Tim Morse

A Conceptual Framework for Integrating Workplace Health Promotion and Occupational Ergonomics Programs

Musculoskeletal, cardiovascular, and mental health are all associated with the physical and psychosocial conditions of work, as well as with individual health behaviors. An integrated approach to workplace health-promotion programs should include attention to the work environment, especially in light of recent findings that work organization influences so-called lifestyle or health behaviors. Macroergonomics provides a framework to improve both physical and organizational features of work and, in the process, to empower individual workers. The Center for the Promotion of Health in the New England Workplace (CPH-NEW) is a research-to-practice effort examining the effectiveness of worksite programs that combine occupational safety and health—especially /sc>ergonomics—with health promotion, emphasizing the contribution of work organization to both. Two intervention studies are underway in three different sectors: health care, corrections, and manufacturing. Each study features participatory structures to facilitate employee input into health goal-setting, program design and development, and evaluation, with the goal of enhanced effectiveness and longer-term sustainability.

Musculoskeletal disorders of the neck and shoulder in the dental professions

The prevalence of and risk factors for neck and shoulder disorders among dental practitioners (dentists, dental hygienists, and dental assistants) is reviewed. Dentists report 26-73% period prevalence of neck symptoms over the previous year, and 20-65% with shoulder symptoms. Dental hygienists report even higher rates, from 54-83% for neck and 35-76% for shoulder, and dental assistants in between (38-62% and 27-62% respectively). Symptoms begin to appear early in the career, with significant increases upon starting clinical practice. Significant social and economic consequences have been reported, including leaving the profession or reducing hours. While ergonomic improvements appear to have some positive impact, these have not been well studied, and some changes (such as the historic shift from standing to seated posture) may have moved risk from the lower back to the upper extremities. Static awkward posture, particularly those with isometric contractions of the trapezius, has been identified as a risk factor particular to these occupations. Ergonomic improvements, health promotion, and organizational interventions have been suggested as needs for reducing risk.

Biomechanical, psychosocial, and organizational risk factors for WRMSD: population-based estimates from the Connecticut upper-extremity surveillance project (CUSP).

In a case-control study of a population-based telephone survey of 3,798 working adults, symptoms of work-related musculoskeletal disorder (WRMSD) were associated with biomechanical, psychosocial, and organizational factors. In several models, biomechanical exposures with strong associations were static postures (odds ratios [ORs] = 2.00-5.45); repeated pushing, pulling, lifting (ORs = 1.86-12.75); and repeated neck bending (ORs = 1.07-12.8). Psychosocial and organizational factors consistently retained in these models were demands (ORs = 1.26-1.59) and organizational support (ORs = 0.53-0.79). Decision latitude entered less frequently (ORs = 0.30-0.49). This research may have implications for intervention strategies. First, reducing both biomechanical and psychosocial risk may be more effective than focusing solely on engineering controls. Second, organizational culture and policy may have strong implications for WRMSD prevalence and control.

Talking About Health: Correction Employeesʼ Assessments of Obstacles to Healthy Living

Objective: Describe health risks/obstacles to health among correctional employees. Methods: Mixed-methods approach combined results from four focus groups, 10 interviews, 335 surveys, and 197 physical assessments. Results: Obesity levels were higher than national averages (40.7% overweight and 43.3% obese), with higher levels associated with job tenure, male gender, and working off-shift. Despite widespread concern about the lack of fitness, leisure exercise was higher than national norms. Respondents had higher levels of hypertension than national norms, with 31% of men and 25.8% of women hypertensive compared with 17.1% and 15.1% for national norms. Stress levels were elevated. Officers related their stress to concerns about security, administrative requirements, and work/family imbalance. High stress levels are reflected in elevated levels of hypertension. Conclusions: Correctional employees are at high risk for chronic disease, and environmental changes are needed to reduce risk factors.

Skin temperature recovery from cold provocation in workers exposed to vibration: a longitudinal study

Background: Vibration white finger (VWF) is characterised by arterial hyperresponsiveness and vasoconstriction following cold provocation. Several years after of removal from exposure, most subjects show improved finger systolic blood pressure (FSBP) under conditions of cold challenge, but continue to report cold hands and finger blanching. Aims: To assess the underlying reasons for the persistence of cold symptoms. Methods: A total of 204 former users of pneumatic tools with cold related hand symptoms were evaluated and then re-evaluated a year later. Symptoms were evaluated using the Stockholm Workshop Scale. Finger systolic blood pressure per cent (FSBP%) was assessed by comparing digital blood pressure in a cold provoked and normalised state. Fingertip skin temperature was measured during cooling and occlusion and during rewarming and recovery. Results: There were dramatic improvements in FSBP% (14.3 mm Hg %), modest improvement in recovered skin temperature (0.86°C), and no change in symptom stage. When the most symptomatic subjects (n = 75) were compared with the less symptomatic subjects (n = 129), there were similar inter-test improvements in FSBP%. Skin temperature recovery improved in the less symptomatic (+1.49°C), but did not change in the most symptomatic group (−0.12°C). However, the more symptomatic group had higher temperatures at the initial test, thus qualifying the result. Conclusions: Skin temperature recovery after cold challenge in subjects with VWF remains reduced in the symptomatic subjects several years after exposure removal. This is evident even when blood pressure has increased in the setting of cold provocation. Results suggest that in VWF, the dermal circulation remains impaired, even after the restoration of arterial blood pressure in the digits.

Health promotion site selection blues: barriers to participation and implementation.

Objective: To shed light on research-to-practice challenges in workplace health promotion research. Methods: More than 1200 companies serviced by a national insurer were assessed by measures, including management surveys, and insurance premium costs and risk profile. A 21-item Workplace Readiness Checklist was the core assessment tool. Quantitative and qualitative measures were used to identify 12 to 14 companies deemed most “ready for change.” Results: The four priority candidate companies decided against participation. A post hoc survey to evaluate reasons for non-participation identified factors such as time allocations, the deteriorating economic environment, and the participatory nature of the interventions proposed for half of the study sites. Differing priorities within management also seemed to interfere with participation. Conclusions: A highly structured process for determining corporate readiness for participatory health promotion produced contradictory results.

Traditional and environmentally preferable cleaning product exposure and health symptoms in custodians.

Background We investigated the associations between traditional and environmentally preferable cleaning product exposure and dermal, respiratory, and musculoskeletal symptoms in a population of custodians. Methods We analyzed associations between symptoms and exposure to traditional and environmentally preferable cleaning product exposure among 329 custodians. Results We observed increased odds of dermal (P < 0.01), upper (P = 0.01) and lower respiratory (P = 0.01), and upper extremity (P < 0.01), back (P < 0.01), and lower extremity (P = 0.01) musculoskeletal symptoms associated with increased typical traditional cleaning product exposure. We observed significant trends for increased odds of dermal (P = 0.03) and back (P = 0.04) and lower (P = 0.02) extremity musculoskeletal symptoms associated with increased typical environmentally preferable cleaning product exposure. Conclusions Fewer positive associations and reduced odds of health symptoms associated with environmentally preferable cleaning product exposure suggest that these products may represent a safer alternative to traditional cleaning products. Am. J. Ind. Med. 58:988–995, 2015.

The Hand-arm Vibration International Consortium (havic): Prospective Studies on the Relationship Between Power Tool Exposure and Health Effects

Objectives: The Hand-Arm Vibration International Consortium (HAVIC) is a collaboration of investigators from Europe and North America studying health effects from hand-arm vibration (HAV). Features include prospective design, cross-cohort exposure, and health assessment methods. Methods: Two new cohorts (dental hygienists and dental hygiene students), two existing cohorts (Finnish forest workers, and Swedish truck cab assemblers), and a previous population (US shipyard workers) are included. Instruments include surveys, quantitative medical tests, physical examination, and work simulation and data logging to assess exposure. New methods were developed for nerve conduction and data logging. Results: Findings on the relationship between nerve conduction and skin temperature in HAV-exposed subjects resulted in a new approach to subject warming. Conclusions: Integrating established cohorts has advantages over de novo cohort construction. Complex laboratory tests can be successfully adapted for field use.

Occupational Tuberculosis Among Deputy Sheriffs in Connecticut: A Risk Model of Transmission

OBJECTIVES The purpose of this study was to identify risk factors for tuberculin skin test conversions among non-infected deputy sheriffs in Connecticut and during an out-break in an urban lock-up. METHODS 377 tuberculin skin-test negative sheriffs statewide in 1994-1995 and 37 sheriffs in the lock-up in 1995 were screened and questionnaires administered. Cellblock volumetric air flow was measured. The Wells-Riley model of airborne transmission [C = S(1-e-Iqpt/Q)] was applied to the epidemiologic and ventilation data. RESULTS Statewide, of 377 sheriffs screened, 22 (5.8%) had positive skin tests. Risk factors included older age (p < .0075) and longer tenure (p < .036). In the lock-up, of 37 sheriffs screened, 4 (10.8%) had positive skin tests. Measured mean outside air flow per occupant (8.0 cfm; S.D. = 2.2) was below design (15 cfm) and recommended (20 cfm) standards. Mathematical modeling estimated that TB transmission would be reduced by 62.5 percent with ventilation at design specifications. CONCLUSIONS Inadequate ventilation may increase the risk for occupational transmission of tuberculosis. Since lock-ups do not have the time to conduct inmate TB screenings, supplemental engineering controls may be required.

Characteristics of effective job health and safety committees.

Although Health and Safety Committees (HSCs) are widely used, there is very little empirical information on what specific characteristics of HSCs (structure, activities, and resources) are associated with effectiveness in lowering injury and illness rates. An exploratory study was conducted in Connecticut, a state which requires HSCs in all workplaces with at least 25 employees. The study included analysis of administrative data (including HSC meeting minutes) of 29 committees. Lower injury rate companies were found to have a higher ratio of hourly workers to managers on the HSC, a larger committee compared to size of the employer, and reviewed a larger average number of worker complaints and suggestions.