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.     

Proposal for an approach with default values for the protection offered by PPE, under European new or existing substance regulations

Introduction of personal protective equipment (PPE) in the process of quantitative exposure and risk assessment should be addressed carefully. PPE which have been designed and manufactured according to CE-criteria and have proved to pass relevant test criteria, can be classified as "proper functioning". However, test criteria for PPE are not equal to levels of protection which can be achieved in the workplace, because actual workplace exposure scenarios, fit, maintenance and storage may differ substantially from the test conditions.The proper use of PPE is related to issues which form a part of a PPE-programme. Such a programme should be implemented in a company to ensure selection of proper PPE and information, training and instruction of employees how to wear PPE properly.Assigned protection factors (APFs) for different designs of respiratory protective devices (RPD) have been introduced to quantify effectiveness of RPD in the workplace. Similar APFs are proposed for dermal protection (gloves and clothing). In general biological monitoring studies show lower reduction of internal exposure than estimated by reduction of external exposure. Therefore, conservative estimates of protection by PPE, i.e. the lowest APFs, are proposed for risk assessment purposes if "proper use of proper functioning" PPE as part of a PPE-programme cannot be demonstrated.     

Interventions for the prevention and management of neck/upper extremity musculoskeletal conditions: a systematic review

Considered from medical, social or economic perspectives, the cost of musculoskeletal injuries experienced in the workplace is substantial, and there is a need to identify the most efficacious interventions for their effective prevention, management and rehabilitation. Previous reviews have highlighted the limited number of studies that focus on upper extremity intervention programmes. The aim of this study was to evaluate the findings of primary, secondary and/or tertiary intervention studies for neck/upper extremity conditions undertaken between 1999 and 2004 and to compare these results with those of previous reviews. Relevant studies were retrieved through the use of a systematic approach to literature searching and evaluated using a standardised tool. Evidence was then classified according to a "pattern of evidence" approach. Studies were categorised into subgroups depending on the type of intervention: mechanical exposure interventions; production systems/organisational culture interventions and modifier interventions. 31 intervention studies met the inclusion criteria. The findings provided evidence to support the use of some mechanical and modifier interventions as approaches for preventing and managing neck/upper extremity musculoskeletal conditions and fibromyalgia. Evidence to support the benefits of production systems/organisational culture interventions was found to be lacking. This review identified no single-dimensional or multi-dimensional strategy for intervention that was considered effective across occupational settings. There is limited information to support the establishment of evidence-based guidelines applicable to a number of industrial sectors.     

Efficacy of an E-mail intervention for the promotion of physical activity and nutrition behavior in the workplace context

PURPOSE: The purpose of this study was to evaluate a 12-week workplace e-mail intervention designed to promote physical activity and nutrition behavior. DESIGN: A pre- and post-test design was conducted to compare the effects of e-mail messages between intervention and control groups. SETTING: Five large workplaces in Alberta, Canada. SUBJECTS: Employees with access to a personal e-mail address (N = 2121) were randomly assigned to an intervention (n = 1566) or a control group (n = 555). INTERVENTION: Physical activity and nutrition messages were based on social-cognitive theories. The intervention group received one physical activity and one parallel nutrition message per week for 12 weeks. The control group received no weekly messages. MEASURES: Each participant completed self-report measures of physical activity and nutrition related to knowledge, attitudes, and behaviors 1 week before (time 1) and 1 week after (time 2) the intervention. RESULTS: The intervention group was more efficacious at time 2 on measures of self-efficacy, pros, cons, intentions, and behavior related to physical activity. This group also reported more favorable changes in practicing healthy eating, balancing food intake with activity level, cooking meals with techniques to reduce fat, and avoiding eating high-fat foods. Effect sizes for all significant differences were small. CONCLUSION: E-mail is a promising mode of delivery for promoting physical activity and nutrition in the workplace. Further theoretically driven studies are needed.     

Smoking intervention in the workplace: review and recommendations

Growing interest has been expressed by the business community concerning intervention against smoking in the workplace. As most adult smokers are unlikely to have access to smokers' clinics or other treatment facilities outside the workplace, the workplace itself could be an ideal location for the provision of treatment programs. If the interest of the business community can be translated into action, large populations of smokers would become accessible to workplace treatment programs. Despite this possibility, the potential of the workplace for smoking intervention remains largely unexplored. In this review, the main reasons for workplace smoking intervention are discussed, and the available evidence for the main strategies (prohibition, incentives, treatment, and multicomponent) is reviewed and critically evaluated. The current emphasis in treatment studies is still on physician counseling, and the quality of reported work uneven. Many published studies not intended as evaluations, and many of those which are, have severe procedural or methodological flaws. The particular problems of evaluating workplace studies are discussed and the current research position is summarized. Because the number of evaluative studies is small, the recommendations that can be based on them are fairly limited. In conclusion, it is argued that a body of well-controlled evaluations is needed before the unique characteristics of the workplace can be assessed and exploited in smoking interventions.     

Prevention of childhood injuries: evaluation of the Statewide Childhood Injury Prevention Program (SCIPP).

We evaluated the effectiveness of a community-based injury prevention program designed to reduce the incidence of burns, falls in the home, motor vehicle occupant injuries, and poisonings and suffocations among children ages 0-5 years. Between September 1980 and June 1982, we implemented five injury prevention projects concurrently in nine Massachusetts cities and town; five sites, matched on selected demographic characteristics, were control communities. An estimated 42 percent of households with children ages 0-5 years were exposed to one or more of the interventions over the two-year period in the nine communities. Participation in safety programs increased three-fold in the intervention communities and two-fold in the control communities. Safety knowledge and practices increased in both intervention and control communities. Households that reported participatory exposure to the interventions had higher safety knowledge and behavior scores than those that received other community exposure or no exposure to intervention activities. We found a distinct reduction in motor vehicle occupant injuries among children ages 0-5 years in the intervention compared with control communities, associated with participatory exposure of about 55 percent of households with children ages 0-5 years. We have no evidence that the coordinated intervention programs reduced the other target injuries--although exposure to prevention messages was associated with safety behaviors for burns and poisonings.     

Systematic Review of Intervention Practices for Depression in the Workplace

Design Systematic Review. Objective To determine which intervention approaches to manage depression in the workplace have been successful and yielded value for employers in developed economies. Data Sources We searched MEDLINE, EMBASE, CINAHL, Central, PsycINFO, and Business Source Premier up to June 2010 using search terms in four broad areas: work setting, depression, intervention, and work outcomes. Study Selection Two independent reviewers selected potential articles that met the following criteria: working age individuals with mild or moderate depression; interventions or programs that were workplace-based or could be implemented and/or facilitated by the employer; inclusion of a comparator group in the analysis; outcomes of prevention, management, and recurrences of work disability or sickness absence, and work functioning. Methods Two reviewers independently reviewed each article for quality and extracted data using standardised forms. Following guidelines from the GRADE Working Group, the quality of evidence addressing each outcome was graded as high, moderate, low, or very low on the basis of six criteria: study design, risk of bias, consistency, generalisability, data precision, and economic benefit. Using this information and following Cochrane Collaboration guidelines, the findings for each intervention were summarised and key messages were developed. Results We identified ten randomised trials and two non-randomised studies from various countries and jurisdictions that evaluated a wide range of intervention practices. The evidence was graded as ??very low?? for all outcomes identified. Therefore, no intervention could be recommended. Conclusions To date, there is insufficient quality of evidence to determine which interventions are effective and yield value to manage depression in the workplace.     

Exposure to a Community-Level HIV Prevention Intervention: Who Gets the Message

As part of the evaluation of a community-level HIV prevention program for women, this study examined predictors of exposure to print media and community outreach and assessed the relationship between exposure to the intervention and condom use behavior. Data from interviews with 479 women randomly selected from the intervention community in 1995 and 1996 were examined. Analysis of demographic and risk characteristics were conducted to identify predictors of exposure to the project's HIV prevention messages. Additionally, logistic regression analyses were conducted to examine the effects of intervention exposure on condom use, controlling for factors related to exposure. The results revealed that the print media campaign reached the largest number of women. However, women at highest risk did not have high rates of exposure to print media, but had greater exposure to outreach. Exposure to print media had an effect on increased communication with a main partner about condom use, but was not significantly related to condom use last time had sex. There were no significant main effects for exposure to outreach on condom use behavior. An important finding of this analysis was that each intervention strategy was successful in reaching a different portion of the target population and that exposure had differential effects on the condom use behavior of particular segments of the target population.     

Ergonomic methods for assessing exposure to risk factors for work-related musculoskeletal disorders

BACKGROUND: This review provides an overview of the range of methods that have been developed for the assessment of exposure to risk factors for work-related musculoskeletal disorders. METHODS: Relevant publications and material on exposure assessment techniques have been gathered for inclusion in this review. RESULTS: The methods have been categorized under three main headings: (1) self-reports from workers can be used to collect data on workplace exposure to both physical and psychosocial factors by using methods that include worker diaries, interviews and questionnaires; (2) observational methods that may be further subdivided between (a) simpler techniques developed for systematically recording workplace exposure that enable an observer to assess and record data on a number of factors using specifically designed pro-forma sheets for establishing priorities for workplace intervention; and (b) advanced techniques developed for the assessment of postural variation for highly dynamic activities that record data either on videotape or are computer analysed using dedicated software; (3) direct measurements using monitoring instruments that rely on sensors attached directly to the subject for the measurement of exposure variables at work. CONCLUSIONS: The choice between the methods available will depend upon the application concerned and the objectives of the study. General, observation-based assessments appear to provide the levels of costs, capacity, versatility, generality and exactness best matched to the needs of occupational safety and health practitioners (or those from related professions) who have limited time and resources at their disposal and need a basis for establishing priorities for intervention.     

Do Drug‐Free Workplace Programs Prevent Occupational Injuries? Evidence from Washington State

OBJECTIVE: To evaluate the effect of a publicly sponsored drug-free workplace program on reducing the risk of occupational injuries. DATA SOURCES: Workers' compensation claims data from the Washington State Department of Labor and Industries covering the period 1994 through 2000 and work-hours data reported by employers served as the data sources for the analysis. STUDY DESIGN: We used a pre-post design with a nonequivalent comparison group to assess the impact of the intervention on injury risk, measured in terms of differences in injury incidence rates. Two hundred and sixty-one companies that enrolled in the drug-free workplace program during the latter half of 1996 were compared with approximately 20,500 nonintervention companies. We tested autoregressive, integrated moving-average (ARIMA) models to assess the robustness of our findings. PRINCIPAL FINDINGS: The drug-free workplace intervention was associated (p < .05) with a statistically significant decrease in injury rates for three industry groups: construction, manufacturing, and services. It was associated (p < .05) with a reduction in the incidence rate of more serious injuries involving four or more days of lost work time for two industry groups: construction and services. The ARIMA analysis supported CONCLUSIONS: The drug-free workplace program we studied was associated with a selective, industry-specific preventive effect. The strongest evidence of an intervention effect was for the construction industry. Estimated net cost savings for this industry were positive though small in magnitude.     

健康促进对职业危害控制效果的研究

目的应用健康促进手段对职业健康危害因素进行干预,为今后有效地开展职业健康促进提供科学依据。方法选择某公司中接触健康有害因素的现场作业人员,对其实施综合性健康促进干预,对比干预前、后目标人群的职业卫生知识、认知情况,作业环境和职工健康状况的改善情况。结果干预后,作业者职业卫生知识知晓率由干预前的51.91%提高到了81.45%,但对岗位职业危害的认知情况仍然不高;作业环境的几种主要指标的达标率均接近90%;除听力损失外,反映健康状况的其他指标的达标率也绝大多数超过了97%。结论综合性的职业健康促进干预措施能够有效地控制作业环境中存在的职业健康危害因素,职业性紧张和岗位危害的防护应成为今后优先考虑的问题。     

Legal risks to employers who allow smoking in the workplace

There is mounting evidence that documents the dangers of exposure to secondhand smoke, including in the workplace. In states that permit workplace smoking, employers face significant legal risks from employees who are exposed to secondhand smoke on the job. Employers have been held liable for employee exposure to secondhand smoke in numerous cases, including those based on workers' compensation, state and federal disability law, and the duty to provide a safe workplace. Given this liability risk, employers should voluntarily adopt smoke-free workplace policies. Such policies do more than fulfill an employer's legal obligation to provide a safe workplace; they also reduce the risk of litigation, potentially reduce workers' compensation premiums, and protect employees from harm.     

Efficiency of five chemical protective clothing materials against nano and submicron aerosols when submitted to mechanical deformations

Due to their potential toxicity, the use of nanoparticles in the workplace is a growing concern. Some studies indicate that nanoparticles can penetrate the skin and lead to adverse health effects. Since chemical protective clothing is the last barrier to protect the skin, this study aims to better understand nanoparticle penetration behaviour in dermal protective clothing under mechanical deformation. For this purpose, five of the most common types of fabrics used in protective clothing, one woven and four nonwoven, were chosen and submitted to different simulated exposure conditions. They were tested against polydispersed NaCl aerosols having an electrical-mobility diameter between 14 and 400 nm. A bench-scale exposure setup and a sampling protocol was developed to measure the level of penetration of the aerosols through the material samples of disposable coveralls and lab coat, while subjecting them to mechanical deformations to simulate the conditions of usage in the workplace. Particle size distribution of the aerosol was determined upstream and downstream using a scanning mobility particle sizer (SMPS). The measured efficiencies demonstrated that the performances of nonwoven materials were similar. Three nonwovens had efficiencies above 99%, while the woven fabric was by far, the least effective. Moreover, the results established that mechanical deformations, as simulated for this study, did not have a significant effect on the fabrics' efficiencies.     

Simulation of nitrous oxide concentrations in operating and recovery rooms

A model was developed to predict nitrous oxide (N2O) concentrations in operating (OR) and recovery rooms. The model incorporates general ventilation characteristics, percentage recirculation and the rate at which N2O is emitted into the OR (emission) for the calculation of environmental exposure. A workplace study was carried out during which N2O concentrations were measured continuously and coupled to anaesthetic activities (type and duration), air-change rate and percentage of recirculated air. The data from this study were used to calculate N2O emission. Subsequently, the model was used to predict the effect of technical measures to reduce emissions on mean environmental exposure. After implementation of the control measures an intervention study was made to check whether the reduction in exposure was predicted by our simulation model. Subsequently the 'validated' simulation model was used: (i) to calculate the exposure for different percentages of recirculation and different air-change rates, and (ii) to estimate N2O levels in another situation, i.e. an operating room in an outpatients clinic. In short, our study shows how modelling can help both occupational hygiene and hospital management to control exposure to anaesthetic gases and to design or adapt ventilation systems of operating rooms and recovery rooms.     

Testing a Theory-Based Health Communication Program: A Replication of Go Sun Smart in Outdoor Winter Recreation

The epidemic of preventable skin cancer in the United States creates an urgent need for health communication campaigns to improve sun protection. Go Sun Smart (GSS), a theory-driven multichannel health communication campaign showed positive effects on sun safety behaviors of employees and guests in a randomized trial at high-altitude ski areas. In this article we report findings from the North American GSS campaign for guests at ski areas that comprosed the original control-group resorts, replicating the results of the original guest intervention. Results showed that after GSS was deployed, guests at the original control group ski areas increased sun protection and reported greater recall of sun safety messages. Conversely, GSS had no effect on sunburning attitudes or self-efficacy beliefs. Like the original GSS guest intervention, the present study found that greater exposure to GSS messages was associated with greater use of sunscreen, sunscreen lip balm, and face covering, but not gloves or overall sun protection. There was no evidence that GSS decreased sunburning or attitudes and self-efficacy beliefs regarding sun safety.     

Staff interactions: communicating with co-workers

The issue of staff attitudes toward their jobs has always been of vital importance, and the pressures of today's healthcare industry makes this issue even more critical. The role communication plays in developing positive attitudes towards one's workplace is immense. Both verbal and non-verbal communication can project an image of being cold, unfeeling, unprofessional and indifferent. These are not the messages anyone wants to receive! Humanistic verbal communications sends the messages that should be received by every staff person--messages of a warm, caring and concerned workplace for everyone.     

Media and community campaign effects on adult tobacco use in Texas

The present study reports on the effects on adult tobacco cessation of a comprehensive tobacco-use prevention and cessation program in the state of Texas. Differences in cessation rates across treatment conditions were measured by following a panel of 622 daily smokers, recruited from the original cross-sectional sample, from baseline to follow-up. The adult media campaign combined television, radio, newspaper and billboard advertisements featuring messages and outreach programs to help adults avoid or quit using tobacco products. The ads also promoted quitting assistance programs from the American Cancer Society Smokers' Quitline, a telephone counseling service. The cessation component of the intervention focused on increasing availability of and access to cessation counseling services and pharmacological therapy to reduce nicotine dependence. Both clinical and community-based cessation programs were offered. Treatment areas which combined cessation activities with high level media campaigns had a rate of smoking reduction that almost tripled rates in areas which received no services, and almost doubled rates in areas with media campaigns alone. Analyses of the dose of exposure to media messages about smoking cessation show greater exposure to television and radio messages in the areas where high level media was combined with community cessation activities than in the other areas. Results also show that exposure to media messages was related to processes of change in smoking cessation and that those processes were related to the quitting that was observed in the group receiving the most intensive campaigns.     

Gloves and dermal exposure to chemicals: proposals for evaluating workplace effectiveness

There are standardized laboratory tests for chemical protective gloves that provide estimates of breakthrough time and steady-state permeation flux. However, there is evidence to suggest that these tests may not be completely relevant to glove usage in the workplace. There is no consensus about how glove workplace effectiveness should be assessed, although a few studies have attempted to measure the effectiveness of chemical protective gloves. We have used a conceptual model of dermal exposure to help analyse how workers' skin may become exposed while wearing gloves, and propose a new glove workplace protection factor (PFgloves), which is based on the ratio of the estimated uptake of chemicals through the hands without gloves to the uptake through the hands while wearing protective gloves. Mathematical simulations demonstrate that glove protection factor is unlikely to be constant for a glove type, but will be strongly influenced by the work situation and the duration of the exposure. This has important consequences for the selection of protective gloves.