Interactions between physical and psychosocial risk factors at work increase the risk of back disorders: an epidemiological approach

Ward-level leadership quality and prospective low-back pain of eldercare workers: do resident handlings mediate the association?

OBJECTIVE

We investigated the extent to which ward-level leadership quality was associated with prospective low-back pain among eldercare workers, and how this association was mediated by observed resident handlings.

METHODS

530 Danish eldercare workers, employed in 121 wards, distributed across 20 nursing homes were evaluated. At baseline, leadership quality was measured using the Copenhagen Psychosocial Questionnaire, and resident handlings [handlings per shift, handlings not using assistive devices, handlings done alone, interruptions to handlings, impediments to handlings] were assessed using observations. Frequency and intensity of low-back pain was assessed monthly during the following year. All variables were averaged for each ward. We used ordinary least squares regressions to examine direct effects of leadership on low-back pain and indirect effects through handlings, using PROCESS-macro for SPSS.

RESULTS

After adjustments for low-back pain at baseline, type of ward, staff ratio (i.e., number of workers divided by number of residents) and proportion of devices not in place, leadership quality showed no effect on prospective low-back pain frequency (β = 0.01 [- 0.05:0.07]) and a small beneficial effect on pain intensity (β = - 0.02 [- 0.04:0.00]). Resident handlings did not mediate the association between leadership quality and frequency or intensity of low-back pain.

CONCLUSIONS

Good leadership quality was associated with a small decrease in prospective low-back pain intensity, but resident handlings did not seem to play a mediating role, although better ward-level leadership quality contributed to fewer workplace-observed resident handlings without assistance. Potentially, organizational factors, such as type of ward and staff ratio, may have a greater influence on handlings and low-back pain than leadership quality per se among eldercare workers.

Interaction between physical demands and job strain on musculoskeletal symptoms and work performance

This study investigated the interaction between physical demands and job strain on musculoskeletal symptoms in upper extremities (MSUE) and work performance. Two years of prospective data were analysed from 713 full-time workers from twelve manufacturing and healthcare facilities in Washington in the United States. Physical exposure was measured by the Strain Index and Threshold Limit Value for hand activity, giving rise to safe, action, and hazardous physical demand groups. Job strain was calculated as the ratio of psychological job demands to job control. Multilevel modelling analysis showed that job strain affected MSUE and limited work performance less in the high physical demand group than the safe group because the protective effect of job control was smaller in these groups. Findings may suggest that high physical demand jobs are structured such that workers have low job control or high physical demand groups experience job strain not adequately captured by psychosocial variables.Practitioner Summary: The effects of job strain and job control on musculoskeletal symptoms in upper extremities and work performance were smaller among workers with higher physical demands. This could imply that high physical demand jobs limit job control or psychosocial variables may not adequately capture job strain among high physical demand groups.

Association between Whole-Body Vibration exposure and musculoskeletal disorders among dumper operators: A case-control study in Indian iron ore mines

BACKGROUND

Dumper operators in mines worldwide are subjected to Musculoskeletal Disorders (MSDs) due to whole-body vibration exposure. This study evaluated the working-life-Whole-Body Vibration (WBV)-exposure and their association with various MSDs among dumper operators in mines which remains poorly addressed.

METHODS

This case-control study in Indian iron ore mines was conducted to compare randomly selected 65 dumper operators and 65 office workers. Data were collected through face-to-face interviews using the Nordic Musculoskeletal Questionnaire (NMQ) and were analysed using logistic regression models.

RESULTS

The study revealed that majority of the dumper operators were exposed to WBV exceeding the ISO-2631 limits. Compared with controls, the dumper operators had a much higher risk of upper back pain (age-overweight-adjusted odds ratio ORao = 5.37, 95%CI = 1.78-16.20), lower back pain (ORao = 2.72, 95%CI = 1.25-5.94), knee and leg pain (ORao = 3.68, 95%CI = 1.22-11.11), and having 2+ MSDs (ORao = 5.05, 95%CI = 1.88-13.51, vs. no MSDs). Working-life-WBV-exposure was higher among dumper operators having upper back pain (mean (SD) = 7.1 (1.91) vs. 5.7 (1.91), p <  0.01) and lower back pain (mean (SD) = 6.63 (2.10) vs. 5.55 (1.71), p <  0.01) compared to those without these MSDs. Older age was associated with higher risk of MSD pains.

CONCLUSION

Dumper operators have excess MSDs due to high working-life-WBV-exposure. Their MSDs and working-life-WBV-exposure should be regularly evaluated and reduced.

Occupational health issues experienced by UK embryologists: informing improvements in clinical reproductive science practice

A consultation exercise was undertaken with UK embryologists to construct knowledge of the occupational health issues they experience in everyday practice. Data were obtained from 223 eligible survey responses. Work-related ill health was self-reported by 58.3% of respondents, 76.2% of whom reported multiple issues. The most frequently disclosed ill-health conditions were musculoskeletal disorders (45.3%) and stress and mental health problems (27.8%). Other issues with an incidence above 3% were ocular and auditory problems and needlestick and liquid nitrogen injuries. Shoulder injury or pain correspondingly increased in incidence with length of time in service. Absence from work and/or light duties were necessitated for 34.5% of those affected. Assessment of the evidence base for these work-related ill-health conditions explored contributory and ameliorating factors, which enabled a series of evidence-based recommendations to be formulated via the adoption of a GRADE-based framework.

Interaction Effects of Physical and Psychosocial Working Conditions on Risk for Sickness Absence: A Prospective Study of Nurses and Care Assistants in Sweden

Employees in health and social care are often simultaneously exposed to both physical and psychosocial challenges that may increase their risk for sickness absence. The study examines interaction effects of physical and psychosocial work conditions on the future risk for sickness absence among nurses and care assistants in Sweden. The study was based on 14,372 participants in any of the Swedish Work Environment Surveys conducted during the years 1993–2013 with linked register information on background factors and compensated sickness absence. Adjusted hazard ratio (HR), stratified by occupation, and measures of additive interaction effects were estimated. The combinations of high psychosocial job demands and heavy physical work and strenuous postures, respectively, significantly increased the risks for sickness absence among nurses (HR 1.43; CI 1.09–1.88 and HR 1.42; CI 1.16–1.74, respectively), as well as among care assistants (HR 1.51; CI 1.36–1.67 and HR 1.49; CI 1.36–1.63, respectively). The combinations of low job control and both heavy physical work (HR 1.44; CI 1.30–1.60) and strenuous postures (HR 1.42; CI 1.30–1.56) were also associated with excess risk for sickness absence among care assistants. We also found interaction effects among care assistants but not among nurses. The results indicate that the high sickness absence rate among care workers in Sweden can be reduced if the simultaneous exposures of high psychosocial and high physical challenges are avoided. Management policies for reduced time pressure, improved lifting aids, and measures to avoid awkward work postures are recommended. For care assistants, increased influence over work arrangements is likely to lower their sickness absence risk.

Interaction effects of physical and psychosocial working conditions on the risk of disability pension among nursing professionals and care assistants in Sweden: A prospective study

BACKGROUND

Nursing professionals and care assistants are often subject to a combination of negative physical and psychosocial work environment factors, but most disability pension studies on such occupations have focused on one or the other of these factors. As they often coexist, there are reasons to assume that simultaneously being exposed to both types of exposures will increase the risk of disability more than being exposed to either.

OBJECTIVES

The study examined combinations of physical and psychosocial work conditions as predictors of future disability pension among nursing professionals and care assistants in Sweden.

PARTICIPANTS

The study was based on a random and representative sample of 79,004 participants in any of the Swedish Work Environment Surveys from 1993 to 2013. A total of 2576 nursing professionals, 10,175 care assistants, and 66,253 workers in other occupations were included.

METHODS

Information on background factors and disability pension was obtained from population registers. Cox proportional hazard regressions with 95% confidence intervals (CI) were performed to study if pairs of combinations of physical and psychosocial factors were related to an increased risk of disability pension. Additionally, measures of synergistic effects were estimated. The analyses were stratified on occupation group, with adjustment for selected confounders.

RESULTS

The results indicated increased hazard ratios (HR) for disability pension for most combinations of physical and psychosocial working conditions. The hazard ratios for joint exposure to high demands and heavy physical work were high among both nursing professionals (HR 1.91; CI 1.06-3.44) and care assistants (HR 2.09; CI 1.63-2.69). Also, the combination of high demands and strenuous postures resulted in significantly elevated risks of disability pension among nursing professionals (HR 1.95; CI 1.20-3.16) and care assistants (HR 2.18; CI 1.71-2.77). The HRs for joint exposure to low control and both heavy physical work and strenuous postures were significant among all other occupations (HR 2.30; CI 2.05-2.58 and HR 2.24; CI 2.01-2.51), and among care assistants (HR 1.52; CI 1.26-1.85 and HR 1.61; CI 1.34-1.93), but not significant among nursing professionals. The synergistic effects on disability pension from combined exposures were generally positive among all three occupational groups.

CONCLUSION

Nursing professionals and care assistants exposed to both negative physical and psychosocial conditions had an increased risk of disability pension. A synergistic effect with respect to disability pension was found among care assistants who reported low control and strenuous postures at work.

Prevalence and Work-Related Factors Associated with Lower Back Musculoskeletal Disorders in Female Shellfish Gatherers in Saubara, Bahia-Brazil

Lower back musculoskeletal disorders (MSDs) are an important public health problem and the leading cause of disability worldwide, but with yet unknown prevalence among shellfish gatherers. To investigate the prevalence and work-related factors associated with lower back MSD in a population of female shellfish gatherers, an epidemiological cross-sectional study was carried out in Saubara, Bahia-Brazil, in 2013. The Brazilian version of the Job Content Questionnaire (JCQ) and the Nordic Musculoskeletal Questionnaire (NMQ), in addition to a questionnaire containing the physical demands adapted to the artisanal work, were applied to a random sample of 209 female shellfish gatherers. The prevalence of lower back MSD was 72.7%. Using multivariate logistic regression, the shellfish gatherers who had worked for more than 26 years in the activity showed a prevalence of 1.22 (95% CI: 1.04–1.44) times higher compared to those unexposed. Lower back MSD was 1.24 (95% CI: 1.08–1.42) times higher among those more exposed to work sitting with trunk flexion. Those performed manual handling and muscle force with the arms had a prevalence ratio of 1.18 (95% CI: 1.01–1.39). These results show the need for greater awareness of health and social welfare factors impacting workers in small-scale fisheries and will promote the elaboration of health care policies for this occupational class.

Psychosocial factors, depression, and musculoskeletal disorders among teachers

Background

One of the occupations that suffer from musculoskeletal disorders (MSD) is the teaching profession. Although teachers are known to have a variety of health and safety issues, few studies have actually been published that relate to somatic health problems of teachers, especially studies conducted in Malaysia. From this viewpoint, it is clearly important to investigate psychosocial factors, and MSD with depression as mediator among school teachers.

Methods

The study aimed to determine the incidence of MSD for school teachers in 15 primary schools in Kuala Lumpur during a 6-month period. Secondly, the study also sought to examine the relationships between psychosocial factors, depression and MSD among teachers. Thirdly, the study aimed to explore depression as mediator. The hypothesis addressed by this cross-sectional study was that depression would prove to be a mediator for the psychosocial factors affecting MSD.

Results

The incidence of MSD during the previous 6 months was 80.1% (95% CI: 75.8–84.2%), with 80.5% of female and 77.5% of male teachers reporting symptomatic pain during that period. There were significant relationships between psychosocial factors, depression, and MSD. The results indicated that in relation to psychosocial factors, depression (r = − 0.25, p < .01) and musculoskeletal disorder (r = −.17, p < .01) were both negative. In addition, depression was positively related to musculoskeletal disorder (r = .30, p < .01). Furthermore, depression appeared to have a partially mediating effect on the relationship between psychosocial factors and MSD.

Conclusions

The findings in this study demonstrate that psychosocial factors and depression are significant predictors of MSD among teachers. Recognizing the relationship between these variables will help in arranging, planning or actualizing preventive intervention programs for teachers with the hope of lessening the incidence of MSD. This study also provides awareness for teachers and the Malaysian Ministry of Education regarding the issues of MSD in the workplace.

Pushing, pulling and manoeuvring an industrial cart: a psychophysiological study

One of the most frequent manual occupational tasks involves the pushing and pulling of a cart. Although several studies have associated health risks with pushing and pulling, the effects are not clear since occupational tasks have social, cognitive and physical components. The present work investigates a real case of a pushing and pulling occupational task from a manufacturing company. The study initially characterizes the case in accordance with Standard No. ISO 11228-2:2007 as low risk. An experiment with 14 individuals during three modalities of pushing and pulling was performed in order to further investigate the task with the application of electrophysiology. At the end, a simple questionnaire was given. The results show electrophysiological differences among the three modalities of pushing and pulling, with a major difference between action with no load and fully loaded with a full range of motions on the cart to handle.

Personal and Workplace Environmental Factors Associated With Reduced Worker Productivity Among Older Workers With Chronic Knee Pain: A Cross-Sectional Survey

OBJECTIVES

The aim of this study was to explore personal and workplace environmental factors as predictors of reduced worker productivity among older workers with chronic knee pain.

METHODS

A questionnaire-based survey was conducted among 129 older workers who had participated in a randomized clinical trial evaluating dietary supplements. Multivariable analyses were used to explore predictors of reduced work productivity among older workers with chronic knee pain.

RESULTS

The likelihood of presenteeism was higher in those reporting knee pain (≥3/10) or problems with other joints, and lower in those reporting job insecurity. The likelihood of work transitions was higher in people reporting knee pain (≥3/10), a high comorbidity score or low coworker support, and lower in those having an occupation involving sitting more than 30% of the day.

CONCLUSION

Allowing access to sitting and promoting positive affiliations between coworkers are likely to provide an enabling workplace environment for older workers with chronic knee pain.

Adverse Work Stress Reactions — A Review of the Potential Influence on Work Related Musculoskeletal Disorders (WMSDS)

Available data show that work stress and work-related musculoskeletal disorders (WMSDs) are the leading occupational health burdens in Member States of the European Union. Cross-sectional data do no provide a clear indication of the impact of work stress upon WMSDs. Studies have used different indicators for stress and this makes comparison between them more difficult. Similar workplace risk factors, including physical and psychosocial, seem to be associated with work stress and WMSDs. Stress has been implicated in the pathology of WMSDs but many hypotheses require further investigation. There is some epidemiological evidence to support work stress reactions as a predictor of WMSDs and a weighted reciprocal relationship may also exist between these two health problems. However, more longitudinal studies are required to clarify this issue.

Improving body posture while fueling with a newly designed pump nozzle

BACKGROUND

Although petrol pumps are a very common and highly used simple technology, their design consideration for comfort and safety to prevent high-pressure load and musculoskeletal injuries to the body is a neglected area in many countries including Iran.

OBJECTIVES

This study attempted to design a new pump nozzle, and to assess the differences in musculoskeletal load related to body posture when a price/volume display is mounted on the pump nozzle.

METHODS

For postural analysis, photographs recording the posture of 100 randomly selected customers while fueling at petrol pumps and the rapid upper limb assessment (RULA) technique were used.

RESULTS

The results of this study showed that RULA scores improved significantly after the newly designed pump nozzle was used.

CONCLUSION

The newly designed pump nozzle is useful in reducing load related to body posture while fueling.

Interaction between physical and psychosocial risk factors on the presence of neck/shoulder symptoms and its consequences

This study aimed to quantify the interaction between physical and psychosocial factors on the presence of neck/shoulder symptoms (NSS) and its consequences (reduced activities and absenteeism) among 1294 coal mining workers in Indonesia. A self-administered questionnaire was used to obtain information on current workplace exposure and NSS and its consequences. Participants were grouped into one of four combination exposure groups: low physical and low psychosocial (as the reference group); low physical and high psychosocial; high physical and low psychosocial, and high physical and high psychosocial (HPhyHPsy). The attributable proportion (AP) due to interaction between both factors was examined. Individuals in the HPhyHPsy group were most likely to report NSS [odds ratio (OR) 4.83, 95% confidence interval (CI) 2.43-9.58], reduced activities (OR 3.90, 95% CI 2.36-6.43), and absenteeism (OR 3.91, 95% CI 2.11-7.25). This study has shown an interaction between physical and psychosocial factors that increases the OR of NSS (AP 0.49, 95% CI 0.08-0.89). Practitioner Summary: Although physical and psychosocial factors are known to be predictors for NSS, little is known about their interaction. Self-reported questionnaire was used to obtain information about physical and psychosocial factors at work. This study found an interaction between the physical and psychosocial risk factors that increases the odds ratio of NSS.

Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are responsible for morbidity in many working populations. Apart from lowering the quality of workers' life and reducing the productivity, WMSDs are the most expensive form of work disability, attributing to about 40% of all costs toward the treatment of work-related injuries. WMSDs are considered to be multifactorials that are caused due to the interactions between various risk factors, which result in conditions that vary across different occupations. Although health care profession is known to be at a high risk for WMSDs, it is one of the least-studied occupations. Most of the previous studies on WMSDs among health care workers were limited to any one of the professional groups such as nurses, physical therapists, dentists, and others. Hence this study was aimed at looking into the WMSDs affecting five different health care professionals working in a tertiary care hospital. It compared the prevalence and distribution of WMSDs among the five groups, evaluated the multiple risk factors that contribute to the development of WMSDs, and identified the high-risk group.

MATERIALS AND METHODS

It was a cross-sectional study conducted among dentists, laboratory technicians, nurses, physicians, and physiotherapists of various clinical departments in a tertiary care hospital in Chennai, India, from January to June 2013. Face-to-face interviews as well as observational analysis of various tasks were employed. Different combinations of validated and standardized questionnaires were used for collecting different types of data.

RESULTS

A high proportion of health care professionals reported WMSDs at one or the other body region, lower back being the most commonly affected area. Working in the same position for long periods, working in awkward or cramped positions and handling an excessive number of patients or samples in one day were found to be the most commonly reported job risk factor that contributed to the development of WMSDs, in this study.

CONCLUSION

Among all the health care professionals assessed in this study, nurses were found to be at the highest risk, whereas physicians were at the lowest risk. A longitudinal study using quantitative analytical tools may give a more accurate estimate of WMSDs and job risk factors, which would pave way for making more precise recommendations to eliminate the risk factors and thereby prevent WMSDs.

Interaction between physical and psychosocial work risk factors for low back symptoms and its consequences amongst Indonesian coal mining workers

This study assessed the interaction between physical and psychosocial factors for low back symptoms (LBS) and its consequences (reduced activities and absenteeism) in a developing country. A sample of 1294 Indonesian coal mining workers reported occupational exposures, LBS and its consequences using a self-administered questionnaire. Respondents were placed into one of four combination exposure groups: high physical and high psychosocial (HPhyHPsy); high physical and low psychosocial (HPhyLPsy); low physical and high psychosocial (LPhyHPsy), and; low physical and low psychosocial (LPhyLPsy). The attributable proportion due to interaction between physical and psychosocial factors was examined. Individuals in the HPhyHPsy group were most likely to report LBS (OR 5.42, 95% CI 3.30-8.89), reduced activities (OR 4.89, 95% CI 3.09-7.74), and absenteeism (OR 4.96, 95% CI 3.05-8.06). Interactions between physical and psychosocial factors were present for LBS, reduced activities, and absenteeism; although for LBS and absenteeism the interactions were not significant. Current smokers were more likely to report LBS consequences. Permanent employment and night shift work increased the odds of LBS and its consequences. We conclude that interventions aimed at reducing LBS and its consequences should address both physical and psychosocial factors, with a focus on smokers, permanent employment and night shift work.

Chinese translation and cross cultural adaptation of the workstyle short form

INTRODUCTION

Workstyle as it is related to symptoms of musculoskeletal symptoms of the upper limbs is the behavioural, cognitive and physical responses that occur in individuals to increases in work demands. A self report measure of this construct was developed that was both associated with and predictive of work related upper extremity symptoms. The aim of this study was to translate, culturally adapt, and validate a Chinese version of the Workstyle Short Form (C-WSF).

METHODS

The C-WSF was translated following a forward and backward translation approach. Content validity was examined by item- and scale-level content validity indices. The intra-class correlation coefficient (ICC) was used to analyze test-retest reliability. Exploratory factor analysis was used to identify factor structures and the internal consistency of these factors was assessed by calculating Cronbach's alpha reliability coefficients. The construct validity of the C-WSF was first determined by convergence in relation to the Cumulative Symptoms Score for Upper Extremity symptoms and then by comparison of those with and without upper extremity pain in Chinese cooks, a work with a high level of exposures to varying levels of work demands coupled with exposure to workplace psychosocial and biomechanical stressors.

RESULTS

The C-WSF demonstrated excellent item- and scale-level content validity index (>0.9). The factor structure of C-WSF was similar to its original English version. The internal consistency of different subscales of C-WSF ranged from 0.65 to 0.91. The ICC was between 0.79 and 0.93 indicating good test-retest reliability. C-WSF was significantly correlated with upper extremity symptoms (r = 0.34, p < 0.001).

CONCLUSIONS

C-WSF is a reliable and valid version of the Workstyle measures for use in Chinese population.

The mediating role of work-related musculoskeletal disorders on the link between psychosocial factors and absenteeism among administrative workers

This study aimed to investigate the association between psychosocial factors (i.e., job demand, decision latitude, social support, physical environment, and personal risk factors), work-related musculoskeletal disorders (WRMDs), and productivity as measured by workers' perceived absenteeism. Data were collected from the selected administrative workers (administrative assistant) and analyzed using cross tabulation. The results indicate that all psychological factors are not significantly associated with WRMDs, except for the association between personal risk factors and hip/thigh disorders. Subsequently, WRMDs do not significantly contribute to explaining absenteeism. The managerial and research implications of this study are deliberately discussed.

The combined effect of physical, psychosocial/organisational and/or environmental risk factors on the presence of work-related musculoskeletal symptoms and its consequences

This study assessed the combined effect of physical and psychosocial/organisational and/or environmental factors on the presence of musculoskeletal symptoms (MSS) and its consequences (reduced activities and absenteeism due to MSS) in a random sample of 3003 workers in New Zealand. By telephone interview, participants reported their current workplace exposures and MSS (neck/shoulder, arm/elbow, wrist and low back) and its consequences. Data were analysed using multivariable logistic regression. Combined exposure to physical and psychosocial/organisational and/or environmental factors increased the odds of MSS in the neck/shoulder (OR 3.14, 95% CI 1.79-5.52), arms/elbow regions (OR 4.14, 95% CI 2.21-7.76) and low back (OR 1.74, 95% CI 1.28-2.37) and its consequences, i.e. reduced activities due to neck/shoulder symptoms (OR 5.45, 95% CI 2.28-13.00), absenteeism due to neck/shoulder symptoms (OR 5.19, 95% CI 2.24-12.01) and absenteeism due to low back symptoms (OR 4.37, 95% CI 2.92-6.53). In contrast, favourable psychosocial/organisational work conditions reduced the odds of wrist symptoms due to poor physical work conditions (OR 2.19, 95% CI 1.44-3.34). We conclude that to reduce MSS and its consequences, employers need to adopt a multifaceted approach: concentrate on improving physical conditions as well as the psychosocial/organisational and environmental aspects of the working environment.

The impact of lean production on musculoskeletal and psychosocial risks: an examination of sociotechnical trends over 20 years

This paper provides an extensive review of studies carried out in lean production environments in the last 20 years. It aims to identify the effects of lean production (negative or positive) on occupational health and related risk factors. Thirty-six studies of lean effects were accepted from the literature search and sorted by sector and type of outcome. Lean production was found to have a negative effect on health and risk factors; the most negative outcomes being found in the earliest studies in the automotive industry. However, examples of mixed and positive effects were also found in the literature. The strongest correlations of lean production with stress were found for characteristics found in Just-In-Time production that related to reduced cycle time and reduction of resources. Increased musculoskeletal risk symptoms were related to increases of work pace and lack of recovery time also found in Just-In-Time systems. An interaction model is developed to propose a pathway from lean production characteristics to musculoskeletal and psychosocial risk factors and also positive outcomes. An examination is also made of the changing focus of studies investigating the consequences of lean production over a 20-year period. Theories about the effects of lean production have evolved from a conceptualization that it is an inherently harmful management system, to a view that it can have mixed effects depending on the management style of the organization and the specific way it is implemented.

Biomechanical and psychosocial occupational exposures: joint predictors of post-retirement functional health in the French GAZEL cohort

OBJECTIVES

Biomechanical and psychosocial occupational exposures are seldom considered simultaneously and over extended follow-up in occupational epidemiologic studies, although there is some evidence that combined exposures have interactive effects on workers' health during working life. Given high prevalence of functional disability among retirees, research on earlier-life determinants of subsequent functional outcomes can help shape workplace policies and practices. This study investigates whether health effects of combined occupational exposures during working life are observed after individuals retire and are no longer exposed.

METHODS

Analyses were conducted among retirees in the French GAZEL occupational cohort (n=9168). Cumulative exposure during working life to eight biomechanical strains and to one or more reports of psychosocial job strain (high-demand, low-control work) were assessed as predictors of three outcomes: difficulty with physical functioning, role limitations due to physical difficulties, and bodily pain. Individuals were classified by joint exposure to both biomechanical and psychosocial constraints. We modeled risk ratios (RR) between exposure to biomechanical and psychosocial factors at work (separately and in combination) and disability after retirement, and we calculated the relative excess risk due to interaction (RERI) to test whether combined effects departed from additivity.

RESULTS

Both psychosocial and biomechanical exposures during working life were independent predictors of the three functional health outcomes. Compared with individuals who had neither biomechanical nor psychosocial exposures, in fully adjusted log-binomial models of the combined effects of biomechanical and psychosocial exposure, among those with low biomechanical exposures, the RR for physical functioning difficulties associated with psychosocial exposures was 1.18 (95% CI 1.01, 1.37). Among those with the highest levels of biomechanical exposures, RR was 1.42 (95% CI 1.21, 1.65) among those with low psychosocial exposures and 1.91 (95% CI 1.61, 2.26) among those with high psychosocial exposures. The two exposure types were modestly super-additive, with an RERI of 0.32 (95% CI 0.00, 0.62) between those with the highest and lowest levels of biomechanical exposures; if the effects were strictly additive, we would have expected an RERI of 0. For the other two outcomes results were similar, although there was no significant departure from additivity. Some effects varied in magnitude by gender.

CONCLUSION

Across the sample, combined biomechanical and psychosocial occupational exposures during working life appear to have additive or perhaps interactive effects on functional health in retirement. However, the relationship is less straightforward among women. Improving overall working conditions may lessen future disability among retirees.

Prevalence of low back symptoms and its consequences in relation to occupational group

BACKGROUND

The purpose of this study was to examine: (1) the prevalence of low back symptoms (LBS) and its consequences (reduced activities and absenteeism); (2) the association between occupational group and LBS; and (3) the association between LBS and its consequences.

METHODS

A self-administered questionnaire was used to determine the prevalence of LBS in 1,294 Indonesian coal mining workers. A Cox proportional hazards model was developed to quantify the 12-monthly hazard of LBS. Logistic regression models were developed to identify risk factors for reduced activity and absenteeism from the workplace.

RESULTS

The 12-month period prevalence for LBS, reduced activities, and absenteeism were 75%, 16%, and 13%, respectively. The 12-monthly hazard of LBS for blue-collar workers was 1.85 (95% CI: 1.06-3.25) times that of white-collar workers. LBS and smoking increased the risk of reduced activity and absenteeism.

CONCLUSIONS

Indonesian coal mining workers have a high prevalence of LBS. The findings imply that efforts to reduce LBS and in the workplace should focus on blue-collar workers. For smokers who report reduced activities and/or absenteeism, there should be a focus on rehabilitation and/or return-to-work programs.

Association between perceived union connection and upper body musculoskeletal pains among unionized construction apprentices

BACKGROUND

Several studies show varying associations between unionization and workers' health and well-being. This study investigated the association between individual worker's perceived union connection and musculoskeletal pains (MSPs).

METHODS

We conducted a cross-sectional survey of 1,757 unionized construction apprentices. Perceived union connection is a psychosocial scale measured by six questions that assessed individual worker's connection to their union (range 10-24) at unionized workplaces. We measured the prevalence of four MSPs (neck, shoulder, arm, and back pain) and difficulty in daily home activities, job activities, and sleeping caused by each of the four MSPs.

RESULTS

We found that a one score increase in perceived union connection was associated with 5% decreased odds of reporting neck pain (OR: 0.95, 95% CI: 0.91-1.00) and back pain (OR: 0.95, 95% CI: 0.91-0.99) after adjusting for confounders including self-reported ergonomic strain. We also found significant associations between perceived union connection and MSPs causing difficulty in daily activities. For a one score increase in perceived union connection, the odds of reporting back pain causing difficulty in home activities, job activities, and sleeping was 9% (95% CI: 0.87-0.96), 8% (95% CI: 0.88-0.96), and 7% (95% CI: 0.89-0.98) lower, respectively.

CONCLUSIONS

Although our findings are limited by the cross-sectional nature of the data, these results suggest that workers' perceived union connection can vary even within unionized workplaces, and it may be associated with the prevalence of MSPs and MSPs causing difficulty in daily activities.

Whole-body vibration: is there a causal relationship to specific imaging findings of the spine?

STUDY DESIGN

Systematic review.

OBJECTIVE

To perform a systematic review of the available literature for those studies that evaluated the role of whole-body vibration (WBV) on the spine, using imaging modalities as well as an estimation of WBV exposure.

SUMMARY OF BACKGROUND DATA

Numerous comparative studies have reported a possible association between the occurrence of spinal symptoms and exposure to WBV. These exposures have commonly been examined in the work environment largely through self-reported questionnaires only. From a scientific perspective, the majority of studies emphasize symptoms and lack objective medical evidence, such as spinal imaging, to help establish a specific spinal disorder. Because both neck and low back pain comprise symptoms that can arise from a host of factors including age, a casual link between spinal disorders and WBV cannot be affirmed.

METHODS

MEDLINE and EMBASE were searched for studies related to WBV and spinal symptoms, diagnosis, and/or disorders. Our searches were limited to studies published prior to August 2011. The resulting 700 citations (after excluding 354 duplicates) were then screened by 3 independent reviewers on the basis of the following predetermined inclusion and exclusion criteria: inclusion-clinical studies with imaging evaluation (radiographs, computed tomographic scans, and/or magnetic resonance images) and documented WBV exposure (occupation, amount of WBV, and/or duration); exclusion-reliance solely on self-reporting of symptoms (neck pain, low back pain, and/or sciatica), those articles based on a clinical diagnosis without use of imaging, and in vitro/animal/biomechanical studies.

RESULTS

Only 7 studies met the inclusion criteria for this systematic review. Included were 5 retrospective cohort and 2 cross-sectional studies. Although mixed results and conclusions were found, the majority of studies did not identify an association between WBV exposure and an abnormal spinal imaging finding indicating damage of the spine. We should also stress that each included study has limitations secondary to quantifying WBV exposure accurately, both as a single encounter and as a total exposure over years.

CONCLUSION

Based on our results from this systematic review, no causality can be shown between WBV and abnormal spinal imaging findings. With the conflicting data available in the literature, WBV has not been established as a cause for objective spinal pathological changes on a scientific basis.

The Road to Psychological Safety

In Part 1 of this article, the legal and scientific origins of the concept of psychological safety are examined as background to, and support for, the new Canadian National Standard on Psychological Health and Safety in the Workplace (CSA Z1003/BNQ 9700). It is shown that five factors influencing psychological safety can be identified as being common to both legal and scientific perspectives: job demands and requirements of effort, job control or influence, reward, fairness, and support. This convergence of evidence from legal and scientific perspectives creates a powerful case for the development of a national standard built around these five factors. In Part 2, it is proposed that the introduction of a national standard can be expected in the long run to have positive social benefits since the health or harm that is generated in the workplace does not remain there but migrates into families, communities, and society at large in the form of either social capital or social exhaust. Consequently, psychological safety is a concept that connects the dynamics of the workplace to the health, resilience, and well-being of society at large.

Gender differences in work-related risk factors associated with low back symptoms

The prevalence of low back symptoms (LBS) in many working populations is high and differences in prevalence between genders are inconsistent. However, gender-specific risk factors for LBS have seldom been examined. Hence, the aim of the present study was to indicate gender-specific LBS risk factors. A sample of 3003 people was interviewed by telephone to get information about current workplace exposure and LBS. The risk of LBS for the whole population increased with work in awkward/tiring positions (OR 1.37, 95% CI 1.12-1.68) and very/extremely stressful jobs (OR 1.46, 95% CI 1.05-2.03). None of the explanatory variables were significantly associated with LBS for males but working in awkward/tiring positions (OR 1.51, 95% CI 1.04-2.20), dissatisfaction with contact and cooperation with management (OR 1.68, 95% CI 1.02-2.78) and finding their job to be very/extremely stressful (OR 2.27, 95% CI 1.46-3.52) were significantly associated with LBS for females. Interventions to reduce LBS in workplaces should focus on reducing working in awkward/tiring positions, improving contact and cooperation with management, and reducing stressful jobs, especially amongst females.

PRACTITIONER SUMMARY

Strategies to prevent or reduce LBS should focus on reducing exposure to awkward or tiring positions at work, improving contact and cooperation with management, and reducing stressful jobs, especially for females.

The health and well-being of remote and mobile workers

BACKGROUND

Remote and mobile workers (RMWs), people who spend the majority of work time away from a home or office base, are estimated to number 1 million in the UK and Ireland. A number of advantages and challenges have been identified with this way of working but little is known about the impact of this type of work on the health and well-being of RMWs.

AIMS

To identify any potential health or psychosocial effects associated with remote and mobile working, identify ergonomic factors that impact on this group and ascertain the effect of organizational or management factors that influence this occupational group.

METHODS

A systematic review methodology was used and a search strategy developed including keywords, which were used to search electronic databases and websites. Data were then extracted from included papers and quality assessed.

RESULTS

Initial searches identified 280 references but only 11 papers reached the inclusion criteria. Health effects identified included musculoskeletal symptoms associated with higher mileage and more time in a vehicle but a number of vehicle design issues were found to improve symptoms. Psychosocial factors including high demands were also found but better mental health was associated with higher mileage and more time with clients. There was a lack of substantive evidence in relation to managing this group.

CONCLUSIONS

There is little research currently available on the general health of RMWs and future research should examine this further and focus on general health and access to support services.

Psychosocial work characteristics, need for recovery and musculoskeletal problems predict psychological distress in a sample of British workers

From an original sample of 2454 participants free of self-reported psychological distress, 1463 workers completed a 15-month follow-up. Baseline measures included exposure to job demands, decision latitude, social support and need for recovery. Psychological distress was assessed using the General Health Questionnaire at baseline and at follow-up. The findings showed that medium and high exposure to job demands and social support increased the risk of reporting psychological distress at 15-months (relative risk (RR) = 1.65, 1.45). The highest adjusted RR was observed for workers reporting a high need for recovery after work (RR 2.12, 1.90) and this finding was independent of the effects of job demands, decision latitude and social support. Neither decision latitude, nor low back problems increased the risk of reporting future psychological distress, although neck problems (RR = 1.66) and hand/wrist problems (RR = 1.45) did. It was concluded that need for recovery appears to be an important indicator of individual workers who are at risk of developing psychological distress long term. STATEMENT OF RELEVANCE: This paper reports the findings of a longitudinal study showing that need for recovery from work was the strongest predictor, relative to psychosocial work characteristics (job demands, decision latitude and social support), and musculoskeletal problems, of psychological distress 15 months later in individuals initially free from distress.

A Population-Based Study of Job Stress in Mexican Americans, non-Hispanic Blacks, and non-Hispanic Whites

There is little known about the association between socioeconomic status and job stress in Mexican Americans. To address this issue, data were originated on a community level using personal interviews from working Mexican Americans using a multistage probability sample. In this study we described the population’s sociodemographic characteristics, health conditions, and job stress measures in Mexican Americans, non-Hispanic Whites, and non-Hispanic Blacks. Regression models were used to examine the associations of sociodemographic characteristics and health conditions for each job stress measure among 937 individuals. Our results indicate an association between low socioeconomic status and the perception of less job control, less job security, and less social support. Mexican Americans demonstrated more job security and social support in comparison to non-Hispanic Whites of similar socioeconomic status. We were able to define potential factors that may contribute to an individual’s perception of job stress.

Factors Related to Musculoskeletal Disorders in Nursing Workers

This cross-sectional study identified factors associated to musculoskeletal disorders in nursing auxiliaries and technicians in Salvador - Bahia. Three hundred and eight randomly selected female workers answered a questionnaire administered by an interviewer, with questions related to physical and psychosocial demands at work, individual characteristics and activities outside work. Multivariate analysis revealed that musculoskeletal disorders in neck, shoulder or upper back and musculoskeletal disorders in low back are associated to physical demand (material handling, poor back posture and work repetitiveness), psychosocial demand and precarious physical fitness. Musculoskeletal disorders in distal upper extremities are associated to physical demands (repetitiveness and force) and years of work (> 19). The results appoint the need for intervention strategies, incorporating both the organizational aspects of work and adaptations in the physical environment and in the characteristics of tasks.

Physically demanding workloads and the risks of musculoskeletal disorders in homecare workers in the USA

Although musculoskeletal disorders (MSDs) are prevalent among homecare workers, little is known about the MSD risk factors. This study investigated whether physically demanding workloads among homecare workers are related to MSDs, especially in neck, shoulder and back pain. Data were taken from two waves of a random sample (June to December 2003 and December 2003 to February 2004). The sample included 1643 homecare workers at Wave 1 and 1198 homecare workers at Wave 2, respectively. A basic telephone interview and 30 minutes computer-assisted interview were performed for homecare workers in Wave 1 and Wave 2. The prevalence of neck, shoulder and back MSDs was assessed at Wave 1 and Wave 2 using the Nordic questionnaire of musculoskeletal symptoms. The incidence of MSDs at 6 months was estimated at Wave 2 using only those who were in the asymptomatic reference group at Wave 1 as the denominator. At Wave 1, back MSDs were the most prevalent (10.2%), followed by neck (9.6%) and shoulder (7.1%) MSDs. After 6 months, the incidence of neck MSDs was the highest (7.0%), followed by back (6.4%) and shoulder (4.8%) MSDs. Physical demands of work were assessed using items developed from focus groups of workers. When compared with asymptomatic workers, those with MSDs showed a dose-response effect for physical job demands. After controlling for age, psychosocial demands and social support on-the-job, physical demands among homecare workers were significantly associated with an excessive odds of neck, shoulder and back MSDs incident at 6 months (odds ratios of 1.14-1.17 for each unit increase on a physical demand scale). Our study shows that the physical demands of work are a significant risk factor for MSDs among homecare workers. Considering the high physical demands among homecare workers, the finding in this study clearly indicates that practical intervention strategies should be implemented to protect homecare workers from exposure to MSD risk factors.

Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day

A relationship between low back pain (LBP) and prolonged standing or prolonged sitting at work has not been clearly shown, despite its biological plausibility. Because sitting and standing postures vary as to duration and freedom to alternate postures, and standing postures vary as to mobility, associations between specific working postures and LBP were explored using multiple logistic regression. Associations between work factors and self-reported LBP during the previous 12 months that interfered with usual activities were examined among 4493 standing workers and 3237 sitting workers interviewed in the 1998 Quebec Health and Social Survey; 24.5% reported significant LBP. Since the same conditions can correspond to different physiological demands for sitting compared with standing workers, analyses were performed separately for the two groups. Standing without freedom to sit was associated with LBP. Different occupational physical and psychosocial factors were associated with LBP in sitting compared with standing populations.

[Physical movement - is it good for the back? Nationwide representative study on different effects of physical activity at the workplace and in leisure time]

Physical activity is an important component of primary and secondary prevention of orthopedic complaints such as back pain as well as for many other syndromes. This epidemiologic research project investigated the multifactorial interaction between physical leisure activities and back pain and also the question whether regular physical activity at the workplace can be equated with the effect of regular leisure activity. From a patients point of view this could be construed as an"excuse" to refrain from leisure and fitness sports. Within the framework of a cooperative project between the Orthopedic University Clinic in Heidelberg and the Robert-Koch Institute in Berlin, representative data were gathered for the first time in Germany on physical activity at the workplace and in leisure time as well as the prevalence of back pain. Within the first national health survey a random sample of 3,488 employed German citizens aged 18-69 years old was investigated with multiple logistic regression analyses.The prevalence of 7-day back pain in Germany was 34% and the prevalence for 1-year was 60%. Physical activity at the workplace was associated with a significantly higher risk for back pain whilst leisure sport activity was accompanied by a lower prevalence of back pain. Although 39% of all persons who were inactive in sport and physical activities claimed to have felt back pain at least once in a retrospective 7-day period, the corresponding values for persons active in sport were 33% (1-2 h sport/week), 27% (2-4 h sport/week) and 30% (>4 h sport/week).This study provides population-based epidemiologic data on the prevalence of back pain among employed German citizens for the first time since the reunification. Although causal conclusions cannot principally be derived from cross-sectional data, the results of this analysis allow the multifactorial conditional structure to be unraveled. Our data demonstrate that manual physical employment does not represent a substitute for fitness leisure sports, but physically demanding working conditions themselves represent a significant risk factor for back pain.

Interactions between physical and psychosocial demands of work associated to low back pain

OBJECTIVE

To examine the interaction between physical and psychosocial demands of work associated to low back pain.

METHODS

Cross-sectional study carried out in a stratified proportional random sample of 577 plastic industry workers in the metropolitan area of the city of Salvador, Northeast Brazil in 2002. An anonymous standard questionnaire was administered in the workplace by trained interviewers. Physical demands at work were self-rated on a 6-point numeric scale, with anchors at each end of the scale. Factor analysis was carried out on 11 physical demand variables to identify underlying factors. Psychosocial work demands were measured by demand, control and social support questions. Multivariate analysis was performed using the likelihood ratio test.

RESULTS

The factor analysis identified two physical work demand factors: material handling (factor 1) and repetitiveness (factor 2). The multiple logistic regression analysis showed that factor 1 was positively associated with low back pain (OR=2.35, 95% CI 1.50;3.66). No interaction was found between physical and psychosocial work demands but both were independently associated to low back pain.

CONCLUSIONS

The study found independent effects of physical and psychosocial work demands on low back pain prevalence and emphasizes the importance of physical demands especially of material handling involving trunk bending forward and trunk rotation regardless of age, gender, and body fitness.

RTW in back conditions

PURPOSE

Back conditions are a group of impairments that induce limitation of activities and restriction of participation, in particular delaying the Return to work (RTW). The purpose of this review is to analyse the components involved in RTW.

METHOD

We have included the studies and reviews about the intervention, assessment tools, variables used to forecast the RTW and the cost-benefit ratio.

RESULTS

We found a relevant number of studies concerning back conditions and Return to work. The evidence is moderate and the meta-analysis failed to show strong indications of efficacy. The better interventions to facilitate RTW are multidisciplinary, not necessarily intensive but taking into account a bio-psycho-social approach. The predictor of RTW does not only concern impairment (pain, rigidity etc.), but the self-estimation of ability is also important to forecast RTW. Intervention seems to be cost-effective if we calculate the saving cost in pension.

CONCLUSIONS

Comprehensive bio-psycho-social approaches seem to be the better modality of intervention to facilitate the RTW. More research is needed to obtain more knowledge about these issues. Particular attention should be placed on the choice of outcome measures and the cost-effectiveness of interventions.

What constitutes evidence for best practice?

The guiding principles, methods, and common factors that serve as the foundation for the Commission of the Council on Chiropractic Guidelines and Practice Parameters best practices initiative are discussed in the context of the chiropractic practice environment.

Prevalence of widespread pain and associations with work status: a population study

Background

This population study based on a representative sample from a Swedish county investigates the prevalence, duration, and determinants of widespread pain (WSP) in the population using two constructs and estimates how WSP affects work status. In addition, this study investigates the prevalence of widespread pain and its relationship to pain intensity, gender, age, income, work status, citizenship, civil status, urban residence, and health care seeking.

Methods

A cross-sectional survey using a postal questionnaire was sent to a representative sample (n = 9952) of the target population (284,073 people, 18–74 years) in a county (Östergötland) in the southern Sweden. The questionnaire was mailed and followed by two postal reminders when necessary.

Results

The participation rate was 76.7% (n = 7637); the non-participants were on the average younger, earned less money, and male. Women had higher prevalences of pain in 10 different predetermined anatomical regions. WSP was generally chronic (90–94%) and depending on definition of WSP the prevalence varied between 4.8–7.4% in the population. Women had significantly higher prevalence of WSP than men and the age effect appeared to be stronger in women than in men. WSP was a significant negative factor – together with age 50–64 years, low annual income, and non-Nordic citizen – for work status in the community and in the group with chronic pain. Chronic pain but not the spreading of pain was related to health care seeking in the population.

Conclusion

This study confirms earlier studies that report high prevalences of widespread pain in the population and especially among females and with increasing age. Widespread pain is associated with prominent effects on work status.

Work stress in radiologists. A pilot study

PURPOSE

We studied occupational stress and its psychosocial effects in a sample of Italian radiologists and radiotherapists:

MATERIALS AND METHODS

Radiologists and radiotherapists attending two medical conferences were invited to complete a questionnaire comprising four sections investigating the risk of occupational stress (organisational discomfort, Karasek's Job Content Questionnaire, Siegrist's Effort-Reward Imbalance, Warr's Job Satisfaction) and four sections investigating the health effects of such stress (Goldberg's Anxiety and Depression Scales, General Health Questionnaire, Lifestyles Questionnaire).

RESULTS

Radiologists and radiotherapists generally expressed high levels of control, reward and satisfaction. However, 38.5% complained of severe organisational discomfort, 24% reported job strain, 28% reported effort/reward imbalance and 25% were dissatisfied. Female radiologists and radiotherapists showed higher levels of organisational discomfort than their male colleagues. Younger and less experienced radiologists and radiotherapists had higher strain scores than their older and more experienced colleagues. A significant correlation was observed between stress predictors and the effects of stress on health, including depression and anxiety, psychological distress and unhealthy lifestyles.

CONCLUSIONS

Radiologists and radiotherapists are exposed to major occupational stress factors, and a significant percentage of them suffer from workplace stress. A special effort is required to prevent this condition.

Keeping nurses working: development and psychometric testing of the Nurse-Work Instability Scale (Nurse-WIS)

AIM

This paper reports a study to develop and test the psychometric properties of the Nurse-Work Instability Scale (Nurse-WIS).

BACKGROUND

Work Instability describes the extent of any mismatch among functional (in)capacity, work demands and its potential impact on efficiency/productivity at work. Recruitment, retention and migration of nurses are global issues influenced by many factors. It is well documented that musculoskeletal pain and subsequent disability account for a high proportion of sickness absence and premature retirement in the nursing workforce. The challenge to clinicians is to identify such problems early so that appropriate interventions can be targeted to facilitate job retention.

METHOD

Analyses of 48 qualitative interview transcripts conducted with nursing staff during 2003 were used to generate potential items for the Nurse-WIS. Analysis of the psychometric properties of the scale derived from these items was undertaken by using the Rasch model and data generated in postal surveys in 2004. The scale was validated against a gold standard of expert vocational assessment by occupational health physiotherapists/ergonomists.

FINDINGS

The resulting self-administered questionnaire consisting of 30 items not only measures the risk of job loss relating to musculoskeletal symptoms, but also captures relevant psychosocial issues. The scaling properties of this questionnaire meet the rigorous psychometric requirements of the Rasch model.

CONCLUSIONS

The Nurse-WIS is a psychometrically sound method for the early identification of nursing staff experiencing difficulties at work. It offers the prospect of positive proactive management to prevent or minimize sickness absence and potentially prevent loss of nursing staff from the workforce through long-term sickness absence and early retirement.

The influence of work-related exposures on the prognosis of neck/shoulder pain

To determine associations between work-related exposures and the prognosis of self-reported neck/shoulder pain. This prospective cohort study was based on 803 working subjects who reported neck/shoulder pain at baseline. The proportion of subjects who 5-6 years later were symptom-free was calculated. Data concerning work-related biomechanical, psychosocial, and organizational exposures were collected at baseline. The Cox regression analyses were used to calculate the relative chances (RC) of being symptom-free at the end of the study for single exposures, and also for up to three simultaneous work-related exposures. Adjustments were made for sex and age. Only 36% of the subjects were symptom-free 5-6 years later. The relative chance for being symptom-free at the end of the study was 1.32 (95% CI = 0.99-1.74) for subjects who were exposed to sitting > or =75% of the working time and 1.53 (95% CI = 1.02-2.29) for subjects who were exposed to job strain, i.e., the combination of high demands and low decision latitude. The relative chance of being symptom-free at the end of the study was 0.61 (95% CI = 0.40-0.94) for subjects with at least two out of three simultaneous biomechanical exposures at work; manual handling, working with the hands above shoulder level, and working with vibrating tools. In a heterogeneous population with moderate nonspecific neck/shoulder pain, sedentary work enhanced the chance of being symptom-free 5-6 years later, whereas simultaneous exposures to at least two of manual handling, working with hands above shoulder level and working with vibrating tools were associated with a lower chance of being symptom-free at the end of the study. This could imply that subjects with neck/shoulder pain should avoid such simultaneous exposures.

Work-related musculoskeletal disorders in urban bus drivers of Hong Kong

INTRODUCTION

Work-related musculoskeletal disorders (WMSD) affect workers in many occupations including drivers of large vehicles. Urban bus drivers have been found to have high prevalence rates of back problems in overseas studies. Hong Kong is a densely populated city and has a large number of double-deck buses that constitute a major means of public transportation. The present study aimed at investigating the prevalence and characteristics of WMSD in male and female bus drivers who operate double-deck buses in Hong Kong.

METHOD

Altogether 481 bus drivers (404 males, 77 females) participated in the study that consisted of a questionnaire survey as well as physical assessment. The questionnaire included questions on work, musculoskeletal complaints and perceived occupational risk factors associated with each discomfort. Physical assessment consisted of measurement of lumbar spine mobility, hand grip strength, sit-and-reach test, and observation of standing and sitting postures.

RESULTS

The results showed generally the male drivers had longer years of work experience but their daily workloads were similar to the females. On the average drivers worked 9-10 h per day, with 5 days on and 1 day off. Neck, back, shoulder and knee/thigh areas had the highest 12-month prevalence rates ranging from 35% to 60%, and about 90% of the discomfort was related to bus-driving. Occupational factors of prolonged sitting and anthropometric mismatch were perceived to be most related to musculoskeletal discomfort. On physical examination, grip strength was significantly related to neck and shoulder discomfort.

CONCLUSIONS

The present results showed high prevalence rates of WMSD among bus drivers in Hong Kong which warrants further investigation.

Effects of psychosocial and individual factors on physiological risk factors for upper extremity musculoskeletal disorders while typing

Psychosocial factors are hypothesized to contribute to work-related musculoskeletal disorder (WMSD) development, although previous research has been largely epidemiological or has focused primarily on the shoulders, back and neck. The objective of this study was to quantify the effects of mental workload and time pressure on perceived workload and physiological responses of the distal upper extremity. A total of 18 typists completed nine 5-min typing sessions representing three levels of time pressure and mental workload. Levels were manipulated by adjusting typing speed and by requiring participants to perform arithmetic tasks while typing. Outcomes were measured in muscle activation levels, wrist postures and movements, key strike force and subjective assessments of workload. In general, increased time pressure increased muscle activation, key strike force and wrist deviations; and increased mental workload increased key strike force. Mental workload and time pressure mediated physical risk factors during typing to increase WMSD risk for the distal upper extremity.

The relations between psychosocial factors at work and health status among workers in home care organizations

A considerable proportion of sickness absence and disability pension is caused by subjective health complaints, especially low back pain (LBP). In recent years focus has been on psychosocial characteristics of work as potential risk factors. The aim of this study is to examine the relations between psychosocial work aspects and subjective health complaints, LBP, and need for recovery. A total of 779 employees working in home care participated in a cross-sectional study. Higher psychological demands were associated with subjective health complaints and need for recovery. However, decision authority, skill discretion, and the 2 aspects of social support did not seem to be important factors. Higher psychological demands do not seem to be associated with severity of LBP, but does show an association with sick leave.

Evaluation of an intervention comprising a no lifting policy in Australian hospitals

The No Lifting Policy has been adopted in Australia to prevent back pain and injuries among nurses. The present study focuses on the intervention of the "No Lift System" (NLS). The purpose of this cross-sectional study was to evaluate the use of transfer equipment, number of injuries, pain/symptoms and absence from work among nurses after the intervention of the NLS (n=201), and compare to nurses at two control hospitals (n=256). A comprehensive questionnaire was used for data collection. The results show that at the hospital where the NLS had been introduced, the nurses used the purchased transfer equipment regularly. They had significantly fewer back injuries, less pain/symptoms and less absence from work due to musculoskeletal pain/symptoms compared with nurses at the control hospitals. The study showed strong evidence for supporting the implementation of the NLS. The positive results shown in the present study can probably be explained by the agreement between the management, the union and the nurses concerning the implementation of the NLS, as well as its comprehensive approach and participatory design.

Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany

Given the increasing medical and economic implications of back pain, occupation-specific prevalence data may provide important pointers for preventive programmes targeted at promoting preventive behaviour and improving conditions. The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence by occupational category. The net sample comprises a total of 3,488 earners aged 18-69. One in three earners in the Federal Republic of Germany (34%) experienced back pain during the 7 days prior to being interviewed. The 1-year prevalence rate is 60%. Occupational categories associated with a lower-than-average back pain prevalence are highly qualified professionals, senior management, and production occupations associated with a comparatively low degree of manual labour. In contrast, an above-average prevalence was identified for occupations associated with physically strenuous work involving one-sided postures, moving, carrying and holding heavy weights, and work typically performed in poor conditions or bad weather. Our data demonstrates significant inter-occupational differences in terms of self-reported back pain. The results underline the importance of measures to promote preventive behaviour and improve the working conditions of those in low-skill manual labour occupations.