Henk F. van der Molen

The Effectiveness of Interventions for Preventing Injuries in the Construction Industry A Systematic Review

BACKGROUND Occupational injury rates among construction workers are the highest among the major industries. A number of injury-prevention interventions have been proposed, yet the effectiveness of these is uncertain. Thus a systematic review evaluating the effectiveness of interventions for preventing occupational injuries among construction workers was conducted. METHODS Seven databases were searched, from the earliest available dates through June 2006, for published findings of injury prevention in construction studies. Acceptable study designs included RCTs; controlled before-after studies; and interrupted time series (ITS). Effect sizes of similar interventions were pooled into a meta-analysis in January 2007. RESULTS Of 7522 titles found, four ITS studies and one controlled ITS study met the inclusion criteria. The overall methodologic quality was low. No indications of publication bias were found. Findings from a safety-campaign study and a drug-free-workplace study indicated that both interventions significantly reduced the level and the trend of injuries. Three studies that evaluated legislation did not decrease the level (ES 0.69; 95% CI=-1.70, 3.09) and made the downward trend (ES 0.28; 95% CI=0.05, 0.51) of injuries less favorable. CONCLUSIONS Limited evidence was found for the effectiveness of a multifaceted safety campaign and a multifaceted drug program, but no evidence was found that legislation is effective to prevent nonfatal or fatal injuries in the construction industry.

Musculoskeletal disorders among construction workers: a one-year follow-up study

BackgroundWork-related musculoskeletal disorders (MSDs) are an important cause of functional impairments and disability among construction workers. An improved understanding of MSDs in different construction occupations is likely to be of value for selecting preventive measures. This study aimed to survey the prevalence of symptoms of MSDs, the work-relatedness of the symptoms and the problems experienced during work among two construction occupations: bricklayers and supervisors.MethodsWe randomly selected 750 bricklayers and 750 supervisors resident in the Netherlands in December 2009. This sample was surveyed by means of a baseline questionnaire and a follow-up questionnaire one year later. The participants were asked about complaints of the musculoskeletal system during the last six months, the perceived work-relatedness of the symptoms, the problems that occurred during work and the occupational tasks that were perceived as causes or aggravating factors of the MSD.ResultsBaseline response rate was 37%, follow-up response was 80%. The prevalence of MSDs among 267 bricklayers and 232 supervisors was 67% and 57%, respectively. Complaints of the back, knee and shoulder/upper arm were the most prevalent among both occupations. Irrespective of the body region, most of the bricklayers and supervisors reported that their complaints were work-related. Complaints of the back and elbow were the most often reported among the bricklayers during work, whereas lower arm/wrist and upper leg complaints were the most often reported among the supervisors. In both occupations, a majority of the participants perceived several occupational physical tasks and activities as causes or aggravating factors for their MSD. Recurrent complaints at follow-up were reported by both bricklayers (47% of the complaints) and supervisors (31% of the complaints). Participants in both occupations report that mainly back and knee complaints result in additional problems during work, at the time of follow-up.ConclusionsA substantial number of the bricklayers and the supervisors report musculoskeletal disorders, mainly back, knee and shoulder/upper arm complaints. The majority of the bricklayers and half of the supervisors believe that their complaints are work-related. Irrespective of occupation, participants with MSDs report substantial problems during work. Workplace intervention measures aimed at occupational physical tasks and activities seem justified for both occupations.

Effects of job rotation on musculoskeletal complaints and related work exposures: a systematic literature review

The aim of this systematic review was to summarise evidence on the effects of job rotation on musculoskeletal complaints, exposures related to musculoskeletal complaints and sustainable working life parameters. A total of 16 studies were included. No studies on sustainable working life parameters were found. The quality of the studies was assessed using a checklist; eight field studies and three laboratory studies of sufficient quality were used to summarise the following evidence: one field study showed positive results and one field study showed negative results for musculoskeletal complaints, two field studies showed positive results and two field studies showed inconsistent results for exposures, and two field studies showed inconsistent results for musculoskeletal complaints and exposures. Two laboratory studies showed inconsistent results and one laboratory study showed no changes for exposures. In conclusion, there is currently inconsistent evidence for positive or negative effects of job rotation on musculoskeletal complaints and exposures related to musculoskeletal complaints. Practitioners Summary: Currently, there is inconsistent evidence for recommending job rotation as a strategy for preventing musculoskeletal complaints. Exposures from all involved work activities and body regions should be identified and assessed first, to determine if job rotation provides increased exposure variation and/or beneficial changes in mean exposures related to musculoskeletal complaints.

Trends in incidence of occupational asthma, contact dermatitis, noise-induced hearing loss, carpal tunnel syndrome and upper limb musculoskeletal disorders in European countries from 2000 to 2012

Objectives The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries. Methods OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of ‘centres’, requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules. Results Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries. Conclusions This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods.

Physical Effects of New Devices for Bricklayers

Bricklaying is a physically demanding job. Bricklayers frequently flex their trunk to pick up bricks and mortar and position these in a wall. The experienced workload is highest working with bricks at 0 to 50 cm from the floor. In this study the effects of 2 devices that have proven to be feasible in practice are evaluated. The 50 cm raise due to the 2 devices is experienced as comfortable, the estimated lumbar compression force was reduced, and observations indicate likewise. It is discussed that the field experiments have many drawbacks. Nevertheless, based on this study in combination with other literature the improvements could be recommended.

Evaluation of methods to assess push/pull forces in a construction task

The objective of the present study was to determine the validity of methods to assess push/pull forces exerted in a construction task. Forces assessed using a hand-held digital force gauge were compared to those obtained using a highly accurate measuring frame. No significant differences were found between the methods, except for peak push forces, for which the forces assessed with the force gauge were significantly lower than those assessed with the measuring frame. When the construction task was reproduced close to the actual workplace by simulation against a fixed object using the force gauge, all exerted forces on the force gauge were significantly lower than those on the measuring frame, except for mean pull forces. When self-reports were compared to the exerted forces on the measuring frame, the construction workers overestimated the exerted push/pull forces by 50%. In conclusion, when applied for direct measurements, the force gauge can be used to validly assess push/pull forces at the workplace.

Annual incidence of occupational diseases in economic sectors in The Netherlands

Objective To report the annual incidence of occupational diseases (ODs) in economic sectors in The Netherlands. Methods In a 5-year prospective cohort study (2009–2013), occupational physicians were asked to participate in a sentinel surveillance system for OD notification. The inclusion criteria for participation were (1) covering a population of employees, (2) reporting the economic sectors and the size of their employee population and (3) willingness to report all diagnosed ODs. In this study, an OD was defined as a disease with a specific clinical diagnosis that was predominantly caused by work-related factors. The economic sectors (n=21) were defined according the NACE (Nomenclature des Activités Économiques dans la Communauté Européenne) classification. Results In a total working population of 514 590 employees, 1782 ODs were reported over 12 months in 2009. The estimated annual incidence for any OD was 346 (95% CI 330 to 362) per 100 000 worker-years. Of all the ODs, mental diseases were reported most frequently (41%), followed by musculoskeletal (39%), hearing (11%), infectious (4%), skin (3%), neurological (2%) and respiratory (2%) diseases. The four economic sectors with the highest annual incidences per 100 000 workers were construction (1127; 95% CI 1002 to 1253), mining and quarrying (888; 95% CI 110 to 1667), water and waste processing (832; 95% CI 518 to 1146) and transport and storage (608; 95% CI 526 to 690). Conclusion ODs are reported in all economic sectors in The Netherlands. Up to 91% of all ODs are mental, musculoskeletal and hearing diseases. Efforts to increase the effective assessment of ODs and compliance in reporting activities enhance the usability of incidence figures for the government, employers and workers.

The use of ergonomic measures and musculoskeletal complaints among carpenters and pavers in a 4.5-year follow-up study

The primary aim of this follow-up study was to evaluate the association between the use of ergonomic measures and musculoskeletal complaints among construction workers during an informational campaign on sector level. A questionnaire was sent twice to a cohort of 914 Dutch carpenters and pavers, once in 2000 and once in 2005. Relative risks (RR) were calculated for the regular use of ergonomic measures and regular or sustained lower back and shoulder pain among workers at baseline and 4.5 years follow-up. The response percentages were 78% (n = 469) for carpenters and 64% (n = 202) for pavers. Regular use of specific ergonomic measures varied from 15–66% at baseline to 17–66% at follow-up. Four specific ergonomic measures showed a statistically significant increase in usage. Regular or sustained lower back and shoulder complaints among carpenters decreased from 38 to 34% (p = 0.07) and 24 to 22% (p = 0.18), respectively. Among pavers, lower back (34%) and shoulder (17 to 18%) complaints remained the same or increased. Regular use of a height-adjustable working platform was associated with a lower likelihood of shoulder complaints at baseline (RR = 0.68; 95% CI: 0.46–<1.00) and low back complaints at follow-up (RR = 0.66; 95% CI: 0.50–0.88) among carpenters. Also regular use of aids for handling heavy loads was associated with no shoulder complaints at baseline RR = 0.62 (95% CI: 0.40–0.97) among carpenters. In conclusion, despite a large informational campaign, regular use of ergonomic measures remained low in a 4.5 year period. Regular use of the majority of ergonomic measures was associated, although not statistically significantly, with a lower likelihood of lower back or shoulder complaints. It is recommended to select, apply and monitor powerful implementation strategies to ensure the use of effective ergonomic measures at construction sites.

A prevention strategy for reducing gypsum bricklayers' physical workload and increasing productivity

Abstract The gypsum bricklayer builds interior walls in houses. The physiological, biomechanical and perceived workload of the gypsum bricklayer were measured and are very high. In two on-site situations the objective was to reduce the physical workload on gypsum bricklayers by means of mechanization, task enlargement and working with lighter bricks. The solutions did reduce the physical workload, improved the organization of the work and lowered construction costs. Nowadays, these primary preventive measures are accepted on a small scale in the construction industry. Relevance to industry Testing ergonomic solutions in daily building practice is necessary for preventive strategies in specific professions. This project shows that all working activities should be studied intensively to identify ways of reducing the physical workload. Preventive measures will be enhanced by having some understanding of the financial implications.

Evidence-based exposure criteria for work- related musculoskeletal disorders as a tool to assess physical job demands

Despite worldwide attention, musculoskeletal disorders (MSDs) remain a substantial concern at work. To support ergonomists to assess the work-related risk factors for MSDs, several instruments are available. Unfortunately, many of these instruments are not supported by evidence-based exposure criteria for particular MSDs. For effective prevention of MSDs, it is important to know to what extent work-related risk factors are present in the work situation. The Netherlands Center for Occupational Diseases (NCOD) develops evidence-based criteria documents for the assessment of work-related MSDs. The exposure criteria of these documents can be used on a group level to support ergonomists in their assessment of the physical job demands that are associated with work-related MSDs. At the moment the NCOD has exposure criteria for the assessment of 22 work-related MSDs, for instance on the work-relatedness of upper extremity disorders, non-specific low back pain or patellar tendinopathy. The use of these exposure criteria enables ergonomist to better assess the work-related risks of MSDs as a starting point for effective prevention.