Monika A. Rieger

Musculoskeletal symptoms of the upper extremities and the neck: A cross-sectional study on prevalence and symptom-predicting factors at visual display terminal (VDT) workstations

BackgroundThe aim of this study was to determine the prevalence and the predictors of musculoskeletal symptoms in the upper extremities and neck at visual display terminal (VDT) workstations.MethodsIn a cross-sectional study 1,065 employees working at VDT > 1 h/d completed a standardised questionnaire. Workstation conditions were documented in a standardised checklist, and a subgroup of 82 employees underwent a physical examination.ResultsUsing the Nordic Questionnaire, the 12-month prevalence of symptoms of the neck, shoulder region, hand/wrist, or elbow/lower arm was 55%, 38%, 21%, and 15% respectively. The duration of VDT work had a significant impact on the frequency of neck symptoms in employees performing such work > 6 h/d.ConclusionWith regard to musculoskeletal symptoms of the upper extremities, preventive measures at VDT workstations should be focused on neck and shoulder symptoms (e.g. ergonomic measures, breaks to avoid sitting over long periods).

Individual and occupational risk factors for knee osteoarthritis: results of a case-control study in Germany

IntroductionA number of occupational risk factors are discussed in relation to the development and progress of knee joint diseases (for example, working in a kneeling or squatting posture, lifting and carrying heavy weights). Besides the occupational factors, a number of individual risk factors are important. The distinction between work-related and other factors is crucial in assessing the risk and in deriving preventive measures in occupational health.MethodsIn a case-control study, patients with and without symptomatic knee osteoarthritis (OA) were questioned by means of a standardised questionnaire complemented by a semi-standardised interview. Controls were matched and assigned to the cases by gender and age. Conditional logistic regression was used in analysing data.ResultsIn total, 739 cases and 571 controls were included in the study. In women and men, several individual and occupational predictors for knee OA could be described: obesity (odds ratio (OR) up to 17.65 in women and up to 12.56 in men); kneeling/squatting (women, OR 2.52 (>8,934 hours/life); men, 2.16 (574 to 12,244 hours/life), 2.47 (>12,244 hours/life)); genetic predisposition (women, OR 2.17; men, OR 2.37); and sports with a risk of unapparent trauma (women, OR 2.47 (≥1,440 hours/life); men, 2.58 (≥3,232 hours/life)). In women, malalignment of the knee (OR 11.54), pain in the knee already in childhood (OR 2.08), and the daily lifting and carrying of loads (≥1,088 tons/life, OR 2.13) were related to an increased OR; sitting and smoking led to a reduced OR.ConclusionsThe results support a dose-response relationship between kneeling/squatting and symptomatic knee OA in men and, for the first time, in women. The results concerning general and occupational predictors for knee OA reflect the findings from the literature quite well. Yet occupational risks such as jumping or climbing stairs/ladders, as discussed in the literature, did not correlate with symptomatic knee OA in the present study. With regards to occupational health, prevention measures should focus on the reduction of kneeling activities and the lifting and carrying of loads as well as general risk factors, most notably the reduction of obesity. More intervention studies of the effectiveness of tools and working methods for reducing knee straining activities are needed.

Cooperation between general practitioners and occupational health physicians in Germany: how can it be optimised? A qualitative study

PurposeGeneral practitioners (GPs) and occupational health physicians (OPs) have several overlapping work fields, such as important functions in prevention, rehabilitation and reintegration into the workplace. In Germany, however, cooperation between GP and OP is often lacking or suboptimal. In this article, we analysed the suggestions for optimisation of cooperation.MethodsThree focus groups were interviewed: GP, OP and medical doctors working in both fields. A qualitative content analysis was performed.ResultsCategories of suggestions could be assigned to five issues: the “Systemic View” concerning the state and/or employer (e.g. the system of remuneration for GPs), “Inter-collegial Contact” (e.g. fostering “friendly exchanges” between both groups), “Medical Education” (e.g. introducing joint quality circles), “Contents of both Specialities” (e.g. necessity of communicating respective contents and competences), and “Patient-centred Care” (e.g. reintegration into workplace after longer periods of illness). The optimisation of cooperation was considered necessary by the OPs, whereas its necessity was sometimes questioned in the GPs’ group.ConclusionIn many aspects, the present data agree with results of studies from other countries addressing the cooperation between GPs and OPs and/or other specialists. Many suggestions obtained in this study are practical and could be implemented into daily routine. Future quantitative research is required to better assess the relative weight of the suggestions presented here.

The Key Indicator Method for Manual Handling Operations (KIM-MHO) - evaluation of a new method for the assessment of working conditions within a cross-sectional study

BackgroundUpper extremity musculoskeletal symptoms and disorders are common in the working population. The economic and social impact of such disorders is considerable. Long-time, dynamic repetitive exposure of the hand-arm system during manual handling operations (MHO) alone or in combination with static and postural effort are recognised as causes of musculoskeletal symptoms and disorders. The assessment of these manual work tasks is crucial to estimate health risks of exposed employees. For these work tasks, a new method for the assessment of the working conditions was developed by the Federal Institute for Occupational Safety and Health (BAuA) and released as a draft in the year 2007. The draft of the so-called Key Indicator Method for Manual Handling Operations (KIM-MHO) was developed in analogy with the existing KIM for Lifting/Holding/Carrying (KIM-LHC) and Pulling/Pushing (KIM-PP) of loads. The KIM-MHO is designed to fill the gap existing in risk assessment of manual work processes, since the existing KIMs deal only with manual handling of loads.This research project focused on the following:- Examination of the validity of workplace assessment with the KIM-MHO comparing expert ratings with the results of the observations.- Examination of the objectivity of workplace assessment with the KIM-MHO applied by different examiners.- Examination of the criterion validity of the risk assessment provided by KIM-MHO with respect to the association between exposure and the occurrence and prevalence of health related outcomes.Methods/DesignTo determine the objectivity and validity of workplace assessment, the KIM-MHO is applied by occupational health and safety officers at different workplaces involving manual handling operations.To determine the criterion validity of risk assessment, a survey of employees at different workplaces takes place with standardised questionnaires and interviews about symptoms in the neck and upper extremities. In addition, physical examinations of these employees following a standardised medical diagnostic procedure are also carried out.DiscussionThis research project will provide scientific evaluation of the new KIM-MHO and, if necessary, indicate areas for modification to improve this new method for assessment of the health risk of manual handling operations at diverse workplaces.

Developing a Nurse-Led Education Program to Enhance Self-Care Agency in Leg Ulcer Patients

Patients with leg ulceration face changing self-care demands associated with the consequences of the disease and treatment. Often patients can manage their self-care for some time, but new therapeutic self-care demands may emerge that require more complex self-care actions. The purpose of this article is to describe the development of a nurse-led education program in North-Rhine Westphalia, Germany, that aims to help patients with leg ulcers to meet their therapeutic self-care demands. Orems self-care deficit nursing theory is used as a framework to provide the conceptual context for this supportive—educative nursing system that is being tested in a multi-site clinical trial.

Patientenversorgung an der Schnittstelle von Rehabilitation und Betriebsärzten

Principal goal of rehabilitation arrangements for patients in employable age are the preservation of the ability to work, the rehabilitation of employability and the prompt reintegration into the professional life respectively. In practice, the reintegration is achieving unsatisfactory results.The systematic literature research (acquisition period: 1998-2013) was conducted on the basis of defined search keywords in electronic databases, online archives, relevant German magazines (via manual search), and in bibliographies of selected publications. The definition of research results has taken place in consensus procedures on the tier of abstracts.Reasons for the unsatisfying reintegration quota are current temporary latencies and qualitative deficits of rehabilitation discharge reports, unsatisfying communication and cooperation between rehabilitation and company doctors, insufficient presence of company doctors, and trust issues between rehabilitant and company doctor among other things.The company doctors have an objective role as mediator based on their internal knowledge, competences and opportunities to influence, and they are awarded with a role as connecting piece on setting the course for rehabilitation.Since the currently available data are dissatisfactory concerning the medical interfaces in the rehabilitation process, despite the high thematically relevance, research activities should absolutely be intensified in this field of interest.

Development of an arm support system to improve ergonomics in laparoscopic surgery: study design and provisional results.

BackgroundLaparoscopic surgery (LS) induces physical stress to the surgeon that is associated with an increased prevalence of musculoskeletal pain and injury in the shoulder–neck region. The aim of this research project is to develop an arm support system (ASsyst) that reduces physical stress and is applicable to various laparoscopic interventions and operation room settings.MethodsA systematic approach to develop an ASsyst started in October 2012 consisting of five consecutive steps. In step 1, 14 laparoscopic interventions were observed using subjective and objective measures to determine key indicators for the conception of an ASsyst in LS. In step 2, an expert workshop was held to find and evaluate solutions to generate concepts for a support system based on the results of step 1 and general methods. During the third step, prototypes of ASsyst were tested in an experimental setting. Steps 4 and 5 are currently in process and include the final development of the ASsyst using the most promising concept for the evaluation during simulated LS.ResultsIncreased levels of physical stress were found in LS. Asymmetric strains were common. Three prototypes of ASsyst emerged from step 1 and 2. These prototypes were a cable construction with a noose for the lower arm, a support from below the elbow and a pneumatic vest supporting the upper arm. The experimental testing of these prototypes demonstrated reduced physical stress when compared to the unsupported environment. The support from below the elbow seemed to be the most practical in terms of implementation in various operation room settings and acceptance by surgeons. Step 4 and 5 are still in process.ConclusionsErgonomic problems have been identified in LS that could be addressed by an ASsyst. The concept of supporting the elbow from below has been found to be the most promising approach.

Psychosomatic consultation in the workplace - a new model of care at the interface of company-supported mental health care and consultation-liaison psychosomatics: design of a mixed methods implementation study

BackgroundMental health issues are gaining in importance in society and the economic system. At the same time, the accessibility and stigmatisation of the mental health care system in Germany can obstruct help-seeking behavior and delay early psychotherapeutic interventions. Therefore, new models of care are being established at the interface of company-supported health promotion and conventional health insurance sponsored outpatient care for people developing mental illnesses. Two large industrial companies, in cooperation with two psychosomatic clinics, have recently established a model of “psychosomatic consultation in the workplace“. This new model of care offers the opportunity for a first psychotherapeutic door to door consultation with occupational medicine within the industrial workplace. The main empirical goals of this study are:1) Describing the differences between patients who use this new diagnostic and therapeutic offer within the industrial workplace vs. patients who visit a conventional regional outpatient clinic, especially in regard to symptom duration and severity, work ability, and demographic characteristics, and2) A first evaluation of how patients may benefit more from this new model of care compared to those first seen by standard outpatient care.In the qualitative part of the study, occupational physicians, psychosomatic therapists, involved personnel and select employees of the involved companies will be asked to comment on their experiences with this new approach.Methods/DesignThe implementation study will take place in Ulm and in Stuttgart, with each site looking at one regional conventional psychosomatic outpatient clinic and one psychosomatic consultation offer within the workplace. 70 consecutive patients in each setting will be recruited (overall n = 280). For the cross-sectional study and pre-post comparison we will use established and validated survey instruments (PHQ, SF-12, WAI, MBI, IS) as well as standardized questions about health care use. For data analysis, we will use uni- and multivariate analytical methods. Qualitative data analysis (expert interviews) will be carried out using Mayring’s content analysis method.DiscussionThe results of this study have the potential to provide evidence-based knowledge about an innovative model of psychotherapeutic outpatient care and to further promote tailored solutions for early psychotherapeutic interventions within the worksite.Trial RegistrationDRKS00003184

Evaluation of objectivity, reliability and criterion validity of the key indicator method for manual handling operations (KIM-MHO), draft 2007.

Upper extremity musculoskeletal symptoms and disorders are common in the working population. The economic and social impact of such disorders is considerable. Long-time, dynamic repetitive exposure of the hand-arm system during manual handling operations (MHO) alone or in combination with static and postural effort are recognised as causes of musculoskeletal symptoms and disorders. The assessment of these manual work tasks is crucial to estimate health risks of exposed employees. For these work tasks, a new method for the assessment of the working conditions was developed and a validation study was performed. The results suggest satisfying criterion validity and moderate objectivity of the KIM-MHO draft 2007. The method was modified and evaluated again. It is planned to release a new version of KIM-MHO in spring 2012.

Occupational risk of infections with Borrelia burgdorferi in agricultural and forestry workers

Summary An epidemiological seroprevalence study was performed to test the hypothesis that there is an increased occupational or leisure time risk of Borrelia burgdorferi infections in southwestern Germany. As a second objective serological results obtained by enzyme-linked immunosorbent assay (ELISA) and immunofluorescence test (IFT) were compared. Test results obtained by means of ELISA and IFT differed greatly (by a factor of about 3). This must be kept in mind, when absolute prevalence rates (from different studies) are interpreted. This is less important if relations of prevalences obtained in one study are analysed. In both forestry and agricultural workers a significantly higher anti- B. burgdorferi -seroprevalence could be demonstrated. Thus, these two groups bear an increased risk of B. burgdorferi -infections due to their occupational exposure to ticks.