendants.

CONCLUSIONS

The results of this study suggested that WMSDs are severe problems among Chinese flight attendants. General factors as well as the passenger-relevant factor were identified as the most influential causes of WMSDs.

The Impact of Workplace Harassment on Health in a Working Cohort

Background: Workplace abuse, including sexual harassment, is frequently experienced worldwide and is related to adverse mental health outcomes, and injuries. Flight attendants are an understudied occupational group and are susceptible to harassment due to working in a feminized, client-facing occupation with few protections or sanctioned responses against aggressive behaviors.

Objective: We investigated the relationship between workplace abuse and health in a cohort of cabin crew. We also aimed to characterize perpetrator profiles.

Methods: We conducted our study among 4,459U.S. and Canada-based participants from the Harvard Flight Attendant Health Study using multivariate logistic regression. Our exposures of interest were episodes of workplace abuse in the past year. We evaluated several mental and physical health outcomes, including depression, fatigue, musculoskeletal injuries, and general workplace injuries.

Results: We report that exposures to verbal abuse, sexual harassment, and sexual assault are common among cabin crew, with 63, 26, and 2% of respondents, respectively, reporting harassment in the past year alone. Workplace abuse was associated with depression, sleep disturbances, and musculoskeletal injuries among male and female crew, with a trend toward increasing odds ratios (ORs) given a higher frequency of events. For example, sexual harassment was related to an increased odds for depression (OR = 1.91, 95% confidence interval [CI]: 1.51–2.30), which increased in a dose response-like manner among women reporting harassment once (OR = 1.44, 95% CI: 0.93–1.95), 2–3 times (OR = 1.83, 95% CI: 1.29–2.38), and 4 or more times (OR = 4.12, 95% CI: 3.18–5.06). We found that passengers were the primary perpetrators of abuse.

Conclusions: Our study is the first to comprehensively characterize workplace abuse and harassment and its relation to health in a largely female customer-facing workforce. The strong associations with health outcomes observed in our study highlights the question of how workplace policies can be altered to mitigate prevalent abuses. Clinicians could also consider how jobs with high emotional labor demands may predispose people to adverse health outcomes, educate patients regarding their psychological/physical responses and coping strategies, and be aware of signs of distress in patients working in such occupations in order to direct them to the appropriate treatments and therapies.

Work demand, stress and work-related musculoskeletal disorders among emergency workers

Purpose

The demanding nature of firefighting exposes firefighters to unprecedented work stress and work-related musculoskeletal disorders (WMSDs). Even though relationships among work demand, work stress and WMSDs have been examined, the mediating role of work stress in the relationship between work demand and WMSDs requires more attention, particularly among emergency workers. The purpose of this paper is to therefore assess the mediation role of firefighters’ work stress in the pathway of work demand and WMSDs.

Design/methodology/approach

A quantitative research design was used. Convenient sampling was employed to select 320 firefighters from the Greater Accra region of Ghana. Data were analyzed using descriptive, correlation and regression.

Findings

The findings revealed that work demand and stress significantly affect WMSDs. Also, work demand has a significant positive effect on work stress. It was further found that work stress partially mediates the relationship between work demand and WMSDs.

Research limitations/implications

The usage of cross-sectional data limits the strength of causality and observation of changes within units of observation over time, hence the need to use longitudinal data in future studies.

Originality/value

The novelty of this study lies in the revelation of the influence of stress in the pathway of work demand and WMSDs among emergency professionals, using an African lens.

Estimating the health consequences of flight attendant work: comparing flight attendant health to the general population in a cross-sectional study

BACKGROUND

Flight attendants are an understudied occupational group, despite undergoing a wide and unique range of adverse job-related exposures. In our study, we aimed to characterize the health profile of cabin crew relative to the U.S. general population.

METHODS

In 2014-2015, we surveyed participants of the Harvard Flight Attendant Health Study. We compared the prevalence of their health conditions to a contemporaneous cohort in the National Health and Nutrition Examination Survey (NHANES 2013-2014) using age-weighted standardized prevalence ratios (SPRs). We also analyzed associations between job tenure and selected health outcomes, using logistic regression and adjusting for potential confounders.

RESULTS

Compared to the NHANES population (n = 2729), flight attendants (n = 5366) had a higher prevalence of female reproductive cancers (SPR = 1.66, 95% CI: 1.18-2.33), cancers at all sites (SPR = 2.15, 95% CI: 1.73-2.67 among females), as well as sleep disorders, fatigue, and depression, with SPRs ranging between 1.98 and 5.57 depending on gender and the specific condition examined. In contrast, we observed a decreased prevalence of cardiac and respiratory outcomes among flight crew relative to NHANES. Health conditions that increased with longer job tenure were sleep disorders, anxiety/depression, alcohol abuse, any cancer, peripheral artery disease, sinusitis, foot surgery, infertility, and several perinatal outcomes.

CONCLUSIONS

We observed higher rates of specific adverse health outcomes in U.S. flight attendants compared to the general population, as well as associations between longer tenure and health conditions, which should be interpreted in light of recall bias and a cross-sectional design. Future longitudinal studies should evaluate specific exposure-disease associations among flight crew.

Job stress dimension and work-related musculoskeletal disorders among southeast Nigerian physiotherapists

BACKGROUND

Although publications describe physical demands of the job in the physiotherapy profession, there is a dearth of literature on job stress dimensions (JSDs), and their relationship to work-related musculoskeletal disorders (WMSDs).

OBJECTIVE

To investigate JSDs and their relationship to WMSDs among physiotherapists currently practicing in southeast Nigeria.

METHOD

A cross-sectional study using items related to the Job Content Questionnaire and the Nordic musculoskeletal questionnaire. Data were summarized with descriptive statistics, and the relationship between WMSDs and JSDs was analyzed with the Mann-Whitney U test.

RESULTS

A total of 126 physiotherapists responded. There were high levels of stress in most of the job dimensions investigated: 82.1% and 22.8% of the physiotherapists had WMSDs in at least one body region in the last 12 months and the last 7 days respectively. The lower back was the most commonly affected in both periods. No specific domain was related to development of WMSDs.

CONCLUSION

Over 80% of physiotherapists in southeast Nigeria have WMSDs. However, despite high levels of physical demands on the job, physiotherapists have job control and good social support. Intervention programs aimed at reducing WMSDs in physiotherapists should focus on risk factors that target the physical demands of the job.

Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey

OBJECTIVES

The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors, and to identify worker groups with an increased vulnerability for low back pain in the United States.

METHODS

The data used for this cross-sectional study came from the 2010 National Health Interview Survey, which was designed to collect data on health conditions and related risk factors from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% confidence interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment, and job insecurity. Work hours, occupation, and other work organizational factors (nonstandard work arrangements and alternative shifts) were also examined.

RESULTS

The prevalence of self-reported low back pain in the previous 3 months among workers in the United States was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15-1.41), exposure to hostile work (OR 1.39, CI 1.25-1.55), and job insecurity (OR 1.44, CI 1.24-1.67), while controlling for demographic characteristics and other health-related factors. Older workers who had nonstandard work arrangements were more likely to report low back pain. Women who worked 41 to 45 hours per week and younger workers who worked >60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including male health care practitioners, female and younger health care support workers, and female farming, fishing, and forestry workers, had an increased risk of low back pain.

CONCLUSIONS

This study linked low back pain to work-family imbalance, exposure to a hostile work environment, job insecurity, long work hours, and certain occupation groups. These factors should be considered by employers, policymakers, and health care practitioners who are concerned about the impact of low back pain in workers.

Exposure to Psychosocial Risk Factors at Work and the Incidence of Occupational Injuries: A Cohort Study in Spain

OBJECTIVES

The aim of this study is to analyze the association between the exposure to psychosocial risk factors at work and the incidence of occupational injuries (OIs).

METHODS

A prospective dynamic cohort study (n = 16,693) of 1-year follow-up. Psychosocial risk factors at work were assessed with the Spanish version of Copenhagen Psychosocial Questionnaire. Incidence rates of OI per 1000 workers-year were calculated and associations between psychosocial risk factors and OI were estimated by Poisson regression models.

RESULTS

Unfavorable levels of esteem in men [rate ratio (RR) = 1.28], and unfavorable levels of social support and quality of leadership (RR = 1.87), psychological demands (RR = 2.20), and active work and possibilities for development (RR = 1.83) among women, were associated with OI incidence.

CONCLUSIONS

Poor quality of psychosocial work environment increases the incidence of OI. Psychosocial intervention programs could be helpful in order to reduce OI incidence rates and their associated costs.

Trabalho e saúde dos comissários de bordo: uma revisão

Resumo Introdução: com o aumento do número de voos e passageiros, as tarefas atribuídas aos comissários de bordo tornam-se mais complexas, podendo gerar sobrecarga e prejuízo à saúde e ao desempenho desses trabalhadores. Objetivos: identificar e sistematizar os artigos publicados em periódicos científicos, sobre o impacto de fatores físicos, ambientais e organizacionais do trabalho dos comissários de bordo na saúde desses trabalhadores. Método: revisão sistemática da literatura, em português e inglês, utilizando as palavras-chave "aeronave", "cabine", "transporte aéreo", "comissário de bordo" e "trabalho", nas bases de dados ScienceDirect, PubMed, Scopus, ProQuest e SciELO, considerando o período de 1983 a 2013. Resultados: 65 artigos atenderam aos critérios de inclusão. Verificou-se um predomínio de trabalhos com foco em fatores físicos e/ou relacionados à saúde/doença e em fatores relacionados à satisfação no trabalho e poucos estudos abordando a organização do trabalho. Conclusão: os estudos encontrados analisaram os fatores presentes nas situações de trabalho de comissários de bordo de forma isolada. Não foram encontrados estudos que adotassem uma metodologia de análise das situações de trabalho que possibilitasse estabelecer inter-relações entre os fatores determinantes da carga de trabalho desses trabalhadores e os impactos para sua saúde.

L4-L5 compression and anterior/posterior joint shear forces in cabin attendants during the initial push/pull actions of airplane meal carts

The aim of the present study was to assess the acute low back load of cabin attendants during cart handling and to identify working situations which present the highest strain on the worker. In a setup, 17 cabin attendants (ten females and seven males) pushed, pulled and turned a 20 kg standard meal cart (L: 0.5m × W: 0.3 m × H: 0.92 m) loaded with extra 20 kg and 40 kg, respectively on two different surfaces (carpet and linoleum) and at three floor inclinations (-2°, 0° and +2°). Two force transducers were mounted as handles. Two-dimensional movement analysis was performed and a 4D WATBAK modelling tool was used to calculate the acute L4-L5 load. No working situations created loads greater than the accepted values for single exertions, however compression and anterior/posterior shear forces during pulling and turning were much higher when compared with pushing. There were significant effects of handling the cart on different floor types, at the varying inclinations and with different cart weights. Additionally, when external forces were reduced, the cabin attendants did not decrease push/pull force proportionally and thus the L4-L5 load did not decrease as much as expected.

Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus?

The aim of our case-control study was to compare selected psychological and social characteristics between diabetic patients with and without the DF (controls).

METHODS

104 patients with and 48 without DF were included into our study. Both study groups were compared in terms of selected psychosocial characteristics.

RESULTS

Compared to controls, patients with DF had a significantly worse quality of life in the area of health and standard of living as shown by lower physical health domain (12.7 ± 2.8 versus 14.7 ± 2.5; P < 0.001) and environment domain (14.1 ± 2.2 versus 15 ± 1.8; P < 0.01) that negatively correlated with diabetes duration (r = -0.061; P = 0.003). Patients with DF subjectively felt more depressed in contrast to controls (24.5 versus 7.3%; P < 0.05); however, the depressive tuning was objectively proven in higher percentage in both study groups (83.2 versus 89.6; NS). We observed a significantly lower level of achieved education (P < 0.01), more patients with disability pensions (P < 0.01), and low self-support (P < 0.001) in patients with the DF compared to controls. In the subgroup of patients with a previous major amputation and DF (n = 6), there were significantly worse outcomes as in the environment domain (P < 0.01), employment status, and stress readaptation (P < 0.01) in contrast to the main study groups.

CONCLUSIONS

Patients with DF had a predominantly worse standard of living. In contrast to our expectations, patients with DF appeared to have good stress tolerability and mental health (with the exception of patients with previous major amputation) and did not reveal severe forms of depression or any associated consequences.

Fear-avoidance beliefs associated with perceived psychological and social factors at work among patients with neck and back pain: a cross-sectional multicentre study

Background

Neck and back pain are common and often account for absenteeism at work. Factors at work as well as fear–avoidance beliefs may influence sick-leave in these patients. The aims of this study were to assess: (1) how sick-listed patients in specialised care perceive demand, control, support, effort, reward, and overcommitment at work compared to a general reference group of workers; (2) if women and men report demand, control, support, effort, reward, and overcommitment differently; and (3) the association between psychological and social factors at work and fear–avoidance beliefs about work.

Methods

A cross-sectional multicentre study was carried out in 373 patients on sick leave due to neck and back pain. Psychosocial work factors were measured by demand, control, and support, (Nordic Questionnaire for Psychological and Social Factors at Work), and effort, reward and overcommitment (Effort Reward Imbalance Questionnaire). Fear avoidance beliefs about work were measured by the Fear–Avoidance Belief Questionnaire Work subscale (FABQ-W).

Results

Although the patients differed significantly from a reference working group regarding several subscales of demand, control, support, effort, reward, and overcommitment, the magnitude of these differences were small. The study population also reported significantly higher scores for ‘demand for physical endurance’ than the reference population, and Cohen’s d = 0.55 here indicated a medium degree of difference. Female patients reported significantly higher on support, whereas male patients reported significantly higher demand for physical endurance, quantitative demand, effort, and overcommitment. Demand for physical endurance, job control, job support, high reward, and overcommitment were significantly associated with FABQ-W.

Conclusions

Perceived psychological and social factors at work were strongly associated with fear–avoidance beliefs about work in sick-listed neck and back patients. The demand for physical endurance, control, support, high reward, as well as overcommittment at work outweighed pain and added to the burden of emotional distress and disability regarding fear–avoidance beliefs.

[Psychosocial work-related factors and musculoskeletal pain among schoolteachers]

This study aimed to investigate the association between work-related psychosocial factors and musculoskeletal pain (MP) among primary schoolteachers in the public school system in Salvador, Bahia State, Brazil. A cross-sectional epidemiological study included all 4,496 teachers from the system. A self-applied mail questionnaire was used to collect information on complaints of musculoskeletal pain in the upper limbs, lower limbs, and back (dependent variables), demand-control model quadrants (independent variables), and covariables. Multivariate logistic regression showed that teachers in high-stress jobs presented the highest MP rates, and that those with low-stress jobs had the lowest rates in all three body segments. Teachers in active jobs presented higher MP rates than those in low-stress jobs, particularly in the upper limbs and back. Higher MP prevalence rates were associated with heavier psychological demand in all three body segments and with limited job control in the upper limbs only.

Prevalence of neck pain and associated factors with personal characteristics, physical workloads and psychosocial among male rubber workers in FELDA settlement Malaysia

Rubber tapping processes posed potential risk of various health problems among rubber workers. It ranges from simple musculoskeletal aches to more serious and complicated structural damage to bone, muscles, tendons and nerves of musculoskeletal system. These health problems might be linked directly to the arduous demands of farm labor.

A biopsychosocial perspective on the management of work-related musculoskeletal disorders

This article provides an overview of current literature about workplace-related musculoskeletal disorders from a biopsychosocial perspective. The authors conclude that disability management and early intervention efforts can only be meaningful within the context of targeted interventions, including mechanisms for psychosocial screening. In addition, they suggest that return to work should be considered an integral, rather than superficial, contribution to the rehabilitative process.

Psychosocial Factors and Work-related Musculoskeletal Disorders among Southeastern Asian Female Workers Living in Korea

OBJECTIVES

A rapid increase in the population of migrant workers in Korea has brought new challenges regarding the possible effects of acculturation on health. The purpose of this study was to examine the influence of acculturation- and work-related psychosocial factors on work-related musculoskeletal disorders among migrant female workers living in Korea.

METHODS

A cross-sectional survey design was used. A translated, structured questionnaire was administrated to 156 southeastern Asian female full-time workers living in Korea.

RESULTS

About 35% of the participants experienced some type(s) of work-related musculoskeletal disorder(s), which were more prevalent in Vietnamese women than in Thai and Filipino women. Women who preferred to maintain their own heritage and to reject the host country heritage were at risk for work-related musculoskeletal disorders.

CONCLUSION

Acculturation strategy and nationality were found to be significant factors associated with work-related musculoskeletal disorders. Health professionals need to accommodate acculturation contexts into risk assessment and intervention development for work-related musculoskeletal disorders separately for different nationalities.

Incidence and predictors of onboard injuries among Sri Lankan flight attendants

Background

Occupational injuries among flight attendants have not been given appropriate attention in Sri Lanka. The purpose of this study was to estimate the incidence of onboard injury among Sri Lankan flight attendants and to describe the determinants of onboard injury.

Methods

A descriptive cross-sectional study was carried out among Sri Lankan flight attendants. All flight attendants undergoing their annual health and first aid training were invited to participate. Flight attendants who flew continuously for a six-month period prior to data collection were included in the study sample. Recall history of injuries for a period of six months was recorded.

Results

The study sample consisted of 98 (30.4%) male and 224 (69.6%) female flight attendants. The mean age of the study sample was 31 years (SD = 8) and the average duration of service was 10 years (SD = 7). A total of 100 onboard falls, slips or trips in the previous six months were reported by 52 (16.1%) respondents. Of the total sample, 128 (39.8%) cabin crew members reported an injury in the six months preceding the study. This represents a total injury incidence of 795 per 1000 person per year. The leading causes of injury was pulling, pushing or lifting (60.2%). The commonest type of injuries were strains and sprains (52.3%). Turbulence related injuries were reported by 38 (29.7%) flight attendants. The upper limbs (44.5%) and the back (32%) were the commonest sites affected. After controlling for other factors, female flight attendants had 2.9 times higher risk (95% CI 1.2–7.2) of sustaining and injury than males. Irrespective of sex, body weight less than 56 kilograms (OR 2.9, 95% CI 1.4–5.8) and less than seven years of on board experience (OR 10.5, 95% CI 3.6–31.0) were associated with higher risk of injury.

Conclusion

Work related injury is a major occupational hazard to flight attendants. Appropriate preventive strategies are required to minimize them.