Effect of job rotation on need for recovery, musculoskeletal complaints, and sick leave due to musculoskeletal complaints: a prospective study among refuse collectors

BACKGROUND: Job rotation might be an effective preventive measure to reduce the prevalence of musculoskeletal complaints, although its effect has not been yet established. The aim of the present study is to evaluate the effect of job rotation in refuse collecting on need for recovery, prevalence of musculoskeletal complaints, and sick leave due to musculoskeletal complaints. METHODS: A 1-year prospective study among refuse collectors was performed, using standardized questionnaires. Job rotation was performed between collecting two-wheeled containers and driving a refuse truck. The experimental groups of rotating refuse collectors at t(0) and t(1) (group R-R) and non-rotating refuse collectors at t(0) and rotating refuse collectors at t(1) (group NR-R) were compared with a reference group of non-rotating refuse collectors at t(0) and t(1) (group NR-NR). RESULTS: The adjusted need for recovery of group R-R was marginally significantly lower than need for recovery of the reference group. Groups R-R and NR-R had a more than two times higher risk for complaints of the low back than the reference group. No other significant results were found. CONCLUSIONS: Job rotation seemed to coincide with a reduced need for recovery and was associated with an increased risk of low back complaints. No effects were found on sick leave due to musculoskeletal complaints. The results might be influenced by the healthy worker selection effect in the reference group and its inverse in the rotating groups.     

Identification of obstacles for chronic pain patients to return to work: evaluation of a questionnaire

The Obstacles to Return-to-Work Questionnaire (ORQ) was developed and evaluated. A total of 154 patients with chronic musculoskeletal pain and prolonged work disability participated in the study. Factor analyses reduced the ORQ to 55 items grouped into 9 subscales. The subscales were named Depression, Pain intensity, Difficulties at work return, Physical workload and harmfulness, Social support at work, Worry due to sick leave, Work satisfaction, Family situation and support, and Perceived prognosis of work return. The subscales showed satisfactory reliability. In order to determine predictive validity a discriminant analysis was conducted with sick leave 9 months after assessment as the outcome. This analysis indicated that the scales Perceived prognosis of work return, Social support at work, Physical workload and harmfulness, Depression, and Pain intensity could significantly predict sick leave and correctly classified 79% of the patients. The Multidimensional Pain Inventory and the Disability Rating Index could also significantly predict sick leave in this sample and correctly classified as many patients as the ORQ. However, these questionnaires do not include any work-oriented items and they had a lower specificity than the ORQ. This study suggests that patients' perceptions and beliefs about work and returning to work may be a significant hindrance for actual recovery.     

Risk factors for sick leave due to low back pain: a prospective study

The objectives of this prospective study were to identify predictive factors for sick leave of 8 days or more due to low back pain (LBSL) and to compare them with predictive factors for low back pain with no or shorter sick leave (LB) in a cohort of French workers. The predictive factors for LBSL were a past history of low back pain (odds ratio [OR], 7.2; 95% confidence interval [CI], 4.1 to 13), a low employment grade (OR, 4.3; 95% CI, 1.7 to 11), heavy smoking (OR, 5.5; 95% CI, 2.3 to 13), a pain score different from zero (OR, 4.9; 95% CI, 2.5 to 9.7), required bending backward or forward at work every day repetitively (OR, 7.4; 95% CI, 2.3 to 23), overall social integration (OR, 2.0; 95% CI, 1.3 to 3.3), and low social support at work (OR, 3.4; 95% CI, 1.6 to 7.3). Low social support at work and bending backward or forward at work were more strongly associated with LBSL than with LB (P = 0.02 and P < 0.01, respectively). The implications of the results of this prospective study are that both the level of biomechanical exposure and the psychosocial work environment, especially social support, represents important dimensions to consider in the reduction of work absenteeism.     

Risk factors for mortality due to shigellosis: a case-control study among severely-malnourished children in Bangladesh

To determine the risk factors for death of severely-malnourished Bangladeshi children with shigellosis, a case-control study was conducted at the Clinical Research and Service Centre of ICDDR,B: Centre for Health and Population Research in Dhaka, Bangladesh. One hundred severely-malnourished children (weight-for-age <60% of median of the National Center for Health Statistics), with a positive stool culture for Shigella dysenteriae type 1 or S. flexneri, who died during hospitalization, were compared with another 100 similar children (weight-for-age <60% and with S. dysenteriae type 1 or S. flexneri-associated infection) discharged alive. Children aged less than four years were admitted during December 1993-January 1999. The median age of the cases who died or recovered was 9 months and 12 months respectively. Bronchopneumonia, abdominal distension, absent or sluggish bowel sound, clinical anaemia, altered consciousness, hypothermia, clinical sepsis, low or imperceptible pulse, dehydration, hypoglycaemia, high creatinine, and hyperkalaemia were all significantly more frequent in cases than in controls. In multivariate regression analysis, altered consciousness (odds ratio [OR]=2.6, 95% confidence interval [CI] 1.0-6.8), hypoglycaemia (blood glucose <3 mmol/L (OR=7.8, 95% CI 2.9-19.6), hypothermia (temperature <36 degrees C) (OR=5.7, 95% CI 1.5-22.1), and bronchopneumonia (OR=2.5, 95% CI 1.1-5.5) were identified as significant risk factors for mortality. Severely-malnourished children with shigellosis having hypoglycaemia, hypothermia, altered consciousness and/or bronchopneumonia were at high risk of death. Based on the findings, the study recommends that early diagnosis of shigellosis in severely-malnourished children and assertive therapy for proper management to prevent development of hypothermia, hypoglycaemia, bronchopneumonia, or altered consciousness and its immediate treatment are likely to reduce Shigella-related mortality in severely-malnourished children.     

Risk factors for falls among Iowa farmers: a case-control study nested in the Agricultural Health Study

BACKGROUND: Farmers are at increased risk for fall-related injury compared with other occupations. Little is known about risk factors for non-fatal falls on the farm. This case-control study, nested within the Agricultural Health Study, aimed to assess risk factors for work-related falls among Iowa farmers. METHODS: A screener questionnaire sent to 6,999 farmers in 1998 identified 79 farmers who reported a fall-related farm injury that required medical advice or treatment in the previous year. Multivariable logistic regression analysis was used to assess several possible risk factors for injury among these farmers compared with 473 farmers with no injury in the previous year. RESULTS: There were significant associations between fall-related farm injury and age between 40 and 64 years (OR = 2.21; 95% CI = 1.20-4.07), doctor-diagnosed arthritis/rheumatism (OR = 2.05; 95% CI = 1.11-3.79), difficulty hearing normal conversation (even with a hearing aid, in the case of those who used one) (OR = 1.82; 95% CI = 1.07-3.08), and taking medications regularly (OR = 1.80; 95% CI = 1.02-3.18). CONCLUSIONS: Aging and health impairments, such as arthritis and hearing difficulties, are risk factors for which accommodations and preventive strategies can be devised to prevent fall-related injuries on the farm.     

Risk factors for back pain among male farmers: analysis of Iowa Farm Family Health and Hazard Surveillance Study.

BACKGROUND: Back pain causes considerable morbidity, disability, and economic loss among workers. Farmers handle heavy objects, often in awkward postures. However, the prevalence of back pain among farmers and the risk factors associated with back pain are not well known. METHODS: In this study, we assess the frequency of risk factors for back pain among 287 Iowa male farmers. From 1992 to 1994, using a mail questionnaire, we collected data on potential risk factors for back pain. Eighteen months later, we surveyed occurrence of back pain as the outcome measure. RESULTS: Thirty-one percent of farmers reported having daily back pain for a week or more during the past 12 months compared to 18.5% in the general working population. Using a multiple logistic regression model, we found two factors associated with back pain: 45-59 years of age (OR = 2.13, 95% CI 1.02-4.43) and having a non-agricultural job as the major occupation (OR = 2.02, 95% CI 0.98-4.17, P = 0.055). CONCLUSIONS: Farmers had a significantly higher prevalence of back pain than the general working population. Middle-aged farmers and those with additional non-agricultural jobs had the highest risk for back pain.     

Risk factors for machinery-related injury among Iowa farmers: a case-control study nested in the Agricultural Health Study

Farm machinery is a major cause of injury morbidity and mortality among farmers. This case-control study assessed risk factors for machinery-related injuries among Iowa farmers. A screener questionnaire sent to 6,999 farmers in 1998 identified 205 farmers who had machinery-related injuries requiring medical advice/treatment in the previous year. Possible risk factors for injury were assessed among these farmers compared with 473 farmers with no injury in the previous year. A multiple logistic regression analysis showed significant associations between machinery-related injury and hours per week spent on farmwork (OR = 2.02; 95% CI 1.38-2.94), fewer years of farming experience (OR = 1.79; 95% CI 1.14-2.79), wearing a hearing aid (OR = 4.37; 95% CI 1.55-12.25), and a high CAGE score suggesting problem drinking (OR = 2.49; 95% CI 1.00-6.19). This is the first study to show associations between machinery-related injury and hearing impairment, problem drinking, and fewer years of farming experience. These findings may be useful for future interventions to decrease injuries related to farm machinery.     

Risk factors for croup in children with recurrent respiratory infections: a case-control study

Croup accounts for approximately 15% of all lower respiratory disease in children, but little is known about risk factors or its recurrence rate. The aim of this study was to determine the risk factors for croup and recurrent croup and to find out whether it is possible to predict the course of the disease. We considered croup patients who visited the Paediatric Department of Oulu University Hospital as primary health care patients at night during 1996–2000. For most analyses we used sex- and age-matched control patients who had had other respiratory infection but for environmental factors we used population controls. We performed conditional logistic regression analysis on data applying to 182 pairs of patients and controls.
The recurrence rate was high, as 61% of the croup patients had had at least three episodes. Family history of croup was the most significant risk factor for both croup itself and recurrent croup. In multivariable analysis the odds ratio (OR) for the parents having a history of croup was 3.2 (95% CI 1.5, 7.1, P  < 0.01) and 4.1 (95% CI 1.4, 11.7, P  < 0.01) for recurrent croup. Parental smoking appeared to be a risk factor for respiratory infections but not for croup. Patients with croup had a cat as a pet less often than the controls, with OR 0.5 (95% CI 0.2, 1.0, P  = 0.04). Family history appeared to be an exceptionally strong predictive factor for croup and its recurrence. In this patient series prone to respiratory infections recurrence of croup was common.     

Tailored physiotherapeutic intervention for musculoskeletal disorders among video display terminal users: a case-control study

Background:Musculoskeletal disorders represent one of the most common complains among video display terminal (VDT) users and are responsible for an important burden of disease in white collars.Methods:From May 2017 to March 2018, 69 VDT users working at Trieste hospitals were recruited for a training session aimed to reduce musculoskeletal disorders in white collars workers. Thirty-three were assigned to the intervention group, whereas 36 were included in the control group. The intervention group received three personalized 1-hour-one-to-one sessions with a physiotherapist and a thorough evaluation of their workstation. Data were collected at baseline (T0), at 2 months (T1) and at 6 months (T2) using a standardized questionnaire and analyzed with the software STATA.Results:Overall pain significantly decreased in cases at T1 and T2 (p < 0.05). Headache significantly decreased in cases at T1 (p < 0.05). Body awareness significantly increased in cases both at T1 and T2 (p < 0.05). Headache was positively correlated with an increased perception of pain (Coef 6.85, CI95% 3.2-10.5; p < 0.001), while the intervention determined a significant reduction of overall pain during the follow up (OR 0.97, IC 0.95-0.99, p = 0.013). Cases showed a significant increase of the cranial-vertebral angle at the 6 months follow up (p < 0.05).Conclusion:A tailored physiotherapeutic intervention has showed a statistically significant decrease in osteoarticular pain and an increased body awareness in VDT users undergoing a personalized training session.     

A prospective study of psychosocial risk factors and absence due to musculoskeletal disorders--implications for occupational screening

OBJECTIVES: There is considerable evidence documenting the association between psychosocial risk factors and work disability due to musculoskeletal disorders, and this has prompted suggestions that psychosocial screening should be administered in the workplace in order to identify individuals at risk of prolonged absence. However, the predictive value of psychosocial risk factors on return-to-work is largely unknown. The present study aimed to explore the predictive relationship between psychosocial risk factors and absence due to musculoskeletal disorders of the lower back and upper limbs. METHODS: A prospective study of 4637 workers from a large, multi-site company in the UK was conducted in which a wide range of established questionnaires were used to collect baseline psychosocial data. Respondents were then followed over the ensuing 15 months, and absence due to musculoskeletal disorders was recorded. RESULTS: 219 workers took absence due to musculoskeletal disorders. Detrimental cut-off scores (risks) on the psychosocial instruments were established, and it was found that work-related psychosocial risk factors predicted the likelihood of a future spell of absence (odds ratios ranging between 1.6 and 3.2), but not the duration of that absence. CONCLUSIONS: Although work-related psychosocial factors were associated with the occurrence of absence due to musculoskeletal disorders, these findings do not lend support to the use of routine occupational psychosocial screening in order to predict prolonged absence.     

Risk factors for oral clefts: a population-based case-control study in Shenyang, China

Shenyang in Northern China has one of the highest reported prevalence rates of oral clefts in the world. To explore the risk factors for oral clefts in Shenyang, we carried out a population-based case-control study. A total of 360 990 births in 2000 to 2007 were screened for oral clefts; the overall prevalence was 1.76 per 1000. The ratio of cleft lip with or without cleft palate (CL ± P) : cleft palate only (CP) was 5.60:1. The overall male : female ratio was 2.02:1. CLP and CL were more common in males than in females with a sex ratio (SR) of 2.88:1 and 1.86:1 respectively, whereas CP was more common in females with an SR of 0.71:1.
Using a multivariable conditional logistic regression model, 586 oral clefts cases were compared with 1172 control mothers. Maternal factors significantly associated with increased risk for oral clefts were history of a fever or cold (adjusted OR 2.34, 95% CI 1.06, 5.60); use of analgesic and antipyretic drugs (adjusted OR 3.10, 95% CI 1.41, 6.86); poor ventilation during heating (adjusted OR 2.25, 95% CI 1.10, 4.60); and consumption of pickled vegetables >6 per week (adjusted OR 3.86, 95% CI 1.11, 13.47) during pregnancy. Factors which appeared to be protective were meat consumption ≥4 times per week (adjusted OR 0.43, 95% CI 0.28, 0.67); and legume consumption >6 times per week (adjusted OR 0.60, 95% CI 0.41, 0.89). Differences in risk were found between the two most common phenotypes, CL ± P and CP only. Most of the environmental factors had stronger associations with risk for CL ± P rather than CP, whereas history of oral clefts, as well as legume consumption, were more strongly associated with the risk for CP than for CL ± P. The findings suggest that aetiological heterogeneity may exist between CL ± P and CP.     

Risk factors for hospitalization due to acute diarrhea in children under two years old: a case-control study

The aim of this study was to investigate the socioeconomic, demographic, and biological determinants of hospitalization due to acute diarrhea (AD) in children under two years old. The hospital-based, case-control study was conducted from May to October 1997 in a pediatric hospital in Recife, Pernambuco, Brazil. Cases (n = 185) were children hospitalized due to AD, and controls (n = 185) were children with various diseases (except AD) presenting in the previous 15 days in the same area and time period. Data analysis used the Epi Info and Stata software. Odds ratios and 95% confidence intervals were calculated by multiple logistic regression to control confounding factors, considering a hierarchical risk factor model. Investigation using the proposed model showed an association between hospitalization due to AD and packed earth or plank floors in the house, greater multiparity, age of child under six months, and severity of bouts of diarrhea, which depended on the interaction between unfavorable socioeconomic conditions, younger age of the child, and severity of the diarrhea.     

Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a three-year follow-up

Objectives

To identify risk factors for new episodes of sick leave due to neck or back pain.

Methods

This prospective study comprised an industrial population of 2187 employees who were followed up at 18 months and 3 years after a comprehensive baseline measurement. The potential risk factors comprised physical and psychosocial work factors, health‐related and pain‐related characteristics and lifestyle and demographic factors. The response rate at both follow‐ups was close to 73%.

Results

At the 18‐month follow‐up, 151 participants reported at least one episode of sick‐listing due to neck or back pain during the previous year. Risk factors assessed at baseline for sick leave due to neck or back pain at the follow‐up were blue‐collar work, back pain one or several times during the previous year, 1–99 days of cumulative sickness absence during the previous year (all causes except neck or back pain), uncertainty of one''s own working ability in 2 years'' time and the experience of few positive challenges at work. After 3 years, 127 participants reported at least one episode of sick leave due to back or neck pain during the year previous to follow‐up. The risk factors for this pain‐related sick leave were blue‐collar work, several earlier episodes of neck pain, no everyday physical activities during leisure time (cleaning, gardening and so on), lower physical functioning and, for blue‐collar workers separately, repetitive work procedures.

Conclusion

The most consistent risk factors for new episodes of sick leave due to neck or back pain found during both the follow‐ups were blue‐collar work and several earlier episodes of neck or back pain assessed at baseline. Preventive efforts to decrease sick leave due to neck or back pain may include measures to increase the occurrence of positive challenges at work and to minimise repetitive work procedures. An evidence‐based secondary prevention of neck and back pain including advice to stay active is also warranted.Lower back and neck pain have a high prevalence and incidence in adult populations,¹ and social expenditure due to these ailments is huge.² Indirect costs such as sickness absenteeism and disability pensions constitute approximately 90% of this expenditure.³ Well‐designed longitudinal studies have been called for to assess factors related to sick leave, including risk factors for being sick‐listed.⁴A large body of research has been aimed at discerning risk factors for developing neck or back pain and/or chronic disability and several reviews have summarised these findings. On the whole, it seems that the physical load at work—for example, manual material handling, bending and twisting and whole‐body vibrations—increases the risk for back pain.^5,6 With regard to psychosocial factors in the workplace, some authors have concluded that, among other things, low job satisfaction and low social support^7,8 are related to the onset of back pain; whereas other researchers have found moderate evidence for no relation between back pain and psychosocial factors at work.⁹ Furthermore, psychological factors such as distress and depressed mood have been related to new episodes of neck or back pain¹⁰ and subsequent chronicity or disability.¹¹ Regarding life‐style factors, some evidence indicates that smoking may be related to back pain^12,13 even though this has not been confirmed in all studies.¹⁴ Physical activity, or inactivity, during leisure time has not been consistently related to the occurrence of back pain.^5,15Most people will experience one or more episode(s) of neck or back pain during their lives,¹ but only a small proportion will seek help and/or become sick‐listed because of these complaints.^16,17 Therefore, it seems reasonable to assume that sick leave due to neck or back pain is predicted by different factors other than those predicting the onset of neck or back pain.^14,18A number of studies have examined factors related to future sick leave due to neck or back pain; however, in a recent systematic review it was concluded that there is only limited evidence that certain work‐related characteristics, together with a few medical/functional factors and some demographic factors, are risk factors for future sick‐listing due to back or neck pain.¹⁹ Physical and/or ergonomic factors such as troublesome working postures and/or heavy lifting have been reported in some studies to increase the risk of future sick leave due to neck or back pain,^{14,20,21,22,23} but they were not related to sick‐listing in other studies.^24,25,26 Psychosocial factors in the work environment have also emerged as predictors of sick listing. These include low job satisfaction,^23,24,26 low control over work and a low work pace among men²⁷; low decision‐making authority and medium skill discretion²⁰ and low coworker support.^14,26 However, in a study by Elders et al,²¹ psychosocial work characteristics were not related to sickness absence due to back pain.Factors such as pain intensity,^21,22 reports of earlier episodes of back pain,^22,27 results from the straight‐leg‐raising test and medical history,²⁴ sick‐listing in general,²⁸ demographics/background such as age,²⁹ employment grade,²⁷ working night shifts²² and a few others such as emotional distress or low mood,^24,30 disability²⁶ and heavy smoking¹⁴ have also predicted sick‐listing attributed to back pain. However, divergent results have been found in other studies—for example, age, earlier back pain and smoking were not found to predict sick leave due to back pain in a study by Burdorf et al.³¹A better knowledge of factors related to future sick leave attributable to neck or back pain could be instrumental in decision‐making regarding preventive measures aimed at reducing sickness absence due to these conditions. The aim of this prospective study was to identify factors that predict new episodes of sick leave attributed to neck or back pain in an occupational population.