Understanding work related musculoskeletal pain: does repetitive work cause stress symptoms?

Background: Pain in the neck and upper extremity is reported with high frequency in repetitive work. Mechanical overload of soft tissues seems a plausible mechanism, but psychological factors have received considerable attention during the past decade. If psychological factors are important for development of regional pain in repetitive work, stress symptoms would likely be on the causal path.

Aims: To examine whether objective measures of repetitive monotonous work are related to occurrence and development of stress symptoms.

Methods: In 1994–95, 2033 unskilled workers with continuous repetitive work and 813 workers with varied work were enrolled. Measures of repetitiveness and force requirements were quantified using video observations to obtain individual exposure estimates. Stress symptoms were recorded at baseline and after approximately one, two, and three years by the Setterlind Stress Profile Inventory.

Results: Repetitive work, task cycle time, and quantified measures of repetitive upper extremity movements including force requirements were not related to occurrence of stress symptoms at baseline or development of stress symptoms during three years of follow up.

Conclusions: The findings do not indicate that repetitive work is associated with stress symptoms, but small effects cannot be ruled out. Thus the results question the importance of mental stress mechanisms in the causation of regional pain related to repetitive work. However, the findings should be interpreted with caution because the stress inventory has not been validated against a gold standard.

     

What makes men and women with musculoskeletal complaints decide they are too sick to work?

OBJECTIVE: The objective of this study was to determine what makes men and women with musculoskeletal complaints decide to call in sick for work. METHODS: Qualitative, face-to-face interviews were used with employees (16 men and 14 women) who had called in sick due to a musculoskeletal complaint and who expected to be absent from work for at least 2 weeks on sick leave. RESULTS: The participants fell into the following two main groups: those who were off sick because of a diagnosed medical condition, such as a fracture, and those who were off sick because of an unidentifiable complaint, such as low-back pain. Employees in the former group called in sick because they were in the hospital or because they reckoned that their condition was too serious to warrant a continuation of work. Employees in the latter group felt hesitant and insecure and found it hard to judge whether absenteeism was justified. They decided either to "play it safe" and stay off work to prevent the complaints from worsening or to seek advice from medical professionals. Their advice did not include explicit instructions to stay at home, but were usually interpreted as such. Finally, women, but not men, were likely to call in sick if they felt that their home situation was being negatively affected by attempts to keep working while suffering physical complaints. CONCLUSIONS: The decision to call in sick is not taken lightly. Employees with nonspecific disorders base their decision on several factors, including advice from medical professionals. A factor found only among women was work-home interference.     

Health complaints and satisfied with the job? A cross-sectional study on work environment, job satisfaction, and subjective health complaints

OBJECTIVE: The aim of this study was to examine the prevalence of subjective health complaints (SHCs) among satisfied and dissatisfied workers. The second aim was to evaluate whether any SHC differences were attributable directly to the work environment or mediated by the individual perception of the environment (satisfactory or not). METHOD: In a cross-sectional study of 458 employees (56% women) in 5 different organizations, work environment, job satisfaction, and SHC were measured. RESULTS: Satisfied workers reported an average of five to six subjective health complaints that correspond to the prevalence found in a Norwegian general population. Work environment explained 43% of the variance for job satisfaction and 9% of the variance in SHCs. CONCLUSION: SHCs are common among satisfied workers. Work environment has only a limited influence on this validated health indicator.     

Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review

Objective

Assessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based measures predict work participation in patients with MSDs?

Methods

A systematic literature search was performed to obtain longitudinal studies that used reliable performance-based measures to predict work participation in patients with MSDs. The following five sources of information were used to retrieve relevant studies: PubMed, Embase, AMA Guide to the Evaluation of Functional Ability, references of the included papers, and the expertise and personal file of the authors. A quality assessment specific for prognostic studies and an evidence synthesis were performed.

Results

Of the 1,230 retrieved studies, eighteen fulfilled the inclusion criteria. The studies included 4,113 patients, and the median follow-up period was 12 months. Twelve studies took possible confounders into account. Five studies were of good quality and thirteen of moderate quality. Two good-quality and all thirteen moderate-quality studies (83%) reported that performance-based measures were predictive of work participation. Two good-quality studies (11%) reported both an association and no association between performance-based measures and work participation. One good-quality study (6%) found no effect. A performance-based lifting test was used in fourteen studies and appeared to be predictive of work participation in thirteen studies.

Conclusions

Strong evidence exists that a number of performance-based measures are predictive of work participation in patients with MSDs, especially lifting tests. Overall, the explained variance was modest.

     

Obesity,binge eating and psychopathology: Are they related?

Obese female subjects with binge eating disorder BED; (N = 107) completed the Beck Depression Inventory, Symptom Checklist-90, Inventory of Interpersonal Problems, and Rosenberg Self-Esteem Scale. Subjects were divided into moderate or severe binger on the basis of scores on the Binge Eating Scale, and grouped into moderately or severely obese by performing a median split on their weights. Spearman correlational analyses were performed to determine the relationship between psychopathol-ogy and obesity and psychopathology and binge eating. Analyses of variance (ANO-VAs) were then performed using scores on the psychological measures with subjects grouped both by severity of obesity and severity of binge eating. The results indicated that in our sample, obesity and scores on the measures of psychiatric symptomatology were unrelated. However, a significant positive relationship was found between binge eating severity and degree of psychiatric symptomatology. We suggest that binge eating may account for the observed relationship between obesity and psychopathology reported in previous studies. We discuss the importance of assessing BED when conducting research with obese individuals. © 1994 by John Wiley & Sons, Inc.     

Are changes in mechanical exposure and musculoskeletal health good performance indicators for primary interventions?

OBJECTIVES: The purpose of this review is to present more insight into the effects of primary interventions on both mechanical exposure and musculoskeletal health and to determine whether these outcomes are good performance indicators of such interventions. METHODS: The literature was scrutinised for relevant references. Primary prevention was defined as any activity aimed at preventing the occurrence of musculoskeletal disorders in occupational populations. Primary outcome measures were mechanical exposure, musculoskeletal health, and sick leave due to musculoskeletal disorders. The impact of interventions was assessed by calculating the reduction in mechanical exposure and the preventable fraction (PF) of the musculoskeletal complaints. After selection, 40 studies were included for further analysis. RESULTS: In general, of the 40 included studies, 29 (73%) found a reduction in musculoskeletal symptoms (PF range 0.10-0.95). Eighteen out of 29 studies (62%) reported a statistically significant reduction in musculoskeletal disorders. In 12 of the 40 studies (30%) changes in both mechanical exposure and musculoskeletal health were used as performance indicators for the intervention. Of these studies nine (67%) showed a reduction in both mechanical exposure (range 14%-87% reduction) and musculoskeletal disorders or sick leave due to musculoskeletal disorders (PF range 0.15-0.92). From these nine it was seen that a reduction of at least 14% in mechanical exposure resulted in a concomitant reduction in musculoskeletal health. CONCLUSIONS: More quantitative information is needed to describe the relationship between mechanical exposure and musculoskeletal health as presented in the model. In this case it is recommended that in primary intervention studies not only changes in health outcomes be measured but also changes in mechanical exposure along the pathway of the intervention. In this way a better insight will be gained about the dose-response relationships between exposure to physical-load risk factors and work-related musculoskeletal disorders (WRMSD). More insight into these relationships will eventually lead to more efficient implementations of primary intervention strategies.     

Are lipid values and BMI related to hospitalizations in the hemodialysis population?

OBJECTIVE: To examine the relationship between lipid values and BMI (body mass index) on hospitalizations in hemodialysis (HD) patients. DESIGN: Retrospective (2-year) study. SETTING: Outpatient dialysis center in a large metropolitan city. PATIENTS: This study used 158 HD patients stratified on the basis of ethnicity (non-Black and Black) and diabetic status (nondiabetic and diabetic). INTERVENTION: Subjects were observed for 2 years. Body weight, BMI, lipid parameters, and hospitalization duration were determined 8 times (3-month intervals). MAIN OUTCOME MEASUREs: Body weight, BMI, lipid parameters (serum triglyceride concentration, serum total cholesterol, high-density lipoprotein [HDL]-, low-density lipoprotein [LDL]-, very low-density lipoprotein [VLDL]- cholesterol concentrations, serum Apo-protein A1 [Apo-A1] concentration, and serum Apo-protein B [Apo-B] concentration), and morbidity data were recorded. RESULTS: Hemodialysis subjects were hospitalized 2.3 +/- 1.6 times over the 2-year experimental period. Length of hospital stay averaged 6.6 +/- 0.5 days/hospitalization. Length of hospital stay was inversely related to HDL concentration (r = -0.21, P <.05, n = 89), but not significantly related to BMI in HD subjects. BMI was positively associated with LDL concentration (r = +0.28, P <.01, n = 97). Cholesterol concentration was directly associated with LDL concentration (r = +0.52, P <.01, n = 138), VLDL concentration (r = +0.47, P <.01, n = 139), and triglyceride concentration (r = +0.54, P <.01, n = 155). Mean concentration of HDL-cholesterol was inversely related serum triglyceride concentration (r = -0.43, P <.01, n = 140). Although Apo-A1 concentration was directly associated with HDL level (r = +0.39, P <.01, n = 139), Apo-B was inversely related to HDL level (r = -0.37, P <.01, n = 138) and directly related to cholesterol concentration (r = +0.71, P <.01, n = 138), VLDL concentration (r = +0.87, P <.01, n = 138), and triglyceride concentration (r = +0.81, P <.01, n = 138). CONCLUSION: Cardiac disease remains the primary cause of morbidity and mortality in HD patients, and results of the present study suggest that dyslipidemias present in the HD population negatively impact cardiovascular profiles which, in turn, influence the frequency/duration of hospitalizations. Among all lipid parameters analyzed in the present study, increased LDL and decreased HDL concentrations were more strongly related to length of hospital stay than was BMI.     

Are parenting style and controlling feeding practices related?

This study examined the relationships between parenting styles, feeding practices and BMI in a non-clinical sample of mothers and fathers of UK preschool children. Ninety-six cohabiting parents of 48 children (19 male, 29 female, mean age 42 months) completed a series of self-report questionnaires assessing parenting style, feeding practices, eating psychopathology and a range of demographic information. There were no relationships between authoritarian parenting and controlling feeding practices. In both mothers and fathers, permissive parenting style was related to lower monitoring of children's unhealthy food intake. Permissive parenting was also associated with increased use of restriction by mothers and pressure to eat by fathers. Authoritative parenting style was also related to lower use of pressure to eat by fathers only. Parenting styles were not related to child BMI in this sample. Higher child BMI was best predicted by lower paternal application of pressure to eat and greater paternal reports of drive for thinness. Parenting style may not have a direct impact on child BMI until child food selection and consumption becomes more autonomous.     

Is work engagement related to work ability beyond working conditions and lifestyle factors?

Purpose

To examine the associations of age, lifestyle and work-related factors, and particularly work engagement with the work ability index (WAI) and its sub-dimensions.

Methods

Step-wise regression analysis with a sample of Finnish firefighters (n?=?403) was used. The outcome variables were the WAI and its six sub-dimensions. The independent variables consisted of age, lifestyle variables (alcohol consumption, BMI, smoking, physical exercise, and sleep problems), working conditions (job demands, physical workload, supervisory relations, and task resources), and work engagement. The outcome variables and all the variables related to lifestyle, working conditions, and work engagement were measured in 2009. Work ability at baseline 10?years earlier was adjusted for in the models.

Results

Work engagement, age, physical exercise, sleep problems, and physical workload were associated with the WAI. All independent variables, except BMI and alcohol consumption, were associated with at least one sub-dimension of the WAI after controlling the baseline WAI. Lifestyle variables, working conditions, and work engagement were more strongly related to the subjective WAI sub-dimensions than to the two more objective WAI sub-dimensions.

Conclusions

Work engagement was significantly associated with work ability even after adjusting for various factors, indicating its importance in promoting work ability. Other key factors for good work ability were frequent exercise, good sleep, non-smoking, low job demands, low physical workload, and high task resources. More specifically, this study suggests that in maintaining work ability, it is valuable not only to promote lifestyle factors or working conditions, but also to enhance employees’ positive state of work engagement.     

Are occupational factors important determinants of socioeconomic inequalities in musculoskeletal pain?

OBJECTIVES: The aim of this study was to quantify socioeconomic inequalities in low-back pain, neck-shoulder pain, and arm pain in the general working population in Oslo and to examine the impact of job characteristics on these inequalities. METHODS: All economically active 30-, 40-, and 45-year-old persons who attended the Oslo health study in 2000-2001 and answered questions on physical job demands, job autonomy, and musculoskeletal pain were included (N=7293). Occupational class was used as an indicator of socioeconomic status. The lower occupational classes were compared with higher grade professionals, and prevalences, prevalence ratios, prevalence differences, and population attributable fractions were calculated. RESULTS: There were marked, stepwise socioeconomic gradients for musculoskeletal pain, steeper for the men than for the women. The relative differences (prevalence ratios) were larger for low-back pain and arm pain than for neck-shoulder pain. The absolute differences (prevalence differences) were the largest for low-back pain. Physical job demands explained a substantial proportion of the absolute occupational class inequalities in low-back pain, while job autonomy was more important in explaining the inequalities in neck-shoulder pain and arm pain. The estimated population attributable fractions supported the impact of job characteristics at the working population level, especially for low-back pain. CONCLUSIONS: In this cross-sectional study, physical job demands and job autonomy explained a substantial proportion of occupational class inequalities in self-reported musculoskeletal pain in the working population in Oslo. This finding indicates that the workplace may be an important arena for preventive efforts to reduce socioeconomic inequalities in musculoskeletal pain.     

What is known about temperature and complaints in the upper extremity? A systematic review in the VDU work environment

Upper extremity musculoskeletal complaints and disorders are frequently reported among visual display units (VDU) workers. These complaints include cold forearms, hands or fingers. Objective: The aim of this systematic review was to gain an insight into the relationship between objective and subjective temperature decrease and musculoskeletal disorders (MSDs) in the upper extremity in a VDU work environment by (internal or external) cooling of the arm and hand. Two questions were formulated: (1) Is a VDU work environment (temperature between 15 and 25°C) associated with temperature decrease of the arm, hand or fingers in healthy subjects? (2) Is there a difference in arm, hand and finger temperature between patients with upper extremity MSDs and healthy subjects in a VDU work environment? Methods: Through a systematic literature search in six databases between 1989 and October 2005, 327 articles were retrieved and 17 included. Results: Forearm, hand and finger temperature significantly decreases when the ambient temperature (between 15 and 25°C) decreases. The skin temperature in the hand that uses a computer mouse is lower than the other hand in the same ambient temperature. At baseline, no objective temperature differences are found between patient groups and controls, whereas in patients with cold hand complaints, lower skin temperatures are found compared to controls. The association between temperature (changes) in the forearm, hand or fingers during VDU work, and MSDs in the upper extremity is not clear. Conclusion: There is no consistent evidence available for the association between upper extremity MSDs and temperature changes in forearm, hand or fingers in an office work environment.     

Can favorable psychosocial work conditions and high work dedication protect against the occurrence of work-related musculoskeletal disorders?

OBJECTIVES: This study investigated whether work dedication and job resources are longitudinally related to work-related musculoskeletal disorders and whether job resources buffer the impact of job demands on these disorders? METHODS: Data were used from a longitudinal three-phase study (2004, 2005, 2006) on health at work among a sample of Dutch workers. The first survey was sent in 2004 by e-mail to 3100 members of an existing panel. For the analyses, 1522 participants were included with full longitudinal data. The analyses were performed using an autoregressive model with generalized estimating equations. RESULTS: The job-resource quality of communication was found to predict the risk of work-related musculoskeletal disorders over time. This effect was not mediated by work dedication. A high quality of communication was also found to buffer the negative effects of a high physical workload on the risk of work-related musculoskeletal disorders. Furthermore, a low level of social support by colleagues was found to buffer the negative effect of a medium physical workload on work-related musculoskeletal disorders. CONCLUSIONS: This study shows that job resources are not only important for promoting work dedication, but may also moderate the negative impact of high job demands on the risk of work-related musculoskeletal disorders. With respect to social support, the question is raised of whether this can also work negatively. The results of this study imply that, besides avoiding or reducing risks to health in the workplace and lowering job demands, strengthening job resources may additionally buffer harmful effects of job demands on musculoskeletal health.     

Are professional attitudes related to gender and medical specialty?

OBJECTIVES: The importance of professional attitudes in medical care has long been recognized; however, medical training has not stressed attitude development until recently. In previous studies among medical students, we found that gender and specialty preference are important factors in attitudes. In this study, patient-centredness of trainees in general practice and surgery and of final-year clerks preferring one of these specialties was assessed in one medical school in The Netherlands. The effect of gender, specialty and training level on attitude was investigated. DESIGN: In 1995, attitudes of 37 general practice trainees, 31 surgery trainees and 120 clerks were measured anonymously using questionnaires containing the Doctor-Patient Scale. This attitude scale measures patient-centredness vs. doctor-centredness. Response rates were 78%, 58% and 84%, respectively. SETTING: University of Utrecht. SUBJECTS: Medical students. RESULTS: Attitudes were related to specialty. General practice trainees showed more patient-centredness than surgery trainees. In accordance with previous findings among younger students, no differences were found between final-year clerks and vocational trainees. In contrast to previous studies, gender was not related to patient-centredness. CONCLUSIONS: Professional attitudes, in particular patient-centredness, seem to be related to specialty preference in the final year of graduate medical training and specialty as a career choice. It remains unclear whether professional socialization reinforces existing attitudes or whether existing attitudes result in specialty preference.     

Are eating behaviors related with by body mass index,gender and age?

The present study was carried out with parents of 520 healthy children between the ages of 2-12 and their parents who were referred to the diet polyclinic of a hospital in Ankara. The data were collected through personal interviews. The interviews included identifying the characteristics of the child and his/her parents, anthropometric measurements, questions investigating eating status, and the Children’s Eating Behavior Questionnaire. According to the body mass index-Z scores, there were differences between subgroups of food responsiveness, emotional overeating, enjoyment of food, food fussiness, and slowness in eating. The gender-based desire to drink score was, on average, higher in boys. No gender-based differences were found in other subgroups, whereas the scores in the food fussiness and slowness in eating and emotional undereating were higher in the preschool group when analyzed by age. In conclusion, eating behaviors of overweight and obese children differ from those of normal and underweight children.     

Is cultural activity at work related to mental health in employees?

Objective

To examine relationships between work-based cultural activities and mental employee health in working Swedes.

Hypothesis

A positive relationship between frequent cultural activity at work and good employee health was expected.

Research design

Random sample of working Swedish men and women in three waves, 2006, 2008 and 2010, on average 60 % participation rate.

Methods

A postal questionnaire with questions about cultural activities organised for employees and about emotional exhaustion (Maslach) and depressive symptoms (short form of SCL). Employee assessments of “non-listening manager” and work environment (“psychological demands” and “decision latitude”) as well as socioeconomic variables were covariates. Cross-sectional analyses for each study year as well as prospective analyses for 2006–2008 and 2008–2010 were performed.

Main outcome and results

Lower frequency of cultural activities at work during the period of high unemployment. The effects of relationships with emotional exhaustion were more significant than those with depressive symptoms. The associations were attenuated when adjustments were made for manager function (does your manager listen?) and demand/control. Associations were more pronounced during the period with low unemployment and high cultural activity at work (2008). In a prospective analysis, cultural activity at work in 2008 had an independent statistically significant “protective” effect on emotional exhaustion in 2010. No corresponding such association was found between 2006 and 2008.

Conclusions

Cultural activities at work vary according to business cycle and have a statistical association with mental employee health, particularly with emotional exhaustion.

Implications for future research

There are particularly pronounced statistical protective effects of frequent cultural activity at work on likelihood of emotional exhaustion among employees.

     

Are child sexual experiences related to eating-disordered attitudes and behaviors in a college sample?

Clinicians and theorists have suggested a link between child sexual abuse (CSA) and the later development of eating disorders. Finkelhor and Browne (1986) argue that this link is mediated by abuse characteristics, personality variables, and levels of family support. The present study investigated child sexual experiences and family support as predictors of disordered attitudes and behaviors in a well-functioning female college sample. Abused respondents had higher total scores on the Eating Disorders Inventory (EDI) than nonabused respondents, but a MANOVA revealed no between-group differences on the EDI subscales. Further, abuse characteristics were either unrelated (e.g., severity) or weakly related (e.g., reaction to abuse) to EDI scores. Family support, especially parental reliability, did predict EDI scores. This was more true for CSA victims. Thus, there appeared to be an interactive relationship between abuse status and family variables in influencing EDI scores.