Improving work for the body - a participatory ergonomic intervention aiming at reducing physical exertion and musculoskeletal pain among childcare workers (the TOY-project): study protocol for a wait-list cluster-randomized controlled trial.

BACKGROUND: The prevalence of musculoskeletal pain (MSP) is persistently high throughout the world. Work-related factors such as high physical workload (lifting, bending and twisting of the back) are considered to be among the main causes of MSP. Work in childcare includes the need to lift, carry, and support children in a range of activities, requiring several demanding postures and movements, such as bending forward and twisting of the back and sitting on the floor. Participatory ergonomics may represent a solution for decreasing the physical workload to reduce MSP. We present the protocol of a study aiming to evaluate the effect and process of a participatory ergonomics intervention designed to reduce physical exertion during work and MSP (including MSP interfering with work) among childcare workers. METHODS/DESIGN: This study will use a two-arm cluster-randomized design employing a wait-list control, with childcare institutions forming the clusters. Three workshops will be conducted during the 4-month intervention period. Participants will identify risk factors for strenuous work and MSP, develop solutions for reducing the identified risk factors, and implement them in their team. An ergonomic consultant will guide the process. The data collection will consist of questionnaires and objective measures of heart rate and physical activity, observations of physical workload, and information on sickness absence based on company records. Primary outcomes are physical exertion during work and MSP (including pain-related work interference) measured at 4 months. Secondary outcomes measured at 4 months are sickness absence due to MSP; objectively measured occupational physical activity and heart rate; and self-reported self-efficacy, employee involvement, and need for recovery. Alongside the trial, a process evaluation and an economic evaluation will be conducted. DISCUSSION: The study will evaluate the effect and process of a participatory ergonomics intervention to reduce physical exertion at work and MSP among childcare workers. By performing a cluster-randomized controlled trial with an effect evaluation based on both objective and self-reported measures with the addition of a process evaluation and economic evaluation, this study will contribute to the evidence for prevention of MSP among a less studied occupational group. Results are expected in 2018-2019. TRIAL REGISTRATION: ISRCTN, ISRCTN10928313 . Registered on 11 January 2017.

The association between health and sickness absence among Danish and non-Western immigrant cleaners in Denmark.

PURPOSE: The aim of the study is to investigate the association between health and sickness absence among Danish and non-Western immigrant cleaners in Denmark. METHODS: This study is based on a cross-sectional analysis of baseline data from 2007 to 2008. The study population includes 276 cleaners, 144 Danish and 132 non-Western immigrant cleaners. Cumulative sickness absences during a 6-month period from administrative records were subdivided into no sickness absence (0 days), low occurrence of sickness absence (1-10 days) and high occurrence of sickness absence (over 10 days). Measures of health consisted of self-report and objective assessments. The relationship between sickness absence and health was analyzed through multinomial logistic regression, stratified by immigrant status. RESULTS: For both Danish and non-Western immigrant cleaners, poor self-reported health was significantly related to high occurrence of sickness absence. Among Danish cleaners, high blood pressure was related to high occurrence of sickness absence. Among non-Western immigrant cleaners, total body pain and having one or more diagnosed chronic disease were related to high occurrence of sickness absence. No association between health and low occurrence of sickness absence was found. CONCLUSIONS: The findings confirm the importance of health for high occurrence of sickness absence, in both ethnic groups. Moreover, low occurrence of sickness absence was not related to the health conditions investigated.

Diet, physical exercise and cognitive behavioral training as a combined workplace based intervention to reduce body weight and increase physical capacity in health care workers - a randomized controlled trial.

BACKGROUND: Health care workers comprise a high-risk workgroup with respect to deterioration and early retirement. There is high prevalence of obesity and many of the workers are overweight. Together, these factors play a significant role in the health-related problems within this sector. The present study evaluates the effects of the first 3-months of a cluster randomized controlled lifestyle intervention among health care workers. The intervention addresses body weight, general health variables, physical capacity and musculoskeletal pain. METHODS: 98 female, overweight health care workers were cluster-randomized to an intervention group or a reference group. The intervention consisted of an individually dietary plan with an energy deficit of 1200 kcal/day (15 min/hour), strengthening exercises (15 min/hour) and cognitive behavioral training (30 min/hour) during working hours 1 hour/week. Leisure time aerobic fitness was planned for 2 hour/week. The reference group was offered monthly oral presentations. Body weight, BMI, body fat percentage (bioimpedance), waist circumference, blood pressure, musculoskeletal pain, maximal oxygen uptake (maximal bicycle test), and isometric maximal muscle strength of 3 body regions were measured before and after the intervention period. RESULTS: In an intention-to-treat analysis from pre to post tests, the intervention group significantly reduced body weight with 3.6 kg (p < 0.001), BMI from 30.5 to 29.2 (p < 0.001), body fat percentage from 40.9 to 39.3 (p < 0.001), waist circumference from 99.7 to 95.5 cm (p < 0.001) and blood pressure from 134/85 to 127/80 mmHg (p < 0.001), with significant difference between the intervention and control group (p < 0.001) on all measures. No effect of intervention was found in musculoskeletal pain, maximal oxygen uptake and muscle strength, but on aerobic fitness. CONCLUSION: The significantly reduced body weight, body fat, waist circumference and blood pressure as well as increased aerobic fitness in the intervention group show the great potential of workplace health promotion among this high-risk workgroup. Long-term effects of the intervention remain to be investigated. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01015716.

Health disparities between immigrant and Danish cleaners.

PURPOSE: It is unknown whether immigrants working in the cleaning industry have a poorer health and work ability than cleaners from the native population. The main aim was to investigate differences in objective and self-reported health measures between immigrant and Danish cleaners. METHODS: Three hundred and fifty-one cleaners, consisting of 166 Danes (88% women) and 179 immigrants (74% women) (6 with unknown ethnicity), from 9 workplaces in Denmark participated in the study. Health and work ability were obtained by objective (e.g., BMI and blood pressure) and self-reported measures (e.g., work ability, self-rated health, and musculoskeletal symptoms). In order to investigate differences between Danish and immigrant cleaners, logistic regression analyses and General Linear Models were performed. RESULTS: When controlling for age, sex, workplace, job seniority, and smoking, more Danish compared with immigrant cleaners were current smokers (42% vs. 28%, p < 0.001 (not controlled for smoking)), had hypertension (46% vs. 26%, p < 0.05) and drank more alcohol (3.0 vs. 0.8 units per day, respectively, p < 0.001). Contrary, more immigrants compared with Danish cleaners were measured to be overweight (47% vs. 30%, p < 0.05), reported less than good work ability (57% vs. 42%, p < 0.01), considered it unthinkable/unsure to be able to perform work 2 years ahead (37% vs. 23%, p < 0.01), reported reduced self-rated health (46% vs. 38%, p < 0.01) and everyday pain in the neck/shoulder (28% vs. 11%, p < 0.01), wrist (18% vs. 7%, p < 0.01), and lower back (21% vs. 10%, p < 0.01). There were no differences in self-reported chronic diseases. CONCLUSIONS: Although the health of the cleaners was alarmingly poor, the immigrant cleaners generally had a poorer self-reported health and work ability than the Danish cleaners. These findings highlight the need for occupational health actions among cleaners, particularly tailored to the immigrant subpopulation.

Successful reach and adoption of a workplace health promotion RCT targeting a group of high-risk workers.

BACKGROUND: Cleaners are rarely introduced to workplace health promotion programs. The study's objective was to evaluate the reach and adoption of a workplace randomized controlled trial (RCT) among cleaners in Denmark. METHODS: Cleaning businesses with at least 30 employees, that could offer a weekly 1-hour intervention during working hours, were invited to participate. Employees working at least 20 hours/week were invited to answer a screening questionnaire and consent to participate. Analyses determined the differences in health variables between responders and non-responders, consenters and non-consenters, participants and non-participants and between participants of the RCT's three groups: physical coordination training, cognitive-behavioural theory-based training and reference group. RESULTS: From 16 eligible workplaces, a representative sample of 50% adopted the trial. Of 758 eligible employees, 78% responded to the screening questionnaire and 49% consented to participate. Consenters and participants differed from non-consenters and non-participants by having higher BMI, more chronic diseases and poorer musculoskeletal health. CONCLUSIONS: This study indicates that workplace health promotion programs directed at health risk factors among cleaners enable significant adoption and reach to a high-risk subgroup of the Danish workforce. TRIAL REGISTRATION: Trial registration ISRCTN96241850.