Psychosocial stress and multi-site musculoskeletal pain: a cross-sectional survey of patient care workers

Musculoskeletal pain latent classes and biopsychosocial characteristics among emerging adults

BACKGROUND

Emerging adults (aged 18-29) report high levels of musculoskeletal pain; however, it is unknown if body location and intensity patterns are related to different biopsychosocial characteristics. This study identified patterns of self-reported musculoskeletal pain among emerging adults and assessed if there were differences in their lifestyle and psychological characteristics.

METHODS

Data from survey responses from a large public university and a large medical university in the United States were used (n = 1,318). Self-reported pain location and intensity at five body regions were assessed, and latent class analysis identified classes separately for men and women. Mental health, physical activity, and sleep outcomes were compared between the classes.

RESULTS

Four classes were identified for men and women. Three of the classes were consistent between genders - "no pain," (women = 28% of their sample; men = 40% of their sample) "mild multisite pain," (women = 50%; men = 39%) and "moderate-severe multisite pain" (women = 9%; men = 7%). The fourth class for women was "moderate spine pain," (13%) and for men was "mild extremity pain" (13%). For both men and women, the "moderate-severe multisite" pain classes reported the highest levels of depression, anxiety, and stress, poorer sleep, and higher work physical activity than the "no pain" class. The "mild multisite" and "moderate spine" (women only) pain classes fell between the "no pain" and "moderate-severe" pain classes. The characteristics of the "mild upper extremity pain" class for men was similar to the "no pain" class.

CONCLUSIONS

The identified classes provide unique information on pain location and intensity in emerging adults. The high prevalence of "mild multisite pain" (n = 593; 45% of the total sample) demonstrates an intervention opportunity during this age range to prevent further increases in musculoskeletal pain later in life. Future work should assess the longitudinal outcomes of these pain classes, the impact of interventions for this age group, and the balance between leisure and occupational physical activity when addressing musculoskeletal health.

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.

Pre-placement examinations for newly recruited health care support staff

Objective

While musculoskeletal disorders (MSD) and physical strength have been extensively studied in health care professionals, little attention has been paid to health care support staff, such as patient care assistants and operation patient assistants, whose jobs are physically demanding. The purpose of this paper was to examine the musculoskeletal symptoms and physical strength of newly recruited health care support staff.

Method

Convenience sampling was conducted on 111 newly employed health care support staff in a public hospital. A custom-made pre-placement examination was performed. Data were analysed using descriptive, correlation, and regression analyses.

Results

Nearly one-third (32%) of the newly recruited health care support staff had experienced musculoskeletal symptoms in at least one body part during the preceding 12 months. Two-thirds (68%) of subjects were physically inactive, and sixty percent was overweight or obese. Handgrip strength was weaker than the local norm. The subjects’ dominant handgrip strength, bilateral lifting, pushing, and pulling force were significantly correlated. Only bilateral lifting was significantly associated with MSD among the newly recruited health care workers.

Conclusions

This study reports the baseline prevalence of MSD symptoms in the newly recruited health care support staff. Their sedentary lifestyle and suboptimal physical strength may render them susceptible to occupational injuries and disease. An effective occupational health programme that provides periodic health surveillance should be considered for high-risk health care workers to allow proper interventions in a timely manner.

Quality of life among district hospital nurses with multisite musculoskeletal symptoms in Vietnam

Background

Nurses are one of the population groups with the highest prevalence of musculoskeletal disorders (MSDs). At many sites, musculoskeletal symptoms (MS) represent a major health‐care burden, adversely affecting nurses' quality of life and giving rise to mental health issues.

Objectives

This study measured the prevalence of multi‐body‐site (two or more anatomical sites) musculoskeletal symptoms (MMS), and the association between MMS, a number of demographic and work characteristics, psychological distress, and the quality of life among district hospital nurses.

Material and Methods

A cross‐sectional study was performed with 1179 nurses in Haiphong City using three questionnaires: the Modified Nordic; Quality of Life Enjoyment and Satisfaction Short Form (Q‐LES‐Q‐SF); and the Kessler Psychological Distress Questionnaire (K6).

Results

Women have a higher MMS prevalence than men (57.1% in women vs 37.6% in men, P < .001). Having a higher number of anatomical sites of MS appears to be associated with a worse quality of life among nurses. Linear regression analysis found a number of other factors negatively associated with the nurses' quality of life: gender (female), age (50‐60 years old vs 19‐29 years old), and psychological distress.

Conclusions

This study shows a high prevalence of MMS and the relationship between, on the one hand, MMS, gender, age, as well as psychological distress and, on the other hand, the quality of life among nurses in Vietnam. Further in‐depth studies are needed to investigate the causal relationships between these indicators.

Prevalence and Characteristics of Multisite Musculoskeletal Symptoms among District Hospital Nurses in Haiphong, Vietnam

Background

Musculoskeletal disorders (MSDs) are commonly observed among workers around the world. These diseases not only affect the health of workers, their quality of life, and their performance, but the effects of such diseases also represent a great burden for the health and social systems. These issues are even more prevalent in developing countries, and nurses are no exception. Many studies worldwide have shown a high prevalence of work-related MSDs in each body position among nurses. However, there are very few studies that have mentioned multisite musculoskeletal symptoms (MMS).

Objectives

To describe the prevalence and characteristics of MMS among district hospital nurses in Haiphong, Vietnam. Material and Methods. A cross-sectional study was carried out on 1179 nurses working in all 15 district hospitals using the Modified Nordic Questionnaire at 9 anatomical sites on the body (neck, shoulder/upper arm, elbow/forearm, wrist/hand, upper back, lower back, hip/thigh, knee/lower leg, and ankle/foot). The following main indicators were calculated: the prevalence of musculoskeletal symptoms (MS) (at least 1 of 9 sites), MMS (two or more sites), and widespread musculoskeletal symptoms (WMS) (MS of the upper limb, the lower limb, and the back or the neck).

Results

The prevalence of MS during the past 12 months and symptoms lasting for at least 30 days was 60.6% and 17.2% in men and 77.6% and 21.5% in women, respectively. The lower back, neck, upper back, and shoulder/upper arm were the most common sites affected. In terms of MMS, the prevalence was 37.6% in men and 57.1% in women during the past 12 months while 8.6% of men and 11.3% of women reported that symptoms lasted for at least 30 days. The prevalence of MMS tended to increase with age, seniority, having a history of musculoskeletal diseases, and in nurses working in district hospitals located in urban areas. Nearly 90% of MMS concerned two or three anatomical regions during the past 12 months, and almost 80% of MMS lasting at least 30 days involved two or three anatomical regions. The prevalence of WMS was 10.4% in men and 18.6% in women during the past 12 months and 0.9% in men and 2.1% in women lasting at least 30 days.

Conclusions

This study showed the high prevalence of MMS and WMS among nursing staff. Further and more extensive research is needed to improve our understanding of multisite musculoskeletal symptoms and act as the foundation for developing preventive measures for nurses.

The prevention of musculoskeletal complaints: long-term effect of a work-related psychosocial coaching intervention compared to physiotherapy alone-a randomized controlled trial

PURPOSE

Research shows that psychosocial factors play a significant role in the emergence of musculoskeletal complaints (MSC). The aim of this study was to determine the long-term effects on unspecific MSC by a combined physiotherapy and coaching intervention compared to physiotherapy alone. The coaching intervention focussed on enabling better strategies for coping with work stressors.

METHODS

The participants of a previous randomized controlled intervention were invited to participate again in a third follow-up survey 22 months after the end of the intervention. In 2014, 65 nurses completed a 10-week personalised physiotherapy. Additionally, the intervention group (n = 33) passed five individual coaching sessions, plus an opening and closing session. 44 nurses (IG: n = 24; CG: n = 20) passed again a physical examination as well as another questionnaire assessment in 2016. The primary outcome was MSC, secondary outcomes were work ability and work-related well-being. Due to missing data, multiple imputations were conducted using the mice package in R. Data were analysed by ANOVA with two-way repeated measures, t tests for independent samples and Chi-squared tests.

RESULTS

In respect of MSC, stronger improvement of movement in the vertebral column was observed in the IG compared to the CG. No differences between the IG and CG regarding other long-term effects were observed.

CONCLUSIONS

The results suggest that the combined intervention of work-related coaching and physiotherapy had only a marginally stronger long-term effect with respect to MSC than physiotherapy alone.

Stressful Factors in the Working Environment, Lack of Adequate Sleep, and Musculoskeletal Pain among Nursing Unit Managers

Background: Middle managers have not received enough attention within the healthcare field, and little is known how stressful factors in their work environment coupled with a lack of adequate sleep are related to musculoskeletal pain. The aim of this study was to examine the correlation between stressful factors in the work environment, lack of adequate sleep, and pain/discomfort in three body areas. Methods: Questionnaire was sent electronically to all female nursing unit managers (NUM) in Iceland through the outcome-survey system. The response rate was 80.9%. Results: NUM who had high pain/discomfort in the neck area also had very high pain/discomfort in the shoulder area and pain in the lower back. The results also revealed positive a medium-strong correlation between mental and physical exhaustion at the end of the workday and musculoskeletal pain. Stress in daily work, mental strain at work, and being under time-pressures had hardly any correlation with pain/discomfort in the three body parts. Adequate sleep had a significant negative correlation with all stressful factors in the work environment and all three body parts under review. Conclusion: The results will hopefully lead to a better consideration of stressful factors in the work environment, sleep, and musculoskeletal pain in middle managers.

Effects of psychosocial work factors on number of pain sites: The role of sleep quality as mediator

Background

Objective of the current study was to determine which of thirteen specific psychosocial work factors were related to number of musculoskeletal pain sites (NPS) prospectively over a two-year time span. Furthermore, the study aimed to explore possible mediation of these prospective relationships through sleep problems.

Methods

The study was a two-wave full panel study. Participants included 6277 employees of Norwegian companies, representing a wide range of occupations. Structural equation modelling was employed to analyze direct and indirect effects of thirteen specific psychological- and social work factors on sleep problems and NPS.

Results

Out of the thirteen work factors studied, positive challenges at work, role conflict, decision control, superior support, coworker support, empowering leadership, and social climate were statistically significantly related to subsequent NPS, both directly and indirectly through sleep quality. Sleep quality was related to NPS in all analyses. Most psychosocial work factors exhibited direct effects on either sleep or number of pain sites. Decision demands and control over work pacing were not statistically significantly related to sleep or pain.

Conclusion

In conclusion, the results suggested sleep quality to be involved in the mechanisms by which work affects the number of pain complaints employees experience.

Significance

Findings from this study suggest sleep may play a role in the complex mechanism from work stressors to musculoskeletal pain. Workplace interventions aiming to reduce musculoskeletal pain may wish to target work factors described in this study, as they affect sleep and may thereby increase number of musculoskeletal pain sites.

Literature Review of Policy Implications From Findings of the Center for Work, Health, and Well-being

OBJECTIVE

To review the publications of a Total Worker Health Center of Excellence, the Harvard T.H. Chan School of Public Health Center for Work, Health, and Well-being, in order to identify research findings relevant to either organizational or public policies.

METHODS

Two researchers independently reviewed 57 publications from 2011 to 2019 to identify cross-cutting themes that focus on working conditions or related health outcomes and their organizational and public policy implications.

RESULTS

Twelve cross-cutting themes were identified with their respective organizational and public policy implications. Several policy implications cut across work-related themes.

CONCLUSIONS

Policy implications of TWH research will aid in setting priorities to translate this from research into practice in future studies and help identify gaps that we and others can use to plan future TWH research.

Longitudinal Associations between Anatomical Regions of Pain and Work Conditions: A Study from The SwePain Cohort

We investigated the time-based associations between workload (physical and mechanical), psychosocial work stressors (demands, control, and support), and the number of anatomical regions with pain (ARP). This population-based study with a two-year follow-up included 11,386 responders (5125 men, 6261 women; mean age: 48.8 years; SD: 18.5) living in south-eastern Sweden. Predictive associations were assessed through generalised linear models, and changes over time were examined using a generalised estimating equation. The results of both models were reported as parameter estimates (B) with 95% confidence interval (CIs). Mean changes in the number of ARP, workload, and psychosocial work stressors were stable over time. High mechanical workload and job demands were likely associated with the number of ARP at the two-year follow-up. In the reverse prospective model, we found that the number of ARP was also associated with high physical and mechanical workload and low job control and support. In the two time-based models of changes, we found a reciprocal association between number of ARP and mechanical workload. Our results add epidemiological evidence to the associations between work conditions and the extent of pain on the body. Components of work conditions, including job demands and mechanical strain, must be considered when organisations and health policy makers plan and employ ergonomic evaluations to minimise workplace hazards in the general population.

Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting

Purpose

Musculoskeletal disorders are considered as a major issue affecting the health and well-being of active duty police. Discomfort from wearing mandatory equipment and sitting for long periods of time in fleet vehicles are workload factors linked to musculoskeletal disorders in police. This study aims to determine the prevalence of multi-site musculoskeletal pain among Swedish police and to explore the possible association to discomfort experience when wearing mandatory equipment and sitting for long periods in fleet vehicles.

Methods

In this cross-sectional study responses from 4185 police were collected through a self-administered online survey including questions about physical work environment, mandatory equipment and musculoskeletal pain. Multi-site pain was determined through summing pain sites from four body regions. Binomial logistic regression was performed to explore the association between multi-site musculoskeletal pain: (1) discomfort from wearing mandatory equipment and (2) sitting for long periods in fleet vehicles.

Results

The prevalence of multi-site musculoskeletal pain at least 1 day per week within the previous 3 months was 41.3%. A statistically significant association between discomfort from wearing mandatory equipment and multi-site musculoskeletal pain was found; duty belt [OR 5.42 (95% CI 4.56–6.43)] as well as body armour [OR 2.69 (95% CI 2.11–3.42)]. Sitting for long periods in fleet vehicles was not significantly associated to multi-site musculoskeletal pain.

Conclusion

Multi-site musculoskeletal pain is a considerable problem among Swedish police and modifying mandatory equipment to decrease discomfort is suggested as a potential means of decreasing the musculoskeletal pain experienced by many police officers.

Work characteristics predict the development of multi-site musculoskeletal pain

PURPOSE

Musculoskeletal pain in more than one body region is common and a barrier to sustaining employment. We aimed to examine whether work characteristics predict the development of multi-site pain (MSP), and to determine differences in work-related predictors between age groups.

METHODS

This study is based on 5136 employees from the Study on Transitions in Employment, Ability and Motivation (STREAM) who reported no MSP at baseline. Measures included physical, emotional, mental, and psychological job demands, social support and autonomy. Predictors of MSP were studied by logistic regression analyses. Univariate and multivariate analyses with age stratification (45-49, 50-54, 55-59, and 60-64 years) were done to explore differences between age groups.

RESULTS

All work characteristics with the exception of autonomy were predictive of the development of MSP, with odds ratios varying from 1.21 (95% CI 1.04-1.40) for mental job demands to 1.63 (95% CI 1.43-1.86) for physical job demands. No clear pattern of age-related differences in the predictors of MSP emerged, with the exception of social support, which was predictive of MSP developing in all age groups except for the age group 60-64 years.

CONCLUSIONS

Adverse physical and psychosocial work characteristics are associated with MSP. Organisations need to comprehensively assess work environments to ensure that all relevant workplace hazards, physical and psychosocial, are identified and then controlled for across all age groups.

Integrating worksite health protection and health promotion: A conceptual model for intervention and research

There is increasing recognition of the value added by integrating traditionally separate efforts to protect and promote worker safety and health. This paper presents an innovative conceptual model to guide research on determinants of worker safety and health and to inform the design, implementation and evaluation of integrated approaches to promoting and protecting worker health. This model is rooted in multiple theories and the premise that the conditions of work are important determinants of individual safety and health outcomes and behaviors, and outcomes important to enterprises such as absence and turnover. Integrated policies, programs and practices simultaneously address multiple conditions of work, including the physical work environment and the organization of work (e.g., psychosocial factors, job tasks and demands). Findings from two recent studies conducted in Boston and Minnesota (2009-2015) illustrate the application of this model to guide social epidemiological research. This paper focuses particular attention on the relationships of the conditions of work to worker health-related behaviors, musculoskeletal symptoms, and occupational injury; and to the design of integrated interventions in response to specific settings and conditions of work of small and medium size manufacturing businesses, based on a systematic assessment of priorities, needs, and resources within an organization. This model provides an organizing framework for both research and practice by specifying the causal pathways through which work may influence health outcomes, and for designing and testing interventions to improve worker safety and health that are meaningful for workers and employers, and responsive to that setting's conditions of work.

Implementing an Integrated Health Protection/Health Promotion Intervention in the Hospital Setting: Lessons Learned From the Be Well, Work Well Study

OBJECTIVE

This study reports findings from a proof-of-concept trial designed to examine the feasibility and estimates the efficacy of the "Be Well, Work Well" workplace intervention.

METHODS

The intervention included consultation for nurse managers to implement changes on patient-care units and educational programming for patient-care staff to facilitate improvements in safety and health behaviors. We used a mixed-methods approach to evaluate feasibility and efficacy.

RESULTS

Using findings from process tracking and qualitative research, we observed challenges to implementing the intervention due to the physical demands, time constraints, and psychological strains of patient care. Using survey data, we found no significant intervention effects.

CONCLUSIONS

Beyond educating individual workers, systemwide initiatives that respond to conditions of work might be needed to transform the workplace culture and broader milieu in support of worker health and safety.

The impact of multi-site musculoskeletal pain on work ability among health care providers

Background

Epidemiologic studies have reported that multi-site musculoskeletal pain threatens work ability. However, no study has been conducted on this topic among health care providers. The aim of the present study was to determine the association between multi-site pain and poor work ability among health care providers.

Methods

A cross-sectional study was conducted. Participants completed a self-administered questionnaire including basic characteristics, job satisfaction, stress screening, musculoskeletal pain at neck, upper extremities, low back, and lower extremities within the last month, and work ability index. Pain intensity was dichotomized according to a numerical pain rating scale score: less than five (no) and at least five (yes). Musculoskeletal pain was divided in three groups: 1) no pain, 2) few pain sites (one to two sites), and 3) many pain sites (three to four sites). The association of the number of pain sites with poor work ability was explored through multivariable logistic regression analysis.

Results

A total of 254 health care providers participated in the present study. The majority of participants were female (73.2 %) with mean age of 33.9 (SD 9.5) years. Few pain sites and many pain sites were reported by 79 (31.1 %) and 39 participants (15.4 %), respectively. The adjusted odds ratio for poor work ability of participants who had few pain sites and many pain sites were 1.85 (95 % CI: 0.91 – 3.76) and 2.41 (95 % CI: 1.04 – 5.58), respectively.

Conclusion

The present study showed that multi-site musculoskeletal pain had an association with poor work ability. The magnitude of association was likely to increase by a higher number of pain sites.

Supervisors’ Support for Nurses’ Meal Breaks and Mental Health

Meal breaks promote occupational health and safety; however, less is known about supervisors’ support for nurses’ meal breaks. In this study, the researchers tested whether the frequency of meal breaks was positively related to supervisors’ support of nurses’ meal breaks, and whether more frequent meal breaks were associated with less psychological distress. This study is based on a cross-sectional survey of 1,595 hospital nurses working on 85 units supervised by nursing directors. Specific meal-break support was measured at the nursing director level; frequency of meal breaks and psychological distress were measured at the individual nurse level. Multilevel adjusted models showed a positive association between supervisors’ support for meal breaks and the frequency of nurses’ meal breaks (β = .16, p < .001). Moreover, nurses who took meal breaks more frequently reported lower psychological distress (β = −.09, p < .05). Meal breaks might be daily opportunities to promote mental health and fatigue recovery and provide downtime.

Psychosocial Factors and Musculoskeletal Pain Among Rural Hand-woven Carpet Weavers in Iran

Background

Musculoskeletal pain (MSP) is a common and disabling problem among carpet weavers and is linked to physical and psychosocial factors of work. This study aimed to determine the prevalence of MSP, its psychosocial risk factors, and association of pain in each pair of anatomical sites among carpet weavers.

Methods

A cross-sectional study was performed among 546 hand-woven carpet weavers in rural small-scale workshops of Iran. Data were collected by using parts of a standardized CUPID (Cultural and Psychosocial Influences on Disability) questionnaire focused on MSP in 10 body sites, including the low-back, neck, both right and left shoulders, elbows, wrists/hands, individual, physical and psychosocial risk factors. Statistical analysis was performed applying logistic regression models.

Results

Prevalence of MSP in at least one body site was 51.7% over the past month. The most common sites were low back and right shoulder pain 27.4% and 20.1%, respectively. A significant difference was found between the mean number of painful anatomical sites and the level of education, age, physical loading at work, time pressure, lack of support, and job dissatisfaction. In pairwise comparisons, strongest association was found between pain in each bilateral anatomical site (odds ratio = 11.6–35.3; p < 0.001).

Conclusion

In home-based workshops of carpet weaving, psychosocial factors and physical loading were associated with MSP. This finding is consistent with studies conducted among other jobs. Considering the preventive programs, the same amount of attention should be paid to psychosocial risk factors and physical loading. Also, further longitudinal studies are needed to investigate the relationship of psychological factors.

Relationship between Psychosocial Risk Factors and Work-Related Musculoskeletal Disorders among Public Hospital Nurses in Malaysia

Objective

This study examined the relationships between psychosocial work factors and risk of WRMSDs among public hospital nurses in the Klang Valley, Malaysia.

Methods

We conducted a cross-sectional study among 660 public hospital nurses. A self-administered questionnaire was used to collect data on the occurrence of WRMSDs according to body regions, socio-demographic profiles, occupational information and psychosocial risk factors. 468 questionnaires were returned (response rate of 71%), and 376 questionnaires qualified for subsequent analysis. Univariate analyses were applied to test for mean and categorical differences across the WRMSDs; multiple logistic regression was applied to predict WRMSDs based on the Job Strain Model’s psychosocial risk factors.

Results

Over two thirds of the sample of nurses experienced discomfort or pain in at least one site of the musculoskeletal system within the last year. The neck was the most prevalent site (48.94%), followed by the feet (47.20%), the upper back (40.69%) and the lower back (35.28%). More than 50% of the nurses complained of having discomfort in region one (neck, shoulders and upperback) and region four (hips, knees, ankles, and feet). The results also revealed that psychological job demands, job strain and iso-strain ratio demonstrated statistically significant mean differences (p < 0.05) between nurses with and without WRMSDs. According to univariate logistic regression, all psychosocial risk factors illustrated significant association with the occurrence of WRMSDs in various regions of the body (OR: 1.52–2.14). Multiple logistic regression showed all psychosocial risk factors were significantly associated with WRMSDs across body regions (OR: 1.03–1.19) except for region 1 (neck, shoulders and upper back) and region 4 (hips, knees, ankles, and feet). All demographic variables except for years of employment were statistically and significantly associated with WRMSDs (p < 0.05).

Conclusions

The findings indicated the high prevalence of WRMSDs in many body regions, and the risks of developing WRMSDs according to the various body regions were associated with important psychosocial risk factors based on the job strain model. These findings have implications for the management of WRMSDs among public hospital nurses in the Klang Valley, Malaysia.

Exploring lifetime occupational exposure and SLE flare: a patient-focussed pilot study

Introduction

Environmental effectors, such as ultraviolet radiation exposure, infection and stress, have been established as having a role in exacerbating lupus symptoms. However, unpredictable patterns of flare events still remain a mystery. Occupational effectors have also been suggested as having a contributing role; however, they are not widely researched. In this paper we report a pilot study designed to generate focus areas for future research regarding occupational exposures and systemic lupus erythematosus (SLE).

Methods

The study explored potential links between exposures and the occurrence of patient-reported flare events in 80 Australian women with SLE (American College of Rheumatology (ACR) criteria classified). Specifically, the study assessed the hypothesis that occupational exposure is associated with significant changes in the likelihood of lupus flares. Lifetime employment history was analysed with the Finnish Job Exposure Matrix (FINJEM), 40 different semiquantified exposure class estimates for a wide number of occupations based on probability of exposure (p≥5%=exposed) were analysed with the construction of negative binomial regression models to test relationships between occupational agents and flare days. A backward stepwise elimination was used to generate a parsimonious model.

Results

Significant associations were noted for exposure classes of manual handling burden, (p=0.02, incidence rate ratio (IRR) 1.01), Iron (p=0.00, IRR 1.37), wood dust (p=0.00, IRR 3.34) and asbestos (p=0.03, IRR 2.48).

Conclusion

Exposure assessment results indicated that occupations, such as nursing, with a high manual handling burden, posed increased risk to patients with SLE, however, the greatest risk was associated with wood dust and iron exposure with teachers and specialist labourers.