Musculoskeletal complaints in the Netherlands in relation to age, gender and physically demanding work

Objectives: This cross-sectional study was performed in order to elucidate the relationship of musculoskeletal complaints with age, gender and physically demanding work in the Netherlands. Methods: Questionnaire data of male (n=36 756) and female (n=7730) employees, gathered as part of periodical occupational health surveys among active workers in the Netherlands, were stratified for age, gender, and type of work demands. For each stratified group prevalence rates (PR) were calculated for complaints of the back, neck, upper and lower extremities. Moreover, prevalence rate differences (PRD) were estimated as an absolute effect measure of exposure to various types of physical work demands, with active employees in mentally demanding work acting as a reference population. Results: Musculoskeletal complaints among workers in physically demanding occupations were found to increase with age for both sexes. For several complaints, substantially higher rates were reported for women than for men, with a relatively high number of complaints observed among the older female workers (around 40% for complaints of back, upper and lower extremities). Significant PRDs were present in particular for employees in heavy physically demanding occupations and in jobs with mixed mental and physical work demands. Conclusions: With the ageing of the workforce in mind, these findings stress the need for implementation of preventive measures. Special attention towards the susceptible group of female employees, the elderly age groups in particular, seems justified. In order to clarify the combined effects of age and physical work demands on musculoskeletal complaints, additional studies are required. Received: 11 November 1996 / Accepted: 7 March 1997     

Health complaints and work conditions among lacquerers in the Danish furniture industry

In the present work, morbidity rates were based upon 418 replies to postal inquiries sent to 478 members of the carpenters/cabinet makers trade union in the Arhus area of Denmark. Lacquerers, when compared with former lacquerers and non-lacquerers, have an excess of neurophysiological symptoms and symptoms from the respiratory tract. The statistical association between exposure to lacquers and lung symptoms persists after checking for differences in age, smoking habits, and exposure to dust. Organic solvents are an important component of lacquers. Far too little is yet known of solvents' long-term effects on the human body. Most of our present knowledge concerns the short-term toxic effects on the nervous system. This study further points out a relation between lung symptoms and exposure to organic solvents, and it is suggested that further research into this association must be carried out.     

Repeated survey on changes in musculoskeletal complaints relative to age and work demands.

OBJECTIVES: To examine changes in musculoskeletal complaints over four years in groups of employees relative to age and work demands. METHODS: Repeated questionnaire data of male employees in heavy physical work (exposed group, n = 7324) and mental work (control group, n = 4686), stratified for age (20-9, 30-9, 40-9, 50-9), were analysed. For each employee, data on the occurrence of musculoskeletal complaints from two surveys with a mean interval of around four years were available. Changes in prevalences over the follow up interval were analysed. Proportions of new, recovered, and chronic cases as well as those free of complaints at both surveys were studied. RESULTS: For most complaints, there were significantly greater increases in prevalences in the exposed group compared with the control group over the follow up interval particularly within the group aged 40-9 for back, neck, and several sites of the upper and lower limbs. The 20-9 year age group also had significantly greater changes for several musculoskeletal complaints. Within the oldest age group (50-9) exposure to heavy physical work demands only affected changes in prevalences of neck and upper arm complaints. After four years in the cohort free of complaints at the start of the follow up the group aged 40-9 had the highest prevalence of complaints of the back, neck, and the upper and lower limbs. CONCLUSIONS: Middle aged and younger employees develop musculoskeletal complaints as a result of exposure to heavy physical work. In the oldest age group health related selection seems to mask the occupational health risks under study. To prevent the expected increase in musculoskeletal disorders and related work disability in our aging workforce, preventive measures should be taken at all stages of a working life.     

Hospital injury rates in relation to socioeconomic status and working conditions

Objectives

To describe the risk of work injury by socioeconomic status (SES) in hospital workers, and to assess whether SES gradient in injury risk is explained by differences in psychosocial, ergonomic or organisational factors at work.

Methods

Workforce rosters and Occupational Safety and Health Administration injury logs for a 5‐year period were obtained from two hospitals in Massachusetts. Job titles were classified into five SES strata on the basis of educational requirements and responsibilities: administrators, professionals, semiprofessionals, skilled and semiskilled workers. 13 selected psychosocial, ergonomic and organisational exposures were assigned to the hospital jobs through the national O*NET database. Rates of injury were analysed as frequency records using the Poisson regression, with job title as the unit of analysis. The risk of injury was modelled using SES alone, each exposure variable alone and then each exposure variable in combination with SES.

Results

An overall annual injury rate of 7.2 per 100 full‐time workers was estimated for the two hospitals combined. All SES strata except professionals showed a significant excess risk of injury compared with the highest SES category (administrators); the risk was highest among semiskilled workers (RR 5.3, p<0.001), followed by nurses (RR 3.7, p<0.001), semiprofessionals (RR 2.9, p = 0.006) and skilled workers (RR 2.6, p = 0.01). The risk of injury was significantly associated with each exposure considered except pause frequency. When workplace exposures were introduced in the regression model together with SES, four remained significant predictors of the risk of injury (decision latitude, supervisor support, force exertion and temperature extremes), whereas the RR related to SES was strongly reduced in all strata, except professionals.

Conclusions

A strong gradient in the risk of injury by SES was reported in a sample population of hospital workers, which was greatly attenuated by adjusting for psychosocial and ergonomic workplace exposures, indicating that a large proportion of that gradient can be explained by differences in working conditions.Main indicators of socioeconomic status (SES) include education, income and occupational class (position in hierarchy).¹ These variables tend to be highly correlated empirically and there is little consensus on which indicator would represent a more valid measure of SES.^2,3Two main theoretical approaches are present in the sociological literature, one considering social stratification due to inequalities in resources distribution and the other due to inequalities in power distribution. The first one identifies social status with social prestige, which would be best described by the access individuals have to limited resources in society, such as goods, services and knowledge.¹ Researchers adopting this theoretical model have mainly used educational attainment or social prestige associated with occupation as measures of SES, because of their direct or indirect influence on access to all these types of resources. According to the second approach, the social status of individuals is best represented by their economic and political power in society, which would be the actual determinant of the distribution of resources. In this view, power is intended as control over the means of production, investments, decision making, other people''s work and one''s own work.⁴ The SES indicator mostly used by this line of research is occupational social class, constructed by reclassifying occupations on the basis of the different aspects of control over work.Although educational level and occupational class are in general strongly correlated, some studies have found them to exert independent effects on mortality and morbidity in multivariate analyses,^2,5,6 suggesting that using either SES classification alone probably results in some misclassification of the social position of individuals. Other authors have stressed the importance of developing more complete SES indicators, which should include different social features, such as social network, income and wealth, apart from occupation and education.^3,7,8Occurrence of injury at work is higher in those with lower education^9,10,11 and lower occupational class.¹² This inverse relationship has been attributed largely to the fact that people in higher SES strata are mainly employed in jobs with less hazardous working conditions. Many of the known risk factors for occupational injury are in fact predominant in lower status jobs; these include ergonomic exposures such as high physical workload, lifting and bending,^11,13,14,15 psychosocial,^10,16 and organisational features such as shiftwork, understaffing, overcrowding, work pressure, overtime level, safety climate and subcontracted work.^{10,17,18,19,20}However, it has also been suggested that lower education could act as an independent risk factor, through lower risk perception, which could lead to unsafe work practices,^21,22 or through less access to information on hazardous jobs.²³ Other individual risk factors, not apparently related to the workplace, include exercise level,^24,25 marital status,¹⁸ smoking,^24,26 family conflicts,¹⁸ stressful life events²⁷ and daily hassles.²⁸ Although some of these may also show a socioeconomic gradient, it is not clear that they exercise causal effects on workplace injury that are independent of occupational conditions.The healthcare sector is one of the industries in the US at highest risk, with yearly rates of 9.7 recordable injury and illness cases per 100 workers in hospitals and 12.6 in nursing homes.²⁹ There were almost 14 million healthcare workers in 2003, representing nearly 10% of the US working population, with a substantial proportion of women (more than 75% of the workers) and racial/ethnic minorities (30% in the US).³⁰ Of these, almost six million were employed in hospitals.³⁰ The wide range of jobs, such as nurses, aides, laundry and food workers, health technicians, clerks, administrators, doctors and clinical scientists, involve very different socioeconomic positions and working conditions. This highly diverse workforce offers an opportunity, at least in principle, to disentangle the respective influences of SES, working conditions and demographic characteristics on injury rates. For this purpose, a new SES classification specific for the healthcare industry, which was explicitly based on power distribution—namely, the responsibility level typical of each job title, but also included education as a prestige‐based measure was developed.Therefore, the objectives of this study were:

• to evaluate the predictive value of SES on the risk of Occupational Safety & Health Administration (OSHA)‐recordable workplace injuries in a sample of the Massachusetts hospital workforce and
• to assess whether any differences in the risk of injury by SES could be explained by psychosocial, physical or organisational factors at work.

     

Comparing working conditions and physical and psychological health complaints in four occupational groups working in female-dominated workplaces

Background  

Dominant theories of working conditions and their effects on poor employee health have been criticized for failing to consider how psychosocial factors interact and how such relationships may differ across occupational groups.     

Health,work and working conditions: a review of the European economic literature

Economists have traditionally been very cautious when studying the interaction between employment and health because of the two-way causal relationship between these two variables: health status influences the probability of being employed and, at the same time, working affects the health status. Because these two variables are determined simultaneously, researchers control endogeneity skews (e.g., reverse causality, omitted variables) when conducting empirical analysis. With these caveats in mind, the literature finds that a favourable work environment and high job security lead to better health conditions. Being employed with appropriate working conditions plays a protective role on physical health and psychiatric disorders. By contrast, non-employment and retirement are generally worse for mental health than employment, and overemployment has a negative effect on health. These findings stress the importance of employment and of adequate working conditions for the health of workers. In this context, it is a concern that a significant proportion of European workers (29 %) would like to work fewer hours because unwanted long hours are likely to signal a poor level of job satisfaction and inadequate working conditions, with detrimental effects on health. Thus, in Europe, labour-market policy has increasingly paid attention to job sustainability and job satisfaction. The literature clearly invites employers to take better account of the worker preferences when setting the number of hours worked. Overall, a specific “flexicurity” (combination of high employment protection, job satisfaction and active labour-market policies) is likely to have a positive effect on health.     

Gastrointestinal complaints in relation to dietary intake in triathletes.

This study examined the relationship between gastrointestinal (GI) symptoms and dietary intake in triathletes. Fifty-five male triathletes (age 31 +/- 6 yrs) were surveyed regarding the most recently completed half Iron Man triathlon. Questions were asked regarding GI symptoms and dietary intake. Fifty-two percent complained of eructation and 48% of flatulence. Other symptoms were abdominal bloating, vomiting urge, vomiting, nausea, stomachache, intestinal cramps, and diarrhea. More symptoms occurred while running than at other times. All individuals who had eaten within 30 min of the start vomited while swimming. Fat and protein intake was greater in those who vomited or had the urge to vomit than in those without these symptoms. Of the former, 93% had consumed a hypertonic beverage. Forty percent of those who drank a hypertonic beverage and only 11% of those who drank an iso- or hypotonic beverage had severe complaints. Four of five individuals with stomachache had consumed a strongly hypertonic beverage. All subjects with intestinal cramps had eaten fiber-rich foods in the prerace meal; only 10% of those without cramps had done so.     

Health complaints in relation to quality of swimming water in participants of a triathlon]

Participants in a triathlon in Alphen aan den Rijn, the Netherlands, reported gastrointestinal symptoms to the local health authority. A study was performed to establish the number of complaints and the relation with the microbiological water quality at the surface water swimming site, which met current standards. An epidemiological survey was carried out with a questionnaire among 629 participants, with non-participating relatives as controls. Faecal samples of patients and water samples were investigated by conventional methods. 439 participants and 217 controls completed the questionnaire. 140 participants had at least one gastro-intestinal symptom and 28 (6.4%) had highly credible gastroenteritis. Participants had an odds ratio for gastro-enteritis of 14.7 (95% CI: 2.39-604.45). Electron microscopic examination in six of 12 patients showed viruses able to cause such symptoms. Water samples showed considerable faecal pollution at the time of the triathlon (geometric mean counts: thermotolerant coliforms 725/100 ml; faecal streptococci 23/100 ml). The most likely source is the effluent discharge of the nearby waste water treatment plant. A surface water swimming site meeting current standards does not exclude health complaints among tri-athletes.     

Deficiencies and resources of working population in relation to age: a multidisciplinary approach

The aging of the population as a whole and the later age at which young people start work are increasing the percentage of older employees. In situations where the working conditions are highly demanding, as in shiftwork, time-pressure jobs, and adaptation to modern technology or skill diversification, this demographic trend may cause serious problems. The way in which job constraints and demands are withstood at various ages should be considered in relation to health, which is often, whether implicitly or explicitly, a selection criterion in the work place. The connection between work and health can rarely be described by a single causal relationship and requires specific epidemiological methods. Moreover, a health problem linked to age can have a feedback effect on the manner in which a job is performed. While these problems do indeed arise in the areas of work and health, they are nonetheless usually symptoms of modifications that have taken place in the work activity itself. The ergonomic approach nevertheless allows us to improve our understanding of changes in work behavior as age increases, as experience is gained, and as skills are acquired. Men and women on the job are not passive spectators of the good or poor fit between the characteristics of their jobs and their own functional state. Consciously or unconsciously, they modify their operating modes (movements, work pace, posture, etc.), reduce their effort level in some subtasks, make more plans to avoid emergency situations, check the outcome of their actions so as to reduce errors that would be costly to correct, and adjust the distribution of tasks in cooperative and collective work situations. But these strategies can only be implemented if the work conditions and organization foster and promote them.