The use of exoskeletons in the occupational context for primary, secondary, and tertiary prevention of work-related musculoskeletal complaints.

OCCUPATIONAL APPLICATIONS This guideline includes 20 recommendations and four key statements that achieved consensus or strong consensus regarding the application of exoskeletons in the workplace for the prevention of musculoskeletal complaints and diseases, the general use and implementation of exoskeletons, and recommendations for risk assessment. The guideline is intended for company physicians, occupational physicians, ergonomists, occupational safety specialists, and employers, and serves as information for all other actors in practical occupational safety. Due to the lack of evidence from the scientific literature, the recommendations and key statements are the result of expert discussions that were conducted at a consensus conference in accordance with the Regulations of the Association of the Scientific Medical Societies in Germany, moderated by an external consultant.

TECHNICAL ABSTRACT Background The prevention of work-related musculoskeletal complaints and diseases has high priority, considering the prevalence of musculoskeletal complaints and diseases and the associated high burden on health care systems, the economy, and the people affected. Purpose: This guideline provided recommendations for potential applications of exoskeletons in the workplace for the primary, secondary, and tertiary prevention of musculoskeletal complaints and diseases, general recommendations on the use and implementation of exoskeletons, and recommendations on risk assessment. Methods: A systematic literature search, a survey among exoskeleton manufacturers and companies using exoskeletons, and expert discussions formed the basis of the formulated recommendations and key statements. For reaching consensus on the recommendations and key statements, we applied the Nominal Group and Delphi Techniques under the supervision of an external, independent moderator. Results: We formulated 20 recommendations and four key statements, all of which reached consensus or strong consensus. Conclusion: No answers could be found in the current scientific literature to the central questions in this guideline about primary, secondary, and tertiary prevention. We outline five main directions for future research on exoskeletons in occupational settings. First, using exoskeletons for prevention should be investigated using randomized controlled trials. Second, the effects of exoskeletons on work-related musculoskeletal stress and strain should be investigated both in the body region intended to be supported by the exoskeleton as well as in other non-supported body regions. Third, the effects of exoskeletons should be investigated in samples varying in age, gender, and health status, as well as during different occupational activities. Fourth, a specific risk assessment tool for exoskeletons in occupational settings should be developed and implemented to meet and evaluate the applicable occupational health and safety standards. Fifth, there is a need to expand upon the very limited social science research on the impacts of exoskeletons on employee professional understanding, social role understanding, or diversity.

Prevalence of falls in elderly women.

OBJECTIVE: To verify prevalence of falls and fear of falling, and to compare functional fitness among elderly women fallers and non-fallers. METHODS: Seventy-eight elderly women participated in this study. Cases of falls and the fear of falling were self-reported by the elderly women, while the functional fitness was measured by a set of functional tests. Mean and standard deviation were used to describe the sample. Independent t-test was used to compare functional fitness between groups. RESULTS: The prevalence of falls in this sample was 32.4%. Among women fallers, 40% self-reported a high fear of falling. CONCLUSION: It is recommended that functional and resistance exercises are included in the preventive strategies for reducing risk factors for falls and its determinants in elderly women. Level of Evidence II, Prognostic-Prospective Study.

Prevalência de quedas em mulheres idosas / Prevalence of falls in elderly women

Objetivo: Verificar a prevalência de quedas e do medo de cair novamente, e comparar a aptidão funcional entre mulheres idosas que sofreram ou não quedas no último ano. Métodos: Participaram deste estudo 78 mulheres idosas. Os casos de quedas e o medo de cair novamente foram auto reportados pelas idosas, enquanto a avaliação funcional foi mensurada por meio de uma bateria de testes funcionais. A descrição da amostra foi realizada pela média e desvio padrão. O Test-t independente foi utilizado para no grupo estudado foi de 32,4%. Dentre as idosas que caíram, 40% reportaram elevado medo de cair novamente. Conclusão: Recomenda-se que exercícios funcionais e resistidos sejam incluídos nas ações preventivas de forma a auxiliar na diminuição dos fatores de risco e nos determinantes de quedas em idosos.

Objective: To verify prevalence of falls and fear of falling, and to compare functional fitness among elderly women fallers and non-fallers. Methods: Seventy-eight elderly women participated in this study. Cases of falls and the fear of falling were self-reported by the elderly women, while the functional fitness was measured by a set of functional tests. Mean and standard deviation were used to describe the sample. Independent t-test was used to compare functional fitness between groups. Results: The prevalence of falls in this sample was 32.4%. Among women fallers,40% self-reported a high fear of falling. Conclusion: It is recommended that functional and resistance exercises are included in the preventive strategies for reducing risk factors for falls and its determinants in elderly women.

Comparison of the functional profile of elderly women with urinary continence and incontinence / Comparação do perfil funcional de mulheres idosas com continentes urinária e incontinentes urinária

Urinary incontinence (UI), more prevalent in women and influencing their functional decline, increases with age. Current longitudinal study with two data collection in 2005-2006 and 2011 compares the functional profile of urinary continence and incontinence in elderly women. Sixty-eight women were divided into females with urinary continence (CG; n = 62) and females with urinary incontinence (IG; n = 6). Dependent variables measured were obesity and body adiposity indexes and functional fitness. Data were given in means with standard deviation (±) and analyzed by the independent t-test (p < 0.05). There were six cases of UI. In the first evaluation group differences occurred for waist circumference (CG: 85.3±9.7 cm; IG: 91.2 ± 12.4cm; t=-2.267; p < 0.05) and cardiorespiratory fitness (CG: 517.9 ± 67.3 m; IG: 463.0±85.9 m; t = 2.571; p < 0.05). CG had a better functional profile, excepting flexibility and lower limbs strength, in the second evaluation. Women with UI had higher waist circumference and lower cardiorespiratory fitness. This may be due to the relationship between the variables and greater abdominal compression and functional decline. Results show that future public health strategies should focus on these factors to decrease the risk of people developing UI and to improve physical-functional and psycho-social benefits to elderly women.

O risco de incontinência urinária (IU) aumenta com o decorrer da idade, sendo mais prevalente em mulheres e pode acelerar o declínio funcional. O objetivo do estudo foi comparar a aptidão funcional de idosas continentes e incontinentes. Estudo longitudinal com duas avaliações: 2005-2006 e 2011. Participaram deste estudo 68 mulheres classificadas em: continentes (GC; n = 62) e Incontinentes (GI; n = 6) . Foram avaliados indicadores de obesidade e adiposidade corporal, e aptidão funcional. Os dados foram descritos pela média, desvio-padrão (±) e analisados pelo Test-t independente. Ocorreram seis casos incidentes de IU. Os grupos diferiram nas variáveis circunferência de cintura (GC: 85,3 ± 9,7 cm; e GI: 91,2 ± 12,4 cm; t = -2,267; p < 0,05) e aptidão cardiorrespiratória (GC: 517,9 ± 67,3 m; e GI: 463,0 ± 85,9 m; t = 2,571; p < 0,05) na primeira avaliação. O GC apresentou melhor perfil funcional, com exceção da flexibilidade e força de membros inferiores na segunda avaliação. Mulheres que desenvolveram IU apresentam excesso de adiposidade central e menor aptidão cardiorrespiratória. Tal fato pode ser explicado pela relação dessas variáveis com maior compressão abdominal e o declínio funcional. Sendo assim, recomenda-se que futuras estratégias de saúde pública enfoquem esses fatores a fim de minimizar o risco de IU, e consequentemente, refletindo em benefícios físico-funcionais, e psicossociais a estes indivíduos.

Estudo longitudinal do nível de atividade física de mulheres idosas / Longitudinal study of physical activity level of older adult women

O objetivo deste estudo foi analisar as alterações longitudinais no nível de atividade física (NAF) de mulheres idosas. Este estudo longitudinal conduziu a primeira avaliação em 2005 e 2006, e a segunda avaliação em 2011, na qual participaram 78 mulheres (73,2±5,2 anos). O NAF foi avaliado através do Modified Baecke Questionnaire for Older Adults, o qual inclui os domínios: doméstico, esportivo e recreativo. A descrição da amostra foi realizada pela média e desvio padrão. A análise dos dados foi realizada por uma MANOVA e do teste multivariado de Hotelling?s trace afim de verificar o efeito do tempo sobre os domínios do NAF (p<0,05). O teste multivariado de Hotelling?s trace indicou diferenças significativas da variável independente (efeito do tempo: avaliações 1 e 2) (F1,154=2,923; p=0,036), para o NAF total (F1,154=5,449; p=0,021), e domínios doméstico (F1,154=4,325; p=0,039) e recreativo (F1,154=5,299; p=0,023). O NAF total alterou em -16,7%, NAF doméstico em -7,6%, NAF recreativo em -48,6% (todos com p<0,05); e o NAF esportivo declinou 12,0% (F1,154 = 0,892; p=0,346). Concomitantemente ao avanço da idade, ocorre um declínio nos domínios do NAF de idosas, seja em atividades relacionadas ao cuidado da residência, exercícios físicos, ou atividades recreativas. Esses resultados demonstram a necessidade de maximizar politicas públicas para o cuidado à saúde do idoso a fim de promover atividades físicas nos diferentes domínios, e motivar idosos a manterem uma vida ativa e independente, principalmente participando regularmente de um programa de exercícios físicos, beneficiando a qualidade e os anos adicionais de vida e desta população.

The aim of this study was to analyze longitudinal changes on physical activity level (PAL) of older adult women. This longitudinal study conducted the first evaluation on 2005 and 2006, and the second evaluation on 2011, in which 78 older women (73.2±5.2 yrs) participated in the follow-up evaluation. PAL was evaluated by the Modified Baecke Questionnaire for Older Adults, which includes the domestic, sportive and recreational domains. Data was described by mean and standard deviation, and was analyzed by using a MANOVA and the Hotelling?s trace multivariate test with the purpose to verify a time main effect on PAL domains (p<0.05). The multivariate test indicated significant differences for the independent variables (time effect: baseline and follow-up evaluations; F1,154=2,923; p=0.036) for PAL-total (F1,154=5,449; p=0.021), PAL-domestic (F1,154=4,325; p=0.039) and PAL-leisure (F1,154=5,299; p=0.023). The PAL-total changed in -16.7%, PAL-domestic in -7.6%, PAL-leisure in -48.6% (all p<0.05); and the PAL-sportive declined in 12.0% (F1,154=0.892; p=0.346). Concurrently with aging, there is a declined on PAL domains that could be related to domestic, exercise, or recreational activities. These results demonstrated the need to maximize public health policies with the purpose to improve the health status of older adults by increasing the PAL on different domains, and also to motivate older adults to maintain an active and independent lifestyle, mainly enrolling in exercise program, leading to positive effects on quality of life, and on the additional years of life of this population.

Ergonomic risk assessment with DesignCheck to evaluate assembly work in different phases of the vehicle development process.

Occupational hazards exist, if the design of the work situation is not in accordance with ergonomic design principles. At assembly lines ergonomics is applied to the design of work equipment and tasks and to work organisation. The ignoring of ergonomic principles in planning and design of assembly work leads to unfavourable working posture, action force and material handling. Disorders of the musculoskeletal system are of a common occurrence throughout Europe. Musculoskeletal disorders are a challenge against the background of disabled workers. The changes in a worker's capability have to be regarded in the conception of redesigned and new assembly lines. In this way ergonomics becomes progressively more important in planning and design of vehicles: The objective of ergonomic design in different stages of the vehicles development process is to achieve an optimal adaptation of the assembly work to workers. Hence the ergonomic screening tool "Design Check" (DC) was developed to identify ergonomic deficits in workplace layouts. The screening-tool is based on the current ergonomic state of the art in the design of physical work and relevant EU legal requirements. It was tested within a federal German research project at selected work stations at the assembly lines at Dr.-Ing. h.c. F. Porsche AG / Stuttgart. Meanwhile the application of the screening-tool DC is transferred in other parts of the Porsche AG, Stuttgart. It is also realized as an ergonomic standard method to perform assembly work in different phases of the vehicle development process.

Eldercare demands, mental health, and work performance: the moderating role of satisfaction with eldercare tasks.

Due to demographic changes, a growing number of employees provide in-home care to an elderly family member. Previous research suggested a negative relationship between employees' eldercare demands and their work performance. However, the empirical nature of this relationship and its boundary conditions and mediating mechanisms have been neglected. The goal of this multisource study was to examine a mediated-moderation model of eldercare demands, mental health, and work performance. Drawing on the theory of conservation of resources (Hobfoll, 1989), it was expected that employees' satisfaction with eldercare tasks would buffer the negative relationship between eldercare demands and work performance, and that mental health would mediate this moderating effect. Data were collected from 165 employees providing in-home eldercare, as well as from one colleague and one family member of each employee. Results of mediated-moderation analyses supported the hypothesized model. The findings suggest that interventions that aim to increase employees' satisfaction with eldercare tasks may help protect employees from the negative effects of high eldercare demands on mental health and, subsequently, on work performance.