A cross-sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management-Implications from a system perspective.

Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management-including barriers and opportunities-across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross-sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management.

Occupational health and safety in agriculture - a brief report on organization, legislation and support in selected European countries.

INTRODUCTION AND OBJECTIVE: Agriculture and forestry are among the most dangerous professions in Europe, with a high level of accidents affecting the sustainability and viability of the sector. International conventions, EU directives and national legislation build the fundamental basis for prevention. The aim of the study is to describe and categorize national mechanisms of occupational safety and health (OSH) for agricultural workers in Europe, to assess the extent of implementing safety regulation, the body in charge, and to give examples of health and safety initiatives. MATERIAL AND METHODS: Results of a questionnaire-survey on basic safety regulations on farms sent by e-mail to the representatives of 30 participating European countries in the context of the Sacurima COST action network (CA 16123) are presented. Due to the complexity, only selected countries are described in this study highlighting the regulative bodies, occupational health services or specific training offers, as well as the complexity of the mechanisms. RESULTS: One of the most serious issues and deficits of EU OSH regulation is the exclusion of self-employed farmers who compose nearly 90% of the farming population. This leads to serious under-reporting of accidents, and because one of the most common measures for the performance of health and safety initiatives are the injury and ill health statistics, better registration systems are urgently needed in almost all countries as a basis for preventive efforts. CONCLUSIONS: The results of the study provide a basis for raising awareness about the current OSH systems in Europe, and the importance of developing sector specific OSH strategies. The proposed activities should assist in tackling high accident rates and poor occupational health for self-employed farmers.

Occupational injury rates among Norwegian farmers: A sociotechnical perspective.

INTRODUCTION: This study addressed relative injury risk among Norwegian farmers, who are mostly self-employed and run small farm enterprises. The aim was to explore the relative importance of individual, enterprise, and work environment risks for occupational injury and to discuss the latent conditions for injuries using sociotechnical system theory. METHOD: Injury report and risk factors were collected through a survey among Norwegian farm owners in November 2012. The response rate was 40% (n = 2,967). Annual work hours were used to calculate injury rates within groups. Poisson regression using the log of hours worked as the offset variable allowed for the modeling of adjusted rate ratios for variables predictive of injury risk. Finally, safety climate measures were introduced to assess potential moderating effects on risk. RESULTS: Results showed that the most important risk factors for injuries were the design of the workplace, type of production, and off-farm work hours. The main results remained unchanged when adding safety climate measures, but the measures moderated the injury risk for categories of predominant production and increased the risk for farmers working with family members and/or employees. An overall finding is how the risk factors were interrelated. CONCLUSIONS: The study identified large structural diversities within and between groups of farmers. The study drew attention to operating conditions rather than individual characteristics. The farmer's role (managerial responsibility) versus regulation and safety climate is important for discussions of injury risk. Practical Applications: We need to study sub-groups to understand how regulation and structural changes affect work conditions and management within different work systems, conditioned by production. It is important to encourage actors in the political-economic system to become involved in issues that were found to affect the safety of farmers.

Exploring multiple working arrangements in Norwegian engineering, procurement, and construction industry from a middle manager and supervisor perspective: A sociotechnical system perspective.

With a scarcity of research on multiple working arrangements, the aim of the paper is to contribute empirical data from a Norwegian engineering, procurement, and construction enterprise that shed light on the challenges and benefits of a 14-21 working arrangement in itself and in relation to other working arrangements. We combine a sociotechnical system perspective with systematic content analysis using QSR NVivo, which reveals organizational complexity comprised of indirect, direct, positive, negative, and mutual interplays between various aspects of the enterprise, including processes and outcomes. We find that the 14-21 working arrangement, in combination with other factors of the work system, sets the premises for work processes and outcome factors that are both beneficial and challenging to individuals and the organization. We also find that work process factors, such as work and information flow as well as follow-up and facilitation, depend on the presence of, and dynamic coordination and communication among, individuals across the organization. This in turn requires a support network, work groups, and supervisors to be on the same working arrangement.

An active transition from offshore work to family life: Activities that may impact recovery.

BACKGROUND: Night shift workers, particularly those working offshore, take a long time to recover from their shifts. The activities that shift workers, such as offshore employees, pursue during their leisure time can influence the process of recovery from work-related fatigue, but little is known about these leisure time activities. OBJECTIVE: To explore what leisure time activities are pursued that may be relevant to recovery for offshore employees. METHODS: Sixty-one offshore working family men-20 night shift, 16 swing shift, and 25 day shift workers-reported on six predefined activities for 14 days following their offshore tours. Generalized estimating equations analysis was used to explore trends in the data. RESULTS: From the start of the free period, almost all participants were involved in household chores and childcare; these activities declined over the 14 days. Throughout the study period, participants actively pursued social, volunteer, and leisure time physical activities. Work-related activities were pursued by half of the participants at some time during the 14 days. Night and swing shift workers were more physically active than day workers throughout the first 14 days of the free period. CONCLUSIONS: The transition from offshore work to family life can be characterised as active. The activities engaged in by this sample of employees are likely to promote their recovery.

Nonstandard working schedules and health: the systematic search for a comprehensive model.

BACKGROUND: Theoretical models on shift work fall short of describing relevant health-related pathways associated with the broader concept of nonstandard working schedules. Shift work models neither combine relevant working time characteristics applicable to nonstandard schedules nor include the role of rest periods and recovery in the development of health complaints. Therefore, this paper aimed to develop a comprehensive model on nonstandard working schedules to address these shortcomings. METHODS: A literature review was conducted using a systematic search and selection process. Two searches were performed: one associating the working time characteristics time-of-day and working time duration with health and one associating recovery after work with health. Data extracted from the models were used to develop a comprehensive model on nonstandard working schedules and health. RESULTS: For models on the working time characteristics, the search strategy yielded 3044 references, of which 26 met the inclusion criteria that contained 22 distinctive models. For models on recovery after work, the search strategy yielded 896 references, of which seven met the inclusion criteria containing seven distinctive models. Of the models on the working time characteristics, three combined time-of-day with working time duration, 18 were on time-of-day (i.e. shift work), and one was on working time duration. The model developed in the paper has a comprehensive approach to working hours and other work-related risk factors and proposes that they should be balanced by positive non-work factors to maintain health. Physiological processes leading to health complaints are circadian disruption, sleep deprivation, and activation that should be counterbalanced by (re-)entrainment, restorative sleep, and recovery, respectively, to maintain health. CONCLUSIONS: A comprehensive model on nonstandard working schedules and health was developed. The model proposes that work and non-work as well as their associated physiological processes need to be balanced to maintain good health. The model gives researchers a useful overview over the various risk factors and pathways associated with health that should be considered when studying any form of nonstandard working schedule.

Self-Reported Recovery from 2-Week 12-Hour Shift Work Schedules: A 14-Day Follow-Up.

BACKGROUND: Recovery from fatigue is important in maintaining night workers' health. This study compared the course of self-reported recovery after 2-week 12-hour schedules consisting of either night shifts or swing shifts (i.e., 7 night shifts followed by 7 day shifts) to such schedules consisting of only day work. METHODS: Sixty-one male offshore employees-20 night workers, 16 swing shift workers, and 25 day workers-rated six questions on fatigue (sleep quality, feeling rested, physical and mental fatigue, and energy levels; scale 1-11) for 14 days after an offshore tour. After the two night-work schedules, differences on the 1(st) day (main effects) and differences during the follow-up (interaction effects) were compared to day work with generalized estimating equations analysis. RESULTS: After adjustment for confounders, significant main effects were found for sleep quality for night workers (1.41, 95% confidence interval 1.05-1.89) and swing shift workers (1.42, 95% confidence interval 1.03-1.94) when compared to day workers; their interaction terms were not statistically significant. For the remaining fatigue outcomes, no statistically significant main or interaction effects were found. CONCLUSION: After 2-week 12-hour night and swing shifts, only the course for sleep quality differed from that of day work. Sleep quality was poorer for night and swing shift workers on the 1(st) day off and remained poorer for the 14-day follow-up. This showed that while working at night had no effect on feeling rested, tiredness, and energy levels, it had a relatively long-lasting effect on sleep quality.

Neuroendocrine recovery after 2-week 12-h day and night shifts: an 11-day follow-up.

PURPOSE: The study aimed to investigate the course and duration of neuroendocrine recovery after 2-week 12-h day and night shift working periods and to study whether there were differences in recovery between the shift groups. METHODS: Twenty-nine male offshore employees working 2-week 12-h shift tours participated in the study; 15 participated after a day shift tour and 14 after a night shift tour. Salivary cortisol was assessed at awakening, 30 min after awakening, and before bedtime on the 1st, 4th, 7th, and 11th day of the free period, with a reference day prior to the offshore tour. Differences were tested using generalised estimating equations analysis. RESULTS: Compared to the reference day, night shift workers had a significantly flatter cortisol profile on the 1st day off, significantly lower cortisol concentrations at 30 min after awakening on day 4 and at awakening on day 7, and a significantly smaller decline to evening concentration on days 4 and 11. Compared to the reference day, day shift workers only showed a significantly lower cortisol concentration at awakening on the 1st day off. Compared to day workers, night shift workers had a flatter profile on the 1st day off and a lower cortisol concentration at awakening on the 4th day. CONCLUSIONS: Following 2-week 12-h night shift working periods, recovery was not fully complete up to day 11. Following 2-week 12-h day shift working periods, an indication of incomplete recovery was found on the 1st day off, with full recovery reached on day 4.

The association between shift work and sick leave: a systematic review.

Shift work is associated with a number of negative health outcomes, although it is not known whether it is associated with sick leave. This systematic review therefore aimed to determine whether an association exists between shift work and sick leave. A systematic literature search was conducted in six databases on observational studies. Two reviewers independently selected relevant articles and appraised methodological quality. Data extraction was performed independently by review couples. Articles were categorised according to shift work characteristics and summarised using a levels of evidence synthesis. In total, the search strategy yielded 1207 references, of which 24 studies met the inclusion criteria. Nine studies were appraised as high quality and used in the levels of evidence synthesis. Two high quality longitudinal studies found a positive association between fixed evening shifts and longer sick leave for female healthcare workers. The evidence was assessed as strong. Evidence was inconclusive for rotating shifts, shift work including nights, for fixed night work, and for 8-hour and 12-hour shifts. The association found between evening work and sick leave in female healthcare workers implies that the association between shift work and sick leave might be schedule and population specific. To study the association further, more high quality studies are necessary that assess and adjust for detailed shift work exposure.

Young workers in the construction industry and initial OSH-training when entering work life.

Studies have found that young workers are at risk for injuries. The risk for accidents is high within construction, indicating that young workers may be especially vulnerable in this industry. In Norway, it is possible to enter the construction industry as a full time worker at the age of 18. The aim of this paper was to explore how young construction workers are received at their workplace with regards to OHS-training. The study was designed as a qualitative case study. Each case consisted of a young worker or apprentice (< 25 years), a colleague, the immediate superior, the OHS manager, and a safety representative in the company. The interviews were recorded and analyzed through content analysis. The results showed that there were differences between large and small companies, where large companies had more formalized routines and systems for receiving and training young workers. These routines were however more dependent on requirements set by legislators and contractors more than by company size, since the legislation has different requirements with impact on OHS.

On long term sick leave due to musculoskeletal diseases and disorders. Experiences of work demands.

OBJECTIVE: The rate of sick leave is higher in the public sector than in the private sector in several countries, making it essential to thoroughly investigate employees in the public sector. The following research question was investigated: How do employees on long-term sick leave (> 8 weeks) due to musculoskeletal disorders or diseases describe their work demands? METHODS: This paper is from the larger Rogaland RTW case study. The informants were female employees (n=8) in the first-line public sector with different types of musculoskeletal diseases or disorders. Qualitative interviews were conducted using a semi-structured interview guide based on two measures: Worker Role Interview and Work Environmental Impact Scale. Data was analysed by condensing and categorizing meaning. RESULTS: Fifty-one work demands were described, only five of which were physical demands. Demands were sometimes described as merely negative or positive for the work performance, but also as both. Most of the negative demands were emotional and cognitive challenges in mastering the work tasks. Most of the demands (n= 36) were experienced to be claimed by the employee herself, with only a few being claimed by the employer or environment (n=7) or by both (n=8). CONCLUSIONS: Eight employees in the public sector on long-term sick leave due to musculoskeletal problems experienced mostly cognitive and emotional demands, and defined themselves as the work-demand claimer. The results of this study point to the importance of broadening the perspective in work rehabilitation for workers absent due to diagnosis of the musculoskeletal system.

Workplace interventions for neck pain in workers.

BACKGROUND: Musculoskeletal disorders are the most common cause of disability in many industrial countries. Recurrent and chronic pain accounts for a substantial portion of workers' absenteeism. Neck pain seems to be more prominent in the general population than previously known. OBJECTIVES: To determine the effectiveness of workplace interventions (WIs) in adult workers with neck pain. SEARCH STRATEGY: We searched: CENTRAL (The Cochrane Library 2009, issue 3), and MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, OTseeker, PEDro to July 2009, with no language limitations;screened reference lists; and contacted experts in the field.   SELECTION CRITERIA: We included randomised controlled trials (RCT), in which at least 50% of the participants had neck pain at baseline and received interventions conducted at the workplace. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias. Authors were contacted for missing information. Since the interventions varied to a large extend, International Classification of Functioning, Disability and Health (ICF) terminology was used to classify the intervention components. This heterogeneity restricted pooling of data to only one meta-analysis of two studies. MAIN RESULTS: We identified 1995 references and included10 RCTs (2745 workers). Two studies were assessed with low risk of bias. Most trials (N = 8) examined office workers. Few workers were sick-listed. Thus, WIs were seldom designed to improve return-to-work. Overall, there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity. If present, significant results in favour of WIs were not sustained across follow-up times. There was moderate quality evidence (1 study, 415 workers) that a four-component WI was significantly more effective in reducing sick leave in the intermediate-term (OR 0.56, 95% CI 0.33 to 0.95), but not in the short- (OR 0.83, 95% CI 0.52 to 1.34) or long-term (OR 1.28, 95% CI 0.73 to 2.26). These findings might be because only a small proportion of the workers were sick-listed. AUTHORS' CONCLUSIONS: Overall, this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term, which was not sustained over time. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. There is an urgent need for high quality RCTs with well designed WIs.

The attribution of work environment in explaining gender differences in long-term sickness absence: results from the prospective DREAM study.

OBJECTIVES: To identify differences in risk of long-term sickness absence between female and male employees in Denmark and to examine to what extent differences could be explained by work environment factors. METHODS: A cohort of 5026 employees (49.1% women, mean age 40.4years; 50.9% men, mean age 40.2years) was interviewed in 2000 regarding gender, age, family status, socio-economic position and psychosocial and physical work environment factors. The participants were followed for 18months in order to assess their incidence of long-term sickness absence exceeding 8 consecutive weeks. RESULTS: 298 workers (5.9%) received sickness absence compensation for 8weeks or more. Women had an excess risk of 37% compared to men, when adjusting for age, family status and socio-economic position. Physical work environment exposures could not explain this difference, whereas differences in psychosocial work environment exposures explained 32% of the differences in risk of long-term sickness absence between men and women, causing the effect of gender to become statistically insignificant. The combined effect of physical and psychosocial factors was similar, explaining 30% of the gender difference. CONCLUSION: Differences in psychosocial work environments in terms of emotional demands, reward at work, management quality and role conflicts, explained roughly 30% of women's excess long-term sickness absence risk. Assuming women and men had identical working conditions would leave the larger part of the gender difference in long-term sickness absence from work unexplained.

Loss of health certificates among offshore petroleum workers on the Norwegian Continental Shelf 2002-2010.

BACKGROUND: A health certificate is required to work on the offshore petroleum installations of the Norwegian Shelf. Loss of health certificate (loss of licence, LOL) may cause economic problems for the individual worker. A private compensation system (OSO) was established for Norwegian offshore workers in 2002, comprising 8000-11,000 individual members of workers organisations: approximately one third of the population offshore. This study aims at describing the reasons for compensation of offshore workers who have lost their certificates. MATERIALS AND METHODS: Of 595 workers who applied for compensation in the period 2002-2010, 38 declined to participate in the study. Of the remaining 557, 507 were granted and 50 were denied compensation. All medical records held by the scheme concerning the 507 compensated applicants were examined. Health data were systematically extracted, analysed, and compared with general population statistics. RESULTS: Musculoskeletal conditions were the most frequent conditions causing LOL for both sexes (42.5%), followed by psychiatric, neurological, and malignant diseases for women, and cardiovascular (19%), neurological, and psychiatric conditions for men. Musculoskeletal disorders were more prevalent than in the general population, and the prevalence of knee problems was particularly high. Among malignant diseases we found a high proportion of brain tumours and renal cancer. The causes are unknown and warrant further investigation in this population. Among women granted compensation, 78% were catering workers, while 50% of the men were process workers, reflecting the gender distribution in these working groups. CONCLUSIONS: Musculoskeletal conditions were the most frequent cause of application for LOL compensation for both sexes, followed by psychiatric, neurological, and malignant diseases for women, and cardiovascular, neurological, and psychiatric conditions for men. The cause of the higher incidence of musculoskeletal diseases, brain tumours, and renal cancer found in this study compared to the general population warrants further investigation.

Exploring perceived tension as a response to psychosocial work stress.

UNLABELLED: This study extends the concept of tension, in part by observing changes in tension during the workday, to identify episodes causing elevated tension and relate them to bodily responses. Methods Both questionnaires and qualitative interviews were used to describe the tension concept. Tension was scored on a visual analogue scale (VAS) every hour, and trapezius muscle activity and heart rate were recorded. Ninety-four female workers from four service occupations participated. RESULTS: Tension was described as a musculoskeletal activation response involving the upper body regions, but also autonomic activation responses were described. The cause of elevated tension comprised a variety of situational demands; however, contact with other people causing negative emotions was a common factor. Averaged muscular activity and heart rate responses did not correlate with prolonged perceived tension, but the differential tension score between high- and low-tension periods correlated with the corresponding differential trapezius activity responses. The regression line indicated no effect of short-term variation in perceived tension on median muscle activity for differential VAS scores of < or = 2 cm. An increase of 2% of maximal electromyographic activity for a differential VAS score of 4-5 cm was indicated. CONCLUSIONS: This study identifies work exposures that cause tension, and it demonstrates a physiological correlate with the subjective perception of tension in the short term. The low recorded muscle activationresponse does not represent a risk factor for pain by the traditional standards used for recording and evaluating muscle activity responses, but it may point to underlying pain-inducing mechanisms, such as low-threshold overexertion of motor units.

Daytime trapezius muscle activity and shoulder-neck pain of service workers with work stress and low biomechanical exposure.

AIM: The study aims to look for an association between trapezius muscle activity and shoulder-neck pain in work situations characterized by work stress and low biomechanical exposure. METHODS: Female subjects (n = 93) were recruited from four occupational groups: health care, shop assistants, banking, and university secretaries. Thirty-eight workers were interviewed and classified as pain-afflicted by their shoulder-neck pain score in the last 6 months; 55 were pain-free. Shoulder-neck pain, bodily state of tension and fatigue, and subjective exposure assessments were monitored by repeated hourly measurements over 24 hr. Trapezius muscle activity was recorded bilaterally by surface EMG. RESULTS: Shoulder-neck pain, perceived tension, work stress ("stressful environment"), and mental fatigue was augmented over the workday and reduced leisure time. Physical fatigue was low and stable. Thus, work stress appeared to be the dominant exposure associated with shoulder-neck pain. Muscle activity was low and similar for pain-afflicted and pain-free subjects during working hours. It was unchanged from work to leisure for the pain-afflicted workers and was significantly reduced for the pain-free group. CONCLUSIONS: Stress-induced shoulder and neck pain is not necessarily associated with elevated trapezius muscle activity, but pain-free workers may benefit from better muscle relaxation in leisure.

Further studies of shoulder and neck pain and exposures in customer service work with low biomechanical demands.

The aim of the study was to establish insight into work exposures that cause shoulder and neck pain among occupational groups that have low biomechanical exposure and experience work stress from client/customer contact, among other exposures. Four occupational groups were studied, in health care (n = 20), retail (n = 22), banking (n = 26), and university secretaries (n = 26), a total of 94 volunteers. Thirty-nine were classified as pain-afflicted in the shoulder and neck, while 55 were pain-free. The subjects' perceptions of biomechanical and psychosocial exposures were established by use of quantitative questionnaires and by explorative interviews with open-ended questions, covering the same themes. Heart rate and trapezius EMG were recorded over a full workday and the following leisure period. Trapezius median and static activity during work were 3.3% and 0.3% EMG(max), only marginally higher than trapezius activity in the leisure period (2.7% and 0.2% EMG(max)). The quantitative questionnaire did not identify any variable that correlated with shoulder and neck pain except perceived general tension. The interviews established that the interaction with clients or customers was an important source of work stress. Such stress appeared to be a complex entity not easily characterized by established psychosocial questionnaires. The physiological variables were at most weakly elevated in periods with high stress as compared to periods with low stress. The authors caution against relying on standardized quantitative questionnaires and/or physiological recordings to characterize work stress in occupations with emotional stress through client/customer service work.