Strategies used by women workers to reconcile family responsibilities with atypical work schedules in the service sector.

OBJECTIVE: Workers' attempts to accommodate family needs may be considered illegitimate in the paid work sphere. Their attempts at work-family balancing (WFB) in that sphere can remain invisible, even when those attempts require considerable energy. Since identification of WFB strategies can potentially lead to suggestions to improve management practices, we report an attempt to find them in the work sphere. PARTICIPANTS: 14 care aides in a Québec residence for seniors and 2~schedule managers were recruited. METHODS: Qualitative ergonomic analysis was employed. 24 hours observation; interviews of nursing and human resources staff; qualitative ergonomic analysis by two researchers; feedback collected from meetings with management and union. Strategies for schedule choice were compared between care aides with heavier vs. lighter family responsibilities. RESULTS: For workers with heavier family responsibilities, choice of work schedules was almost entirely conditioned by family considerations, leaving little leeway to manage workers' own health protection. CONCLUSIONS: Family constraints affected activity at work, and strategies for handling family constraints could potentially be affected by changes in work organization. Managers should encourage full discussion of work-family balancing strategies if they wish to adapt their working conditions to the workers, and ergonomists should include this balancing as a facet of work activity, despite possible negative consequences.

Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day.

A relationship between low back pain (LBP) and prolonged standing or prolonged sitting at work has not been clearly shown, despite its biological plausibility. Because sitting and standing postures vary as to duration and freedom to alternate postures, and standing postures vary as to mobility, associations between specific working postures and LBP were explored using multiple logistic regression. Associations between work factors and self-reported LBP during the previous 12 months that interfered with usual activities were examined among 4493 standing workers and 3237 sitting workers interviewed in the 1998 Quebec Health and Social Survey; 24.5% reported significant LBP. Since the same conditions can correspond to different physiological demands for sitting compared with standing workers, analyses were performed separately for the two groups. Standing without freedom to sit was associated with LBP. Different occupational physical and psychosocial factors were associated with LBP in sitting compared with standing populations.

Indicators for choosing an optimal mix of major working postures.

North American workers usually stand while working, and prolonged standing is associated with discomfort and cardiovascular problems. Since prolonged sitting is also associated with health problems, and standing postures differ as to mobility and access to seating, it is desirable to identify an optimal mix of postures. As a step towards this identification, it is desirable to develop indicators of potential health effects that respond to changes in work requirements. We observed 65 subjects who usually stood at work, in four types of workplaces. Pressure-pain threshold (PPT) recorded on the plantar surface was used as an indicator of discomfort and arterial blood pressure was used as an indicator of cardiovascular effects. PPT after work was significantly lower than that before work. Sitting for even a small part of the day appeared to be protective. The effects of static vs. dynamic work on PPT and arterial blood pressure may differ.

Standing, sitting and associated working conditions in the Quebec population in 1998.

Working posture is an important determinant of musculoskeletal and vascular health. Knowledge of the context and type of postures is necessary in order to examine their associations with health-related outcomes. This study describes self-reported usual working postures in a population and their associations with other working conditions and demographic variables. The 1998 Quebec Health and Social Survey is a population-based survey of 11,986 private households in the province of Quebec. It contained a self-administered questionnaire, including an extensive occupational health section. The analyses in this study were limited to respondents with paid employment who had at least 6 months seniority in their current job, comprising 9,425 subjects. The overall prevalence of usual work in a standing posture is 58%; it is more common among men, workers under 25 years, those in the two lowest educational quintiles and those with incomes under 20,000 Canadian dollars. Only one person in six who works standing reports being able to sit at will. Women and men differ in the types of usual standing and sitting postures at work. Those who work standing and/or who work in more constrained postures are more likely to be exposed to other physical work demands, such as handling heavy loads, repetitive work, forceful exertion and low job decision latitude. The association between decision latitude and constrained postures is an important link between psychosocial and physical stressors in the workplace. In epidemiological studies, exposure covariation and interactions should be considered in the generation and interpretation of the associations between work postures and musculoskeletal disorders.

Chronic fatigue among bank workers in Brazil.

The present study examines the prevalence of chronic fatigue (CF) among bank workers in Brazil and possible associations with gender and working conditions. The study sample included all 735 workers from the department of data processing of a state bank. CF was assessed using the Chalder Fatigue Scale. Working conditions and socio-demographic, socio-economic and psychosocial factors at work were analysed. Psychiatric symptoms were measured with the SRQ-20. The overall estimate of the prevalence of CF was 8.7% [95% confidence intervals (95% CI) = 6.4-10.9%]: 7.8% (95% CI = 5.5-10.7%) among men and 11.0% (95% CI = 6.7-16.9%) among women. The male-female difference was not statistically significant, even after adjusting for minor psychiatric disorders. The overall prevalence of CF without minor psychiatric disorders was 4.5% (95% CI = 2.7-6.3%): 3.9% (95% CI = 1.9-5.9%) among men and 6.4% (95% CI = 2.0-10.1%) among women. In the final model, risk factors for CF were fast work speed [odds ratio (OR) = 3.5], dissatisfaction at work (OR = 3.1), minor psychiatric disorders (OR = 6.8), and medium (OR = 1.8) and heavy domestic workload (OR = 12.0). CF is common among these bank workers and is associated with psychosocial factors at work. Particularly among women, domestic workload, marital status and the presence of young children were associated with CF in the stratified analysis. Domestic workload may add physical and mental stress, putting employees at risk for CF from overload, or CF may cause workers to perceive domestic work as heavy.

Women workers confront one-eyed science: building alliances to improve women's occupational health.

Women suffer many health problems related to their work, but attempts to improve their situation face obstacles at two levels: recognition of their problems and ability to organize to prevent them. Recognition by occupational health specialists has been delayed due in part to: A perception that women's issues have been included in research focussed on male workers; pressure to deal with more visible issues of mortality and well-established illness; ignorance of women's working conditions; methodological biases and inadequacies. Recognition by unions is slowed when women and their concerns are absent from union membership and/or governing structures. Feminist health advocates have not often participated in these struggles, due to social class differences and difficulties in linking with some male-dominated unions. Also, due to the wide variety of hazardous working conditions, they do not emerge from population-based analyses of health determinants in the same way as do domestic violence, tobacco or poverty. The authors describe three alliances necessary for successful research, policy and practice in women's occupational health: between feminist and working-class organizations; between feminists and occupational health scientists; between researchers and women workers.

Effect of cutting flute design on cortical bone screw insertion torque and pullout strength.

OBJECTIVE: To determine the effect of the number and length of cutting flutes on the insertion torque and pullout strength for self-tapping 4.5-millimeter cortical bone screws. DESIGN: Screws were self-tapped in the diaphysis of human cadaver femurs. Each of the six screw types studied had different designs with varying cutting flute lengths and numbers. Bone mineral density, insertion torque, and pullout strength were measured. SETTING: The study was conducted at an experimental biomechanics laboratory associated with a university medical center. OUTCOME MEASUREMENTS: Insertion torque and pullout strength were normalized by the local bone mineral density. RESULTS: The mean normalized insertion torque of the design with four full-length cutting flutes was less than the design with three full-length flutes and the two designs with one-third length flutes (p < 0.05). The mean normalized pullout strength of the screw with four full-length flutes was significantly greater than that of all screws with fewer than three flutes (p < 0.05). CONCLUSIONS: Priorities for a cutting flute design should ideally include ease of screw insertion, minimal soft tissue irritation, and maximal screw holding power. Screws with more than two flutes were easier to insert and did not cause cortical damage during insertion. The screw with four full-length flutes showed a trend toward being the easiest to insert and having the greatest holding strength.

Standing and very slow walking: foot pain-pressure threshold, subjective pain experience and work activity.

Prolonged standing is described as uncomfortable by exposed workers, but the discomfort has not been linked to precise descriptions of workplace activity. We observed 10 sales and kitchen workers ("group 1") who worked standing. We compared the plantar pain-pressure threshold (PPT) of "group 1" (10 standing workers) to that of "group 2" (11 researchers who could choose their posture freely). Group 1 spent an average time of 62% standing still compared to 5% for group 2. Despite the fact that group 1 were primarily confined to defined areas and stood for 62% of the time, their mean time standing still was only 7 s. They walked 35% of the time, but 57% of walking sequences were only one or two steps. Group 1 PPT declined by 23% over the work day compared to 5% among group 2 (p < 0.05, ANOVA). Foot PPT is a promising quantitative indicator of effects of standing work.

Ergonomic studies provide information about occupational exposure differences between women and men.

This article reviews published information and ergonomic analyses of work activity in several jobs usually done by women in order to help researchers and clinicians determine the extent to which women's health problems can be attributed to the workplace and where to intervene. Women in the workplace are often exposed to different musculoskeletal and psychological constraints, even when they share job titles with men. Job and task assignments may differ by sex, and gender-associated biological and social characteristics may interact with workplace constraints to modify the exposures or the effects of working conditions. Jobs preferentially assigned to women may have specific exposures that escape the attention of researchers.

One-eyed science: scientists, workplace reproductive hazards, and the right to work.

Although most occupational health research has been done with male subjects and on jobs traditionally done by men, research on reproductive hazards is an exception. Researchers were late to realize that men were exposed to reproductive hazards. However, women's health problems have been excluded from the large scientific literature on reproductive hazards, which has concentrated on hazards to fetuses. This is true even of much feminist-oriented research. This neglect is attributable to a reluctance to emphasize health hazards for women at work, since identifying those specific to women may militate against women's employment. Union action is in fact necessary to protect access to employment and health at the same time.

'Light' and 'heavy' work in the housekeeping service of a hospital.

Work is organized based in part on the perceptions, by managers and workers, of workers, their abilities and the characteristics of the work to be done. Physical tasks in factories and services have often been divided into 'light' and 'heavy', a division that often corresponds formally or informally to gender. We have observed the work of cleaners on wards and in offices in an acute-care hospital, using several indicators of workload to identify and characterize typical work situations. 'Heavy' work was characterized by neutral postures, walking, repetitive movements involving the articulations of the upper limb pushing a 1-6 kg (wet or dry) mop, with occasional more intense effort. 'Light' work was characterized by flexed postures, walking, rapid repetitive movements involving the articulations of the upper limb and light weights (dusting) or 1-3 kg weights (emptying wastebaskets), with more occasional intense effort. We did not discover any compelling reason to divide cleaning into 'light' and 'heavy' work. Task assignment by sex may appear to be a solution to excessive job demands which would be better addressed by job re-design.

Hospital trash: cleaners speak of their role in disease prevention.

Feminist researchers have contrasted the caring provided by women in hospitals with a more fragmented "curing" approach, which they identify with the predominantly male professions of medicine and surgery. The author spoke with hospital cleaners about their jobs and their health. Several themes emerged: the invisibility of the cleaning function, lack of respect for cleaners, representations of cleaning as undemanding, and assumptions that women's work in cleaning is particularly easy. Cleaners use various strategies to combat these stereotypes but receive little help from administrators or fellow employees. There is a hierarchy in the status of Québec hospital workers with curing (doctors) at the top, followed by caring and healing (nurses, therapists, and attendants), and hygiene (cleaners, sterilizers, and launderers) at the bottom. Authority hierarchies in health care are not related to gender in a simple way, although there is discrimination against women cleaners. The fact that cleaning, especially cleaning performed by women, is invisible to managers, other hospital personnel, and patients has important consequences for cleaners' and for patients' health.

Sex as a variable can be a surrogate for some working conditions: factors associated with sickness absence.

More than twice as many workdays are lost to illness than for personal or family reasons. We examine possible workplace determinants of sickness absence among French workers in the food processing industry. These workers are exposed to a variety of environmental and organizational constraints: cold, uncomfortable postures, assembly-line work, and irregular schedules. In 1987-1988, a medical examination and questionnaire were administered to 558 men and 790 women as part of a study of 17 poultry slaughterhouses and 6 canning factories. Women's and men's working conditions were very different, and their sickness absences for musculoskeletal and respiratory illnesses were related to some of their specific working conditions: cold exposure, ill-adapted work stations, and problems with their supervisors and co-workers. If male and female workers were combined into a single analysis that adjusted for sex, many of the associations operant for a single sex could no longer be seen.

Star wars and strategic defense initiatives: work activity and health symptoms of unionized bank tellers during work reorganization.

Work activity and health symptoms of bank tellers whose work was undergoing reorganization were examined during a university-union study of the health effects of work in women's traditional jobs. Data were gathered through collective and individual interviews, analysis of work activity, and a questionnaire administered to 305 tellers. Employees worked in a standing posture over 80 percent of the time. More than two-thirds frequently suffered pain in back, legs, and feet. The average teller had been involved in 3.7 robberies as a direct victim and six as a witness. Work required feats of memory and concentration. In order to meet job demands, tellers engaged in supportive activities and teamwork. The introduction of individualized objectives threatened the employees' ability to collaborate and induced distress. More than twice as many tellers as other female workers in Québec experience psychological distress (Ilfeld scale), related to: robbery during the past two years (odds ratio = 1.7; confidence interval = 1.0-2.9); difficult relations with superiors (O.R. = 2.6; C.I. = 1.3-5.3); and full-time work (O.R. = 2.3; C.I. = 1.3-3.9). Diverse methods enriched the analysis, and union participation allowed the proposal of concrete correction measures.

Women's occupational health: a critical review and discussion of current issues.

Action to improve women's occupational health has been slowed by a notion that women's jobs are safe and that any health problems identified among women workers can be attributed to unfitness for the job or unnecessary complaining. With increasing numbers of women in the labor force, the effects of work on women's health have recently started to interest health care providers, health and safety representatives and researchers. We begin our summary of their discoveries with a discussion of women's place in the workplace and its implications for occupational health, followed by a brief review of some gender-insensitive data-gathering techniques. We have then chosen to concentrate on the following four areas: methods and data collection; directing attention to women's occupational health problems; musculoskeletal disease; mental and emotional stress. We conclude by pointing out some neglected occupational groups and health issues.

The 120-S minute: using analysis of work activity to prevent psychological distress among elementary school teachers.

Primary school teachers in Québec suffer psychological distress, as shown by the Québec Health Survey (M. Gervais, 1993; Santè Québec, 1995). The authors applied and extended the French model (F. Guérin, A. Laville, F. Daniellou, J. Duraffourg, & A. Kerguelen, 1991) of analysis of work activity to observing classroom teaching (14 women in 10 classrooms for a total of 48 hr 24 min) to identify stressful elements. The authors observed a rapid sequence of actions, eye fixations of short duration, little physical or mental relaxation, multiple simultaneous activities, and uncomfortable temperature and humidity levels. Teachers use many strategies to teach, to create a learning environment, and to maintain attention in classrooms under adverse conditions. Examination of these strategies led to recommendations to improve relations between the teachers and their supervisors and to make the classroom an easier place to teach.

Perimenstrual symptoms and working conditions among hospital workers in Quebec.

Perimenstrual symptoms are among the most common disorders of women. Seven perimenstrual symptoms were related to working conditions among 539 hospital workers in a retrospective cohort questionnaire study, as part of a larger examination of health problems and working conditions of Quebec hospital workers. Only 8% of women had experienced no symptoms of discomfort associated with their last menstrual period. Lower abdominal pain, the most common symptom (58% prevalence), was associated with lifting weights (usually patients) in a logistic regression adjusted for parity and contraceptive use. Back pain, leg pain, swelling, and headache were associated with indicators of time pressure and fast work speed. Back pain during menstruation was experienced by 44% of workers. Studies of the prevalence and etiology of back pain, a common occupational health problem among hospital workers, may be confused if perimenstrual back pain is not taken into account. Similar reservations hold for the results on other perimenstrual symptoms that are also likely to occur outside the perimenstrual period, such as leg pain, irritability, and headache.

Evaluation of exposure data from men and women with the same job title.

In the epidemiological approach to occupational cancers, large bodies of data must be analyzed to find rare cases of cancer. The exposure status of workers must therefore be assessed. Inaccuracies will lead to bias toward the null value in certain cases. Job title has often been used as a proxy for exposure status. This study was undertaken to examine content (ie, tasks and activities) associated with job title among men and women in a large Québec municipality. Occupational accident reports were studied for 1589 accidents, and 113 men and women workers were interviewed about job content. Women and men did not seem to have the same accident rates. From interview data, it appeared that women and men with the same job title did not perform the same tasks. Thus, they might have different exposures. The data reported here support caution in using job title to estimate exposure for both genders if the job-exposure matrix has not previously been validated separately by gender. In addition, it may be unwise to adjust relationships between job title and cancer incidence for gender, thus treating gender as a confounder when it may be a proxy for specific exposures.

Effects of lymphocyte subpopulations on the clonal assay of HPRT mutants: occupational exposure to cytostatic drugs.

The mutagenic effect of occupational exposure to antineoplastic agents was studied in chemotherapy nurses and pharmacists using the T-lymphocyte clonal assay. A significant increase in mutant frequency was observed compared to controls. However, in the present study, cloning efficiency without selection (CEU) was significantly reduced in exposed personnel raising the possibility of an overestimation of the calculated MF. Changes in lymphocyte populations and clonal potential of T-cells were also observed following exposure. CEU was related to % CD4 cells but CE with selection (CETG) was not. Differences in clonal ability of T-cells under selective and unselective conditions coupled with differential lethal effect of antineoplastic agents on lymphocyte subsets may result in inaccurate estimation of MF.

HPRT-mutant frequency and lymphocyte characteristics of workers exposed to ionizing radiation on a sporadic basis: a comparison of two exposure indicators, job title and dose.

Using the clonal HPRT-mutant frequency assay, mutant frequencies of humans have been shown to rise following exposure to large doses of mutagens during radiotherapy, chemotherapy or after an atom bomb explosion. Success in relating mutant frequencies to exposure to high levels of mutagens has encouraged researchers to examine the effects of lower doses, such as those found among workers exposed at their jobs. In order to relate low doses of mutagens to biological effects, accurate characterization of exposure is critical, but most occupational studies are forced to use gross measures of exposure derived from job title or professional judgments as to potential exposure. Mutant frequencies and other relevant lymphocyte characteristics of 58 industrial workers were related to exposure status in two ways. When workers were classed as "exposed" or "unexposed" to ionizing radiation, no difference in any biological variable was seen between the two groups. When dosimeter readings were used as the exposure indicator, significant relationships appeared between dose and mutant frequency and CD4/CD8 lymphocyte subpopulation ratios. Mutant frequency was also positively related to age and smoking status. The time course of exposure and of appearance of mutant cells is discussed and it is suggested that this relationship receive attention in occupational studies of genotoxic effects.