Inpatient hospital care for lumbar intervertebral disc disorders in Finland in relation to education,occupational class,income, and employment

The object of the study was to describe socioeconomic and demographic determinants of inpatient hospital care for lumbar intervertebral disc disorders (LIDD) in Finland. Information from the 1996 Finnish Hospital Discharge Register was linked with the 1995 Population Census. Poisson regression analyses were made with the total and the gainfully employed workforce aged 20-64 y as reference. All 48 public and seven private acute care general hospitals treating LIDD patients in Finland. In the workforce, 4643 patients aged 20-64 y (3692 among the gainfully employed) were admitted to the hospital due to LIDD (ICD-10: M51.1-M51.9) in 1996. About one-half were treated surgically. The duration of unemployment in 1995 was inversely associated with hospitalisation for LIDD in 1996, allowing for age, sex, education and personal income (unemployed for 12 months vs 0 months: rate ratio 0.66; 95% CI 0.57-0.77). Among those employed for 12 months in 1995, the level of education was inversely associated with the hospital admission rate. The rate was also higher in manual occupations as compared with the upper white-collar employees. The associations were clearer among the medically than the surgically treated patients. Hospitalisation for back disorder was, however, less common in the lowest income group as compared with the highest (0.65; 0.57-0.77) allowing for education, occupational class, age and sex. Women were less often admitted to the hospital than men, allowing for the socioeconomic factors (0.83; 0.77-0.90). When indicated by education or occupation, low socioeconomic status was associated with a relatively high rate of inpatient hospital care for LIDD. When indicated by personal income, the situation was the reverse. Unemployment and female gender predicted a relatively low rate of hospitalisation.     

Psychosocial risk factors for musculoskeletal symptoms among women working in geriatric care

BACKGROUND: Nursing is a stressful, physically demanding occupation and a rush setting for musculoskeletal problems. The aim of this study is to explore the extent of the association between psychosocial work characteristics and musculoskeletal symptoms among women working in geriatric care. METHODS: The participants were female employees of all geriatric nursing homes and geriatric hospital wards in Iceland having a staff of 10 or more. A total of 1,886 questionnaires were distributed. The response rate was 80%. RESULTS: Finding the job mentally difficult, mental exhaustion after one's shift, dissatisfaction with supervisors or the flow of information, insufficient influence at work, dissatisfaction with the hierarchy, intense time pressure, lack of solidarity, dissatisfaction with the job, harassment, violence or threats at work; all of the aforementioned gave crude odds ratios (OR) two or above for one or more musculoskeletal symptoms. Mental exhaustion and harassment, violence, and threats were the factors connected with symptoms from all the body regions studied. CONCLUSIONS: The extent of the association of work-related psychosocial factors and musculoskeletal symptoms among the geriatric female nursing staff is substantial and needs to be taken into account by occupational health services and others involved in preventive work. Am. J. Ind. Med. 44:679-684, 2003.     

Risk factors for work-related musculoskeletal disorders in an aluminum smelter

A cross-sectional study of selected jobs in an aluminum smelter was conducted to assess the prevalence of work-related musculoskeletal disorders (WMDs), and to estimate their association with physical and psychosocial characteristics of the jobs. A structured interview and physical exam were used to assess the musculoskeletal health status of the participants, and a self-administered questionnaire was used to assess the psychosocial factors. Observational job analysis was conducted to evaluate 37 potential physical risk factors. Complete data were available for 104 subjects. The prevalence of WMDs on interview and physical exam were 0.8%, 14.9%, 11.6%, 14.9%, and 17.4% for the neck, shoulder, elbow/forearm, hand/wrist, and low back regions, respectively. Unconditional multiple logistic regression was used to model the relationship between physical and psychosocial factors and health status. Years of forearm twisting were found to be a significant predictor for hand/wrist disorders on interview (OR = 17, 95% CI = 2.9–106); for elbow/foream disorders on physical exam and interview (OR = 37, 95% CI = 3.0–470); and for shoulder disorders on interview (OR = 92, 95% CI = 7.3–∞) and on interview and physical exam (OR = 46, 95% CI = 3.8–550). Low decision latitude was also found to be significant for the shoulder on interview (OR = 4.5, 95% CI = 1.3–16). High job satisfaction (OR = 5.9, 95% CI = 1.4–25) and low social support (OR = 5.3, 95% CI = 1.3–22) were associated with low back pain report on interview; only high job satisfaction (OR = 5.3, 95% CI = 1.1–26) was associated with low back pain on both interview and physical exam. Am. J. Ind. Med. 32:66-75, 1997. © 1997 Wiley-Liss, Inc.     

Risk and severity of non-back occupational injuries after lumbar laminectomy for degenerative disc disease

An increased risk, after lumbar laminectomy, for lost work time occupational back injury (odds ratio, 5.9; 95% confidence interval, 1.9-18.8) and disability (mean 292.8 days vs. 24.8 for controls) was previously demonstrated. Such differences could be due to physical sequelae of back surgery or to psychosocial factors. Extensive literature addresses the impact of psychosocial factors on the incidence of occupational injury and severity of disability. This study assumes that psychosocial factors would affect both back and non-back injuries, while surgery-related physical factors would not. The odds ratio for non-back lost work time injury for subjects in the same cohort studied previously was 1.5 (0.5-4.5), with no significant increase in duration of disability (mean 27.0 days vs. 24.8 for controls). The increased risk for back injury in the absence of an increased risk for other injuries suggests that physiologic rather than psychosocial factors provide the more likely explanation for the differences in back injuries.     

Combined ergonomic exposures and development of musculoskeletal pain in the general working population: A prospective cohort study

Objective:This study aimed to investigate the importance of combined ergonomic exposures at work for the development of musculoskeletal pain.Methods:Through four rounds (2012–2018) of the Work Environment and Health in Denmark Study, 18 905 employees of the general working population replied to a baseline and 2-year follow-up questionnaire. First, a k-means cluster analysis of seven ergonomic factors (back bending, arm above shoulders, lifting etc., from ‘never’ to ‘almost all the time’) identified nine naturally occurring clusters. Second, using a weighted survey regression model controlling for age, gender, survey year, education, lifestyle, influence at work, and pain intensity at baseline, we estimated development of pain intensity (0–10) in the neck-shoulder and low-back in these clusters. The largest cluster served as reference to the other clusters and was characterized by low ergonomic exposures.Results:Clusters characterized by multiple combined ergonomic exposures for a relatively high percentage of the working time showed the largest increase in neck-shoulder as well as low-back pain intensity from baseline to follow-up. However, clusters characterized by high exposure to a few specific ergonomic factors also increased pain significantly, eg, standing/walking combined with lifting/carrying or twisted/bent back for the majority of the working time increased low-back pain, whereas repetitive arm movements for the majority of the working time with or without standing/walking increased neck-shoulder pain.Conclusion:Combined occupational ergonomic exposures play an important role in the development of musculoskeletal pain. Workplace preventive approaches should consider this in risk assessments and organization of the work.     

腰腿痛患者中腰椎间盘磁共振成像局限性高信号区的分布特点及相关因素分析

目的 探讨腰腿痛患者中腰椎间盘磁共振成像(MRI)局限性高信号区(HIZ)的分布特点,并分析发生HIZ的相关因素.方法 选取2009年6月至2010年8月因腰腿痛行腰椎MRI检查的患者628例.分析HIZ在年龄、椎间盘节段和椎间盘退变中的分布特点及其相关因素.结果 628例患者3140个椎间盘中,172例(27.39％,172/628 )206个椎间盘(6.56％,206/3140)存在HIZ.其中男性患者和女性患者HIZ的发生率分别为26.38％(86/326)和28.48％( 86/302),差异无统计学意义(P=0.556).40～49岁是HIZ发生率最高的年龄段[40.22％(72/179)].椎间盘节段存在HIZ的发生率:L1～2 0.80％(5/628)、L2～3 2.07％ (13/628)、L3～42.07％(13/628)、L4～5 14.01％(88/628)、L5～S113.85％(87/628).有和无HIZ时椎间盘退变程度≥Ⅳ级者的发生率分别为49.03％( 101/206)及23.76％(697/2934),差异有统计学意义(P＜0.01).年龄、椎间盘退变程度、椎间盘节段与HIZ均具有相关性(r=-0.040,P=0.025;r=0.217,P＜0.01;r=0.179,P＜0.01).结论 腰腿痛患者中腰椎间盘MRI发生HIZ与年龄、椎间盘节段、椎间盘退变程度之间存在相关性,椎间盘退变程度是最重要的影响因素.HIZ最常发生于L4～5和L5～S1节段,40～ 49岁是高发年龄段.     

Stressful psychosocial work environment increases risk for back pain among retail material handlers

BACKGROUND: Back pain is a major source of lost work time. Occupational physical activity only accounts for a fraction of low back pain; therefore, there is growing interest in investigating other possible causes of back pain including the psychosocial work environment. METHODS: Material handlers (N = 6,311) in 160 newly opened stores were interviewed at study entry and approximately 6 months later. Factor analysis was used to reduce the 37 psychosocial questionnaire items to seven distinct factors. RESULTS: After adjusting for history of back problems and work-related lifting, risk of back pain was moderately increased among employees who reported high job intensity demands (odds ratio (OR) = 1.8), job dissatisfaction (OR = 1.7), and high job scheduling demands (OR = 1.6). CONCLUSIONS: Modification of the psychosocial work environment for material handlers in large retail stores may help reduce back pain among employees.     

Musculoskeletal complaints and psychosocial risk factors among Chinese hospital nurses

BACKGROUND: Musculoskeletal complaints represent a common occupational problem for health care workers throughout the world. Despite their sizeable numbers, however, few epidemiological studies have investigated musculoskeletal complaints among Chinese hospital nurses. Objective To assess the prevalence of, and risk factors for, musculoskeletal complaints among hospital nurses in mainland China. METHODS: A total of 282 female, registered nurses were surveyed (92% response rate) using a modified Chinese-language version of the Standardized Nordic Questionnaire. Body sites were divided into the neck, shoulder, upper back and lower back regions. RESULTS: The 12 month period-prevalence of musculoskeletal complaints at any of the four regions was 70%. The lower back was the most commonly reported body site (56%), followed by the neck (45%), shoulder (40%) and upper back (37%). High mental pressure, boring or tedious tasks and limited work support were identified as significant risk factors (adjusted odds ratios: 1.79-2.52). No correlations were found between manual handling or perceived physical exertion and increased reporting of musculoskeletal complaints. CONCLUSION: This study has shown that musculoskeletal complaints are prevalent among Chinese hospital nurses. The correlation with various psychosocial factors is also consistent with evidence from other countries.     

The role of physical workload and pain related fear in the development of low back pain in young workers: evidence from the BelCoBack Study; results after one year of follow up

Aims

To study the influence of work related physical and psychosocial factors and individual characteristics on the occurrence of low back pain among young and pain free workers.

Methods

The Belgian Cohort Back Study was designed as a prospective cohort study. The study population of this paper consisted of 716 young healthcare or distribution workers without low back pain lasting seven or more consecutive days during the year before inclusion. The median age was 26 years with an interquartile range between 24 and 29 years. At baseline, these workers filled in a questionnaire with physical exposures, work related psychosocial factors and individual characteristics. One year later, the occurrence of low back pain lasting seven or more consecutive days and some of its characteristics were registered by means of a questionnaire. To assess the respective role of predictors at baseline on the occurrence of low back pain in the following year, Cox regression with a constant risk period for all subjects was applied.

Results

After one year of follow up, 12.6% (95% CI 10.1 to 15.0) of the 716 workers had developed low back pain lasting seven or more consecutive days. An increased risk was observed for working with the trunk in a bent and twisted position for more than two hours a day (RR 2.2, 95% CI 1.2 to 4.1), inability to change posture regularly (RR 2.1, 95% CI 1.3 to 3.5), back complaints in the year before inclusion (RR 1.7, 95% CI 1.1 to 2.8), and high scores of pain related fear (RR 1.8, 95% CI 1.0 to 3.1). Work related psychosocial factors and physical factors during leisure time were not predictive.

Conclusion

This study highlighted the importance of physical work factors and revealed the importance of high scores of pain related fear in the development of low back pain among young workers.     

Anxiety and depression predict musculoskeletal disorders in health care workers

Incidence of musculoskeletal disorders (MSDs) is high among health care workers (HCWs). To determine whether MSDs are associated with preexisting anxiety and/or depression, a case-control study was carried out in female HCWs (56 cases/55 controls). Cases were HCWs with a first-time clinical diagnosis of MSD within the previous 2 years. Occupation, workplace, work shift, direct patient assistance, and anxiety/depression scores (Goldberg scale) were assessed. Increased risk of incident MSDs (multivariate logistic regression) was found in workers with preexisting anxiety/depression compared to those without (OR 5.01; 95% CI 2.20–12.05; p < .01). Other significant risk factors were direct patient assistance (OR 2.59; 95% CI 1.03–6.92; p = .04) and morning work shift (OR 2.47; 95% CI 0.99–6.48; p = .05). Preexisting anxiety/depression was associated with incident MSDs in HCWs, adjusting for occupational exposure risk factors.     

Psychological and occupational predictive factors for back pain among employees of a university hospital in southern Spain

OBJECTIVES: To identify the individual and occupational factors that are predictors for low back pain among the employees of a university hospital in southern Spain. METHODS: A transverse study was conducted in which the population used was the hospital employees who volunteered to participate. The information was obtained by using a questionnaire, which included demographic and anthropometric variables, habits, characteristics of the work done, and of any pain experienced. The mental health condition of subjects was measured using the GHQ-28, using a score of > or = 6 as the cut-off point. To study the variables associated with pain, crude odds ratios (ORs) were calculated (+/- 95% CI) and adjusted according to a logistic regression model. RESULTS: One thousand one hundred and four subjects participated in the study but only 890 of these completed the questionnaire in full (rate of response, 35.7% of total employees). The population studied was notable for the high proportion of women, for subjects > 41 years of age, and subjects who undertook little or no physical exercise. In addition, according to the GHQ-28 test, 29.9% of the total were 'probable psychiatric cases'. The crude ORs were high in all the occupational categories in comparison with the doctors, with the exception of the maintenance, cleaning, and catering group. They were also higher among women, among subjects with poor mental health, and among women with one or more children. The adjusted ORs showed that having a GHQ-28 score of > or = 6, and belonging to the auxiliary technician category, were independent risk factors for suffering low back pain. Being older than 41 years and in temporary employment were protective variables. CONCLUSIONS: The presence of probable mental illness is the variable most strongly associated with the presence of low back pain in the population studied. Its diagnostic confirmation and appropriate treatment could contribute to reducing the prevalence of vertebral pains in this occupational group.     

A case-control study of risk factors for industrial low back injury: implications for primary and secondary prevention programs.

Data were collected on 228 consecutive back injuries in Boston's General Mail Facility and 228 non-injured controls drawn randomly from each case's work unit, matching on craft (clerk, mailhandler, maintenance), shift, and general supervisor. Data were collected on age, gender, duration of employment, 3 year history of injury claims, overtime work in the past 2 weeks, job change in the past 60 days, and machine vs. manual job. Risk factors for back injury were examined simultaneously in a conditional logistic regression for matched pairs. Risk factors included history of back injury claim (OR = 16.5, p less than 0.0001), younger age (OR = 3.0, p = 0.0001), shorter duration of employment (OR = 2.6, p = 0.0007), recent job change (OR = 2.5, p = 0.06), and history of non-back injury claim (OR = 2.0, p = 0.08). Among heavy lifters (vs. clerks) overtime and being female increased the risk of injury. In this setting, higher risk workers who may benefit from preventive education programs can be identified.     

Barriers to patient information provision in primary care: patients' and general practitioners' experiences and expectations of information for low back pain

Background As patient involvement in health‐care increases, the role of information is crucial, especially in conditions where self‐management is considered an integral part of care. However, the suitability and applicability of much patient information has not been appraised in terms of how far it meets patients' information needs. Aims To ascertain patients' and clinicians' experiences and expectations of information in low back pain in order to suggest a suitable ‘patient‐centred’ content for a patient information pack to be used in a primary care setting. Methods A qualitative study using semi‐structured interviews with General Practitioners (GPs) (n = 15) and focus groups comprising patients with low back pain (n = 37). Results Barriers to information‐giving for low back pain in primary care exist. Patients are dissatisfied with the information they receive from their GPs, especially regarding diagnosis and treatment. Patients tend to access information from a variety of other sources, which is often contradictory, conflicts with research evidence and leads to unreasonable expectations. GPs have varying views regarding the value of patient information and are equivocal about their roles as information providers. Although The Back Book is generally acceptable as a patient information leaflet for low back pain, attention to the tone of the text is required. Conclusions Barriers exist to patient information provision, both generally and for low back pain, which need to be addressed in order to close the gap between strategy and implementation. Improving clinician communication skills and involving patients in developing information materials which meet their needs are crucial to this process.