A scoping review to identify strategies that work to prevent four important occupational diseases.

BACKGROUND: Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts. METHODS: To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants. RESULTS: We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity. CONCLUSIONS: This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.

Are work organization interventions effective in preventing or reducing work-related musculoskeletal disorders? A systematic review of the literature.

Objectives We sought to determine whether interventions that target work organization or the psychosocial work environment are effective in preventing or reducing work-related musculoskeletal disorders (WMSD) compared to usual work. Methods We systematically reviewed the 2000-2015 English- and French-language scientific literature, including studies evaluating the effectiveness of an organizational or psychosocial work intervention on incidence, prevalence or intensity of work-related musculoskeletal pain or disorders in the neck, shoulders, upper limbs and/or back or of work absence due to such problems, among non-sick-listed workers. We excluded rehabilitation and individual-level behavioral interventions and studies with >50% attrition. We analyzed medium- and high-quality studies and synthesized the evidence using the Grading of Recommendations Assessment, Development & Evaluation (GRADE) approach. An analysis of key workplace intervention elements supplemented the interpretation of results. Results We identified 884 articles; 28 met selection criteria, yielding 2 high-quality, 10 medium-quality and 16 low-quality studies. There was moderate evidence that supplementary breaks, compared to conventional break schedules, are effective in reducing symptom intensity in various body regions. Evidence was low-to-very-low quality for other interventions, primarily due to risk of bias related to study design, high attrition rates, co-interventions, and insensitive indicators. Most interventions lacked key intervention elements, such as work activity analysis and ergonomist guidance during implementation, but the relation of these elements to intervention effectiveness or ineffectiveness remains to be demonstrated. Conclusions Targeting work-rest cycles may reduce WMSD. Better quality studies are needed to allow definitive conclusions to be drawn on the effectiveness of other work organizational or psychosocial interventions to prevent or reduce WMSD.

Relations between work and upper extremity musculoskeletal problems (UEMSP) and the moderating role of psychosocial work factors on the relation between computer work and UEMSP.

PURPOSE: Computer work has been identified as a risk factor for upper extremity musculoskeletal problems (UEMSP). But few studies have investigated how psychosocial and organizational work factors affect this relation. Nor have gender differences in the relation between UEMSP and these work factors  been studied. We sought to estimate: (1) the association between UEMSP and a range of physical, psychosocial and organizational work exposures, including the duration of computer work, and (2) the moderating effect of psychosocial work exposures on the relation between computer work and UEMSP. METHODS: Using 2007-2008 Québec survey data on 2478 workers, we carried out gender-stratified multivariable logistic regression modeling and two-way interaction analyses. RESULTS: In both genders, odds of UEMSP were higher with exposure to high physical work demands and emotionally demanding work. Additionally among women, UEMSP were associated with duration of occupational computer exposure, sexual harassment, tense situations when dealing with clients, high quantitative demands and lack of prospects for promotion, and among men, with low coworker support, episodes of unemployment, low job security and contradictory work demands. Among women, the effect of computer work on UEMSP was considerably increased in the presence of emotionally demanding work, and may also be moderated by low recognition at work, contradictory work demands, and low supervisor support. CONCLUSIONS: These results suggest that the relations between UEMSP and computer work are moderated by psychosocial work exposures and that the relations between working conditions and UEMSP are somewhat different for each gender, highlighting the complexity of these relations and the importance of considering gender.

Obstacles to and facilitators of return to work after work-disabling back pain: the workers' perspective.

INTRODUCTION: Back pain entails considerable costs, particularly because many injured workers are absent from work for long periods. Factors that influence return to work among workers with back pain are still, however, not well understood. This qualitative study aimed at documenting affected workers' perspective on the: 1--difficulties caused by back pain, and 2--most important obstacles to and facilitators of return to work. METHODS: Two focus groups composed of workers having suffered from work-disabling back pain were held: a group of participants who had returned to work (n = 9) and a group of participants who had not returned or had recently returned to work (n = 10). The verbatim accounts of the discussions were transcribed and a content analysis was carried out that included a ranking of items. RESULTS: Difficulties caused by back pain were related to: (1) personal, (2) family, (3) social, (4) occupational, and (5) financial factors, and (6) health services. Obstacles to and facilitators of return to work were of 4 different types: (1) occupational factors, (2) factors associated with the utilization of health services, (3) clinical, and (4) personal factors. Persistent pain, lack of access to information or support groups, and lack of collaboration and understanding from employer were the most important obstacles identified, whereas knowledge of one's limits and physical training were perceived to be the most important facilitators of return to work, ahead of work-related factors. Differences between groups' perceptions were attributed mainly to control beliefs. CONCLUSIONS: Personal, clinical, occupational and health services factors are perceived by workers with back pain to play a crucial role in determining whether they return to work or not.

Are there health effects of harassment in the workplace? A gender-sensitive study of the relationships between work and neck pain.

The aim of this study was to identify workplace physical and psychosocial risk factors for neck pain among male and female workers and, in particular, to study the relationship between neck pain and intimidation and sexual harassment in the workplace in a representative sample of the Quebec working population. The study sample included 5405 men and 3987 women. In multiple logistic regression analyses, when taking into account individual and other workplace factors, neck pain was significantly associated with intimidation at work among both male (odds ratio (OR) 1.4 (1.01-1.8)) and female workers (OR 1.3 (1.01-1.8)). Among female workers, neck pain was alsosignificantly associated with unwanted sexual attention (OR 1.6 (1.1-2.4)). If confirmed in prospective studies, these results suggest that interventions to prevent harassment in the workplace may help reduce musculoskeletal disorders in the workplace and that workplace programmes to reduce harassment in the workplace should include prevention of sexual harassment. PRACTITIONER SUMMARY: While taking into account relevant personal factors and previously identified workplace physical and psychosocial risk factors, this gender-based study identifies new work exposures associated with neck pain that have not previously been studied, including unwanted sexual attention, intimidation and difficult or tense situations with the public.

Research opportunities using administrative databases and existing surveys for new knowledge in occupational health and safety in Canada, Quebec, Ontario and British Columbia.

In Canada, many datasets are initially collected for purposes other than occupational health and safety (OHS) research. These include administrative health care billing records, pharmaceutical records, vital statistics, provincial cancer registries and workers' compensation claims data. In addition, many national and provincial health surveys, while not focused specifically on occupational health and safety, collect data on the health status and health determinants of populations, and such data can be used for investigating OHS issues among Canadian workers. This paper provides examples of the use of administrative and survey data for OHS research projects from the provinces of Quebec, Ontario and British Columbia to illustrate the potential of such data. These three provinces have a long history of using administrative and survey data for OHS research and have developed capacity in this regard for improving access to data, for linkage of records across databases and for developing methods to answer OHS questions. As research using these data sources expands, a consistent understanding within the work and health research community must be forged concerning the strengths and limitations of these data resources and their comparability.

Should studies of risk factors for musculoskeletal disorders be stratified by gender? Lessons from the 1998 Québec Health and Social Survey.

OBJECTIVES: Several studies have reported male-female differences in the prevalence of symptoms of work-related musculoskeletal disorders (MSD), some arising from workplace exposure differences. The objective of this paper was to compare two strategies analyzing a single dataset for the relationships between risk factors and MSD in a population-based sample with a wide range of exposures. METHODS: The 1998 Québec Health and Social Survey surveyed 11 735 respondents in paid work and reported "significant" musculoskeletal pain in 11 body regions during the previous 12 months and a range of personal, physical, and psychosocial risk factors. Five studies concerning risk factors for four musculoskeletal outcomes were carried out on these data. Each included analyses with multiple logistic regression (MLR) performed separately for women, men, and the total study population. The results from these gender-stratified and unstratified analyses were compared. RESULTS: In the unstratified MLR models, gender was significantly associated with musculoskeletal pain in the neck and lower extremities, but not with low-back pain. The gender-stratified MLR models identified significant associations between each specific musculoskeletal outcome and a variety of personal characteristics and physical and psychosocial workplace exposures for each gender. Most of the associations, if present for one gender, were also found in the total population. But several risk factors present for only one gender could be detected only in a stratified analysis, whereas the unstratified analysis added little information. CONCLUSIONS: Stratifying analyses by gender is necessary if a full range of associations between exposures and MSD is to be detected and understood.

Determinants of "return to work in good health" among workers with back pain who consult in primary care settings: a 2-year prospective study.

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.

A clinical return-to-work rule for patients with back pain.

BACKGROUND: Tools for early identification of workers with back pain who are at high risk of adverse occupational outcome would help concentrate clinical attention on the patients who need it most, while helping reduce unnecessary interventions (and costs) among the others. This study was conducted to develop and validate clinical rules to predict the 2-year work disability status of people consulting for nonspecific back pain in primary care settings. METHODS: This was a 2-year prospective cohort study conducted in 7 primary care settings in the Quebec City area. The study enrolled 1007 workers (participation, 68.4% of potential participants expected to be eligible) aged 18-64 years who consulted for nonspecific back pain associated with at least 1 day's absence from work. The majority (86%) completed 5 telephone interviews documenting a large array of variables. Clinical information was abstracted from the medical files. The outcome measure was "return to work in good health" at 2 years, a variable that combined patients' occupational status, functional limitations and recurrences of work absence. Predictive models of 2-year outcome were developed with a recursive partitioning approach on a 40% random sample of our study subjects, then validated on the rest. RESULTS: The best predictive model included 7 baseline variables (patient's recovery expectations, radiating pain, previous back surgery, pain intensity, frequent change of position because of back pain, irritability and bad temper, and difficulty sleeping) and was particularly efficient at identifying patients with no adverse occupational outcome (negative predictive value 78%- 94%). INTERPRETATION: A clinical prediction rule accurately identified a large proportion of workers with back pain consulting in a primary care setting who were at a low risk of an adverse occupational outcome.

Reproducibility and validity of workers' self-reports of physical work demands.

The objective of this paper is to provide a systematic review of the reproducibility and validity of self-report questions concerning physical work demands. After a bibliographic search of Medline and Ergonomic Abstracts for 1980-2003, 15 articles meeting the eligibility criteria were reviewed for methodological quality; 82 formulations of questions on physical work demands were evaluated for reproducibility and 83 for validity. Questions evaluated for both reproducibility and validity that performed well in both sets of studies included those on duration or presence of sitting and standing posture, the presence of walking, kneeling or squatting postures, duration or frequency of hands above shoulders, manual handling of more than or less than 10 kg, general level of physical effort, presence and duration of whole-body vibration, and duration of the use of visual display terminals. Suggestions for improving the design of reproducibility and validity studies and directions for future research in physical workload measurement are proposed.

The interrater reliability of a functional capacity evaluation: the physical work performance evaluation.

The purpose was to evaluate the interrater reliability of the Dynamic Strength, Position Tolerance, and Mobility tasks of the Physical Work Performance Evaluation (PWPE), a Functional Capacity Evaluation often used with workers disabled due to back pain. For each worker's evaluation, two raters were preselected among five trained raters. One of the raters administered the PWPE while the other functioned as a silent rater. A convenience sample of 40 workers disabled due to back pain and referred to an occupational rehabilitation center was used. In general, the reliability was "substantial" (0.61 < or = kappa < or = 0.80) to "almost perfect" (0.81 < or = kappa < or = 1.00) for most of the 21 tasks and three sections of the PWPE evaluated with the exception of three tasks in the Mobility section (ladder climbing (kappa = 0.47), repetitive trunk rotation--standing (kappa = 0.54), and repetitive trunk rotation--sitting (kappa = 0.37)) task and the Mobility section itself (kappa = 0.54). Several reasons could explain the lower agreement on the observation of the physical signs associated with these tasks. Since these tasks involve rotation movements or complex neuromuscular integration, it seemed difficult for the raters to define what are the normal physical signs and when physical signs of maximal functional capacity are present. The criteria for establishing the presence of the physical signs in the PWPE should be improved.

Be the fairest of them all: challenges and recommendations for the treatment of gender in occupational health research.

BACKGROUND: Both women's and men's occupational health problems merit scientific attention. Researchers need to consider the effect of gender on how occupational health issues are experienced, expressed, defined, and addressed. More serious consideration of gender-related factors will help identify risk factors for both women and men. METHODS: The authors, who come from a number of disciplines (ergonomics, epidemiology, public health, social medicine, community psychology, economics, sociology) pooled their critiques in order to arrive at the most common and significant problems faced by occupational health researchers who wish to consider gender appropriately. RESULTS: This paper describes some ways that gender can be and has been handled in studies of occupational health, as well as some of the consequences. The paper also suggests specific research practices that avoid errors. Obstacles to gender-sensitive practices are considered. CONCLUSIONS: Although gender-sensitive practices may be difficult to operationalize in some cases, they enrich the scientific quality of research and should lead to better data and ultimately to well-targeted prevention programs.