J.W.J. van der Gulden

Work related risk factors for musculoskeletal complaints in the nursing profession : results of a questionnaire survey

OBJECTIVES: To determine the prevalence of musculoskeletal complaints of the back, arms or neck, and legs among nurses, and to investigate the relation between these complaints and various work related and personal variables. METHODS: A questionnaire survey was carried out in four nursing homes in The Netherlands. RESULTS: The response was 95% and resulted in 846 completed questionnaires. It was found that a large proportion of the subjects regularly had back complaints (36%) but also had arm or neck (30%) and leg complaints (16%). Almost all respondents (89%) considered nursing work as physically strenuous. Most of them complained of working under time pressure (69%), increased work pressure (70%), and having no opportunity to take a break from the work (70%). The physical variables which seem to trouble the subjects most were lifting (65%), working in awkward postures (47%), and stooping (34%). Moreover, 53% of the subjects responded that the ergonomic lay out of the ward was disagreeable. Most of the work related variables under study seemed to be associated with musculoskeletal complaints. For all types of complaints the strongest associations were found with having to lift heavy loads. Apart from physical stress various aspects of work pressure showed strong associations with the occurrence of musculoskeletal complaints. The variables on the ergonomy of the ward showed less clear associations with musculoskeletal complaints than were found for physical stress and work pressure. CONCLUSIONS: From these results it may be concluded that future research of health risks of nursing work should have a wider focus than the relation between physical workload and low back pain.

A simple method to evaluate the reliability of OWAS observations

Slides showing nurses in different working postures were used to determine the reliability of OWAS observations. Each slide could be looked at for 3 seconds, while a new slide was shown every 30 seconds to resemble the normal practice of observation. Two observers twice scored a series of slides, some of them being identical at both viewings. To reduce effects of recall there was a time interval of 4 weeks or more between the two viewings and the slides were in a different order the second time. Different series were used to evaluate inter- and intra-observer reliability. The OWAS scores of corresponding slides were compared. In almost all comparisons percentages of agreement over 85% and kappas over 0.6 were found, which is considered as good agreement. The procedure described seems to be a useful and simple technique to determine such reliability.

Longitudinal changes in lung function associated with aspects of swine confinement exposure.

Several aspects of swine-confinement farming appear to be leading to adverse respiratory effects. This study was set up in a longitudinal design to study the association between certain characteristics of farms or the way they are run and a decline in lung function. A cohort of 171 pig farmers was observed for 3 years. Lung function was measured. Exposure to farm characteristics was determined at the start of the observation period, using data from standardized farm surveys and from diaries kept by the participants. Mean decline in lung function was 73 mL/year for forced expiratory volume in 1 second (FEV1) and 55 mL/year for forced vital capacity (FVC). A longitudinal decline in FEV1 was significantly associated with the use of quaternary ammonium compounds as disinfectants (an additional 43 mL/year) and also with the use of an automated dry feeding system (an additional 28 mL/year). The association with the use of wood shavings as bedding material was not statistically significant. The impact of these characteristics in a longitudinal study provides stronger evidence for causal inference than that shown in previous cross-sectional designs. This may be useful in promoting preventive measures.

Metal workers and repairmen at risk for prostate cancer: A review

BACKGROUND The objective is to summarize the results of studies of prostate cancer risk among metal workers, mechanics, and repairmen in order to evaluate the magnitude of risk and to investigate the role of specific work-related hazards in the development of this disease. METHODS Review of literature. RESULTS In most of the studies reviewed, a slight excess risk of prostate cancer incidence or mortality was observed among metal workers and repairmen. It is as yet unclear, however, whether this excess risk is caused by particular occupational exposures or by risk factors in personal life style (e.g., dietary habits). Hardest evidence is found of a relationship to exist between the use of cutting oils or other metal-work liquids and prostate cancer risk. CONCLUSIONS It would appear that metal workers, mechanics, and repairmen run a slightly elevated risk of prostate cancer. However, the actual risk factors are still unknown. Prostate 30:107–116, 1997.

“My Lung Disease Won’t Go Away, it’s There to Stay”: Profiles of Adaptation to Functional Limitations in Workers with Asthma and COPD

Purpose Earlier research has shown that adaptation (i.e., the way in which employees cope with limitations resulting from their disease) is associated with sick leave. Our aim was to investigate signs of adequate or inadequate adaptation in employees with asthma and COPD. Methods A Q-methodological study was carried out among 34 workers with asthma or COPD. Results Four adaptation profiles were distinguished: the eager, the adjusted, the cautious, and the worried workers. The adaptation profiles provide insight into the different ways in which workers with asthma and COPD cope with their illness at work. Conclusions The adaptation profiles serve as a starting point for the design of appropriate (occupational) care. The eager workers experience little difficulties at work; the cautious workers may need assistance in learning how to accept their disease; the worried workers need reassurance, and may need reactivation; the adjusted workers deserve extra attention, and, when necessary, advice on how to live with their asthma or COPD.

Age as a moderator in the relationship between work-related characteristics, job dissatisfaction and need for recovery

Job dissatisfaction and need for recovery are associated with voluntary turnover, absenteeism and diminished health. In the light of encouraging working longer, this study investigated whether the relationships between various work characteristics and job dissatisfaction and need for recovery are dependent on age. Cross-sectional questionnaire data from 591 university employees were divided into four age groups: < 36, 36–44, 45–54 and ≥ 55 years. Multivariate regression analyses were used, including interaction variables to detect a moderating effect of age group. Limited age group effects were found: only the association of Feedback with job dissatisfaction and Task variety with need for recovery were influenced by age group. The salience of specific work characteristics within the age groups varied: for job dissatisfaction, Task variety ( < 55) and Changes in tasks ( ≥ 55) were most important. For need for recovery, this applied to Autonomy ( < 36) and Workload ( ≥ 45). To encourage working longer, age-specific measures could be considered, in addition to individual measures, to respond to individual needs. Practitioner summary: Demographic changes increase the importance to stimulate working longer. Using questionnaire data, we investigated the relationship between work characteristics, job dissatisfaction and need for recovery in four age groups. Although the moderating effect of age group was rather limited, the salience of specific work characteristics within the age groups varied.

Reproductive hazards related to perchloroethylene

SummaryThe literature of perchloroethylene (PER) was scrutinized to find answers to the following questions: (1) is an effect of PER on reproduction to be expected, and (2) if so, has such an effect actually been shown in animal experiments and/or in epidemiological studies? From this review it can be concluded that the first question should be answered in the affirmative, considering the various mechanisms capable of leading to defects in the reproductive processes and the information about how PER can interact (and in fact does interact) with these mechanisms. The few studies in which the effects of PER exposure on reproductive outcome have been studied are, however, not very conclusive. Some suggest an effect, others do not. In view of the incompleteness of the experimental results and the methodological shortcomings especially of the epidemiological studies, there is a need for a suitably designed epidemiological investigation on the reproductive consequences of exposure to PER. In order to avoid the methodological problems of the above-mentioned studies, the design should be a prospective one.

Elaboration of the contextual factors of the ICF for Occupational Health Care

BACKGROUND Many work-related items are not included in the current classification of environmental factors from the International Classification of Functioning, Disability and Health (ICF). Furthermore, personal factors are not classified and the ICF only provides a very limited list of examples. These facts make the ICF less useful for occupational health care and for research in the field of occupation and health. OBJECTIVE The objective of this discussion paper is to introduce an elaboration of contextual factors, focussing on factors that influence work participation. METHODS During the last 12 years, we developed two concept lists from the bottom up. These lists are based on our experiences in teaching and research, suggestions from students and other researchers, and factors found in the literature. In the fall of 2015 a scoping literature review was done to check for missing factors in these two concept lists. RESULTS An elaboration of contextual factors, consisting of a list of work-related environmental factors and a list of personal factors. CONCLUSIONS Important contextual factors that influence work participation are identified. Researchers, teachers, students, occupational and insurance physicians, allied health care professionals, employers, employees, and policy makers are invited to use the elaboration and to make suggestions for improvement. The elaboration and the suggestions received can be used in the ICF revision process. The development of an ICF ontology must be given priority, to give room to this elaboration, which will increase the applicability of the ICF and enable mapping with other terminologies and classifications.

Prevention of musculoskeletal complaints in nursing: Aims, approach and content of an ergonomic-educational programme

In 1992 a comprehensive health-promotion project was initiated in seven nursing-homes in the Netherlands. This project was designed to implement an ergonomic-educational programme, with the intention of reducing physical workload and to bring about safe working in order to prevent work-related musculoskeletal complaints. After a period of external support, employees of the nursing-homes should be able to proceed with the programme independently. In this paper the content of the programme and its underlying strategies and theories are described. So far, the programme has got off to a good start in all the nursing-homes. Positive effects of the programme could be demonstrated and guidelines and protocols for safe working were introduced. However, it is as yet too early for definitive conclusions to be drawn regarding the aspect of continuity.

Validity of self reported workload.

EDITOR—Recently, Houtman et al published the results of an interesting study on workstress and physical work load which was based on self reported data gathered from employers and from a sample of their employees. It was found that the employers recognised risk factors for both physical load and stress, but that they reported considerably fewer problems than their employees did. This contrast raised the question whether the employers underestimated the problems or whether the employees tended to exaggerate them. Houtman et al concluded that the self reports of employees seem to be the more valid estimations of work related risks, arguing that there is a substantial body of empirical evidence that such data have considerable prognostic value in predicting adverse health eVects. It is not surprising that employers and employees give diVerent opinions of the same situation. The employer’s estimation of the workload in a specific function is based on his judgement of the load a capable worker will experience on an average workday. Even when this is a valid and objective estimation of workload, several workers will perceive a higher load as a result of their personal style of working, for instance, due to perfectionism, uncertainty, or inexperience. Prevalent health complaints may also increase the perceived workload and the reporting of hindrance: subjective physical load will be higher when a person has low back pain. Besides, there seems to be a “spillover” between the domains of work and non-work. The conditions and demands outside work aVect the perceived physical load and pressure on time: when starting a shift feeling fatigued by activities in leisure time, workload will be perceived as higher. An employer is unable (and probably unwilling) to take the eVects of such subjective and personal influences into account; for the individual employee, however, it is (almost) impossible to appreciate them as such. Bearing in mind the spillover eVect and the additional sources of bias in self reported physical load and workstress it is strongly recommended that both risk factors at work and during leisure time are measured in future research based on self reports. Studies in which this has been done—very rare so far—show that this is a promising approach. 3