Jon Boyer

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.

Violence at the workplace increases the risk of musculoskeletal pain among nursing home workers

Background Despite the high prevalences of workplace physical violence and musculoskeletal symptoms among health care workers, very few studies have examined the relationship between these two phenomena. Methods We surveyed 920 clinical nursing home workers by questionnaire regarding musculoskeletal pain in the low back, shoulders, wrists or hands, and knees. Information was also collected on exposure to physical assaults at work during the preceding 3 months, other workplace safety features, physical workload and psychosocial work environment. Log-binomial regression was used to estimate the prevalence ratios (PR) with 95% CIs. Results Almost one-half of respondents reported being assaulted at least once during the preceding 3 months by a resident or residents visitor. The prevalence of low back pain increased from 40% among non-assaulted workers to 70% among those assaulted three or more times. The highest risk was found for widespread pain (three or more areas), with an adjusted PR of 2.7 (95% CI 1.8 to 3.9) for workers assaulted three or more times. Good workplace safety buffered the effects, so that violence increased the risk of most pains considerably less in a work environment perceived to be safe. Conclusions To our knowledge, this is the first study to show a dose–response association between physical assaults and musculoskeletal pain in a health care setting where violence is a frequent occurrence. This emphasises the need to address violence as a workplace hazard through practical measures for prevention as well as in future aetiological research on musculoskeletal disorders.

Use of O*NET as a Job Exposure Matrix: A Literature Review

BACKGROUND O*NET is a publicly available online database that describes occupational features across US job titles and that has been used to estimate workplace physical and psychosocial exposures and organizational characteristics. The aim of this review is to describe and evaluate the use of O*NET as a job exposure matrix. METHODS A review of the peer-reviewed published and gray literature was conducted. Twenty-eight studies were found that used O*NET to estimate work exposures related to health or safety outcomes. Each was systematically evaluated across eight main features. RESULTS Many health outcomes have been studied with O*NET estimates of job exposures. Some studies did not use conceptual definitions of exposure; few studies estimated convergent validity, most used predictive validity. Multilevel analysis was underutilized. CONCLUSION O*NET is worthy of exploration by the occupational health community, although its scientific value is still undetermined. More studies could eventually provide evidence of convergent validity. O*NET has the potential to allow examination of occupational risks that might have otherwise been ignored due to missing data or resource constraints on field data collection of job exposure information.

Inter-rater reliability of PATH observations for assessment of ergonomic risk factors in hospital work

This study examined the inter-rater reliability of expert observations of ergonomic risk factors by four analysts. Ten jobs were observed at a hospital using a newly expanded version of the PATH method (Buchholz et al. 1996), to which selected upper extremity exposures had been added. Two of the four raters simultaneously observed each worker onsite for a total of 443 observation pairs containing 18 categorical exposure items each. For most exposure items, kappa coefficients were 0.4 or higher. For some items, agreement was higher both for the jobs with less rapid hand activity and for the analysts with a higher level of ergonomic job analysis experience. These upper extremity exposures could be characterised reliably with real-time observation, given adequate experience and training of the observers. The revised version of PATH is applicable to the analysis of jobs where upper extremity musculoskeletal strain is of concern.

Health Behaviors and Overweight in Nursing Home Employees: Contribution of Workplace Stressors and Implications for Worksite Health Promotion.

Background. Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors. Methods. A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity. Results. Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity. Conclusions. Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health.

Description and analysis of hand forces in medicine cart pushing tasks.

The primary objectives of this study were to describe and analyze the hand force exertion patterns of experienced nursing home nurses and nursing students during dynamic medicine cart pushing tasks in Initial, Sustained, Turning, and Stopping motion phases. A 2 × 2 × 2 factorial experiment was conducted with 22 participants to estimate the effects of lane congestion, precision cart control, and floor surface on horizontal hand forces. Root mean squared (RMS) lane deviation patterns were also described to provide an indicator of cart handling difficulty across the different study conditions. Descriptive statistics revealed that nurses exerted greater mean hand force (10%) and made more (12%) lane deviation than students and that the highest two-hand forces of 147N were measured in the Turning phase on carpet. Strong correlations between work experience group, body mass, and BMI required that force data for nurses and students be collapsed in analytical models where no group differences existed. Predicted pushing forces on carpeted floor surface were significantly greater than on tile in Initial (14N), Sustained (14N) and Turning (18N), except in stopping where pulling forces were 37N lower. High lane congestion predicted significant peak force increases of 4N and 7N in Sustained and Turning, respectively, but decreased by 20N in Initial. High precision control led to significant decreases in two-hand forces that ranged from 4 to 20N across motion phases. Complex interactions among the experimental factors suggest that work environment (lane congestion and floor surface) and work demands (precision control) should be included in the evaluation of pushing tasks and considered prior to making renovations to nursing home environments.

Exposure Assessment of Musculoskeletal Disorder Risk Factors in Hospital Work: Inter-Rater Reliability of Path Observations

We examined the inter-rater reliability (IRR) of expert observations of ergonomic risk factors by four analysts. Ten jobs were observed at a hospital using a revision of the PATH method (Buchholz 1996). Two of four raters simultaneously observed each worker onsite. A total of 18 categorical exposure items were available for analysis. For most of the items, kappa coefficients were 0.4 or higher, showing that the IRR of the revised method was good. As predicted, agreement among observers was higher for the jobs with less rapid hand activity and for the analysts with more ergonomics and job analysis experience. The results show that the revised method can be reliably applicable to hospital work, and suggest that it can reasonably assess ergonomic exposure in any type of non-routine job across industries including healthcare industry.

Development of a Group-Based Ergonomic Assessment Strategy for Characterizing Physical Workload in Healthcare Workers

Musculoskeletal disorders of the back are a widespread problem in the healthcare sector and have been associated with trunk bending, twisting, and manual handling. The objective of this study was to conduct a group-based exposure assessment of trunk postures, loads, and work activities for use in epidemiology studies of back disorders in healthcare workers. All job titles in 4 healthcare facilities were assigned to a-priori ergonomic exposure groups to guide the sampling protocol. Ergonomic exposures were collected through direct observation of a population subset (n=180), in 94 job titles, at 90-second intervals, using a modification of the PATH method. A total of 23,071 direct observations were collected over 225 observation periods (1–8hrs). Exposures were analyzed by job groups and group exposures were ranked by their location relative to underlying distributions. A final set of 8 similar exposure groups were produced through combination of qualitative and quantitative methods. The semi-quantitative group ranks explained postural and load handling exposure profiles in nursing home and hospital workers.