Assessing contact dermatitis risk among Manitoba workers in the Manitoba Occupational Disease Surveillance System.

INTRODUCTION: This exploratory study aimed to assess contact dermatitis (CD) risk among workers using the Manitoba Occupational Disease Surveillance System (MODSS). METHODS: The MODSS linked accepted time-loss claims from the Workers' Compensation Board of Manitoba (2006-2019), with administrative health data from medical and hospital records (1996-2020). CD risk by occupation and industry (hazard ratio, 95% confidence intervals) was estimated using Cox proportional hazard models, adjusted for age and stratified by sex. RESULTS: Increased risk of new onset CD was observed among some occupations and industries with known skin irritants and allergens. Some occupations with known increased risks of CD remained elevated when removing the accepted WCB cases was performed, suggesting that all CD cases in these occupations may not show up in WCB statistics. Increased risk was also observed for occupations and industries with unknown exposures related to CD, whereas some groups known to be at risk of CD were not observed to have elevated risks in this cohort. DISCUSSION: The MODSS successfully identified some occupations and industries known to be at high risk of occupational CD, but not others. Some occupations not typically associated with work-related CD were also identified, which warrants further investigation.

Sex and Gender Differences in Occupational Hazard Exposures: a Scoping Review of the Recent Literature.

PURPOSE OF REVIEW: Comparative research on sex and/or gender differences in occupational hazard exposures is necessary for effective work injury and illness prevention strategies. This scoping review summarizes the peer-reviewed literature from 2009 to 2019 on exposure differences to occupational hazards between men and women, across occupations, and within the same occupation. RECENT FINDINGS: Fifty-eight studies retrieved from eight databases met our inclusion criteria. Of these, 30 studies were found on physical hazards, 38 studies on psychological/psychosocial hazards, 5 studies on biological hazards, and 17 studies on chemical hazards. The majority of studies reported that men were exposed to noise, vibration, medical radiation, physically demanding work, solar radiation, falls, biomechanical risks, chemical hazards, and blood contamination; while women were exposed to wet work, bullying and discrimination, work stress, and biological agents. Within the same occupations, men were more likely to be exposed to physical hazards, with the exception of women in health care occupations and exposure to prolonged standing. Women compared to men in the same occupations were more likely to experience harassment, while men compared to women in the same occupations reported higher work stress. Men reported more exposure to hazardous chemicals in the same occupations as women. The review suggests that men and women have different exposures to occupational hazards and that these differences are not solely due to a gendered distribution of the labor force by occupation. Findings may inform prevention efforts seeking to reduce gender inequalities in occupational health. Future research is needed to explain the reasons for sex/gender inequality differences in exposures within the same occupation.

Utility of algorithms for the analysis of integrated Salmonella surveillance data.

The objective of this study was to assess the use of statistical algorithms in identifying significant clusters of Salmonella spp. across different sectors of the food chain within an integrated surveillance programme. Three years of weekly Salmonella serotype data from farm animals, meat, and humans were used to create baseline models (first two years) and identify weeks with counts higher than expected using surveillance algorithms in the third (test) year. During the test year, an expert working group identified events of interest reviewing descriptive analyses of same data. The algorithms did not identify Salmonella events presenting as gradual increases or seasonal patterns as identified by the working group. However, the algorithms did identify clusters for further investigation, suggesting they could be a valuable complementary tool within an integrated surveillance system.

Physical Activity and Exercise Interventions in the Workplace Impacting Work Outcomes: A Stakeholder-Centered Best Evidence Synthesis of Systematic Reviews.

BACKGROUND: The prevention of work disability is beneficial to employees and employers, and mitigates unnecessary societal costs associated with social welfare. Many service providers and employers have initiated workplace interventions designed to reduce unnecessary work disability. OBJECTIVE: To conduct a best-evidence synthesis of systematic reviews on workplace interventions that address physical activities or exercise and their impact on workplace absence, work productivity or financial outcomes. METHODS: Using a participatory research approach, academics and stakeholders identified inclusion and exclusion criteria, built an abstraction table, evaluated systematic review quality and relevance, and interpreted the combined findings. A minimum of two scientists participated in a methodological review of the literature followed by a consensus process. RESULTS: Stakeholders and researchers participated as a collaborative team. 3363 unique records were identified, 115 full text articles and 46 systematic reviews were included, 18 assessed the impact of physical fitness or exercise interventions. 11 focused on general workers rather than workers who were absent from work at baseline; 16 of the reviews assessed work absence, 4 assessed productivity and 6 assessed financial impacts. CONCLUSION: The strongest evidence supports the use of short, simple exercise or fitness programs for both workers at work and those absent from work at baseline. For workers at work, simple exercise programs (1-2 modal components) appear to provide similar benefits to those using more complex multimodal interventions. For workers off-work with subacute low back pain, there is evidence that some complex exercise programs may be more effective than simple exercise interventions, especially if they involve workplace stakeholder engagement, communication and coordination with employers and other stakeholders. The development and utilization of standardized definitions, methods and measures and blinded evaluation would improve research quality and strengthen stakeholder-centered guidance.

Mental Health Interventions in the Workplace and Work Outcomes: A Best-Evidence Synthesis of Systematic Reviews.

BACKGROUND: Mental health issues in the workplace are a growing concern among organizations and policymakers, but it remains unclear what interventions are effective in preventing mental health problems and their associated organizational consequences. This synthesis reports on workplace mental health interventions that impact absenteeism, productivity and financial outcomes. OBJECTIVE: To determine the level of evidence supporting mental health interventions as valuable to work outcomes. METHODS: Databases were searched for systematic reviews between 2000 and 2012: Medline, EMBASE, the Cochrane Database of Systematic Reviews, DARE, CINAHL, PsycINFO and TRIP. Grey literature searches included health-evidence.ca, Rehab+, National Rehabilitation Information Center (NARIC), and Institute for Work and Health. The assessment of articles for inclusion criteria and methodological quality was conducted independently by two or more researchers, with differences resolved through consensus. RESULTS: The search resulted in 3363 titles, of which 3248 were excluded following title/abstract review, with 115 articles retrieved for full-text review. 14 articles finally met the inclusion criteria and are summarized in this synthesis. CONCLUSION: There is moderate evidence for the effectiveness of workplace mental health interventions on improved workplace outcomes. Certain types of programs, such as those incorporating both mental and physical health interventions, multicomponent mental health and/or psychosocial interventions, and exposure in vivo containing interventions for particular anxiety disorders had a greater level of research evidence to support their effectiveness.

Social Support and Supervisory Quality Interventions in the Workplace: A Stakeholder-Centered Best-Evidence Synthesis of Systematic Reviews on Work Outcomes.

BACKGROUND: There is controversy surrounding the impact of workplace interventions aimed at improving social support and supervisory quality on absenteeism, productivity and financial outcomes. OBJECTIVE: To determine the value of social support interventions for work outcomes. METHODS: Databases were searched for systematic reviews between 2000 and 2012 to complete a synthesis of systematic reviews guided by the PRISMA statement and the IOM guidelines for systematic reviews. Assessment of articles for inclusion and methodological quality was conducted independently by at least two researchers, with differences resolved by consensus. RESULTS: The search resulted in 3363 titles of which 3248 were excluded following title/abstract review, leaving 115 articles that were retrieved and underwent full article review. 10 articles met the set inclusion criteria, with 7 focusing on social support, 2 on supervisory quality and 1 on both. We found moderate and limited evidence, respectively, that social support and supervisory quality interventions positively impact workplace outcomes. CONCLUSION: There is moderate evidence that social support and limited evidence that supervisory quality interventions have a positive effect on work outcomes.

Economic evaluation of occupational health and safety programmes in health care.

BACKGROUND: Evidence-based resource allocation in the public health care sector requires reliable economic evaluations that are different from those needed in the commercial sector. AIMS: To describe a framework for conducting economic evaluations of occupational health and safety (OHS) programmes in health care developed with sector stakeholders. To define key resources and outcomes to be considered in economic evaluations of OHS programmes and to integrate these into a comprehensive framework. METHODS: Participatory action research supported by mixed qualitative and quantitative methods, including a multi-stakeholder working group, 25 key informant interviews, a 41-member Delphi panel and structured nominal group discussions. RESULTS: We found three resources had top priority: OHS staff time, training the workers and programme planning, promotion and evaluation. Similarly, five outcomes had top priority: number of injuries, safety climate, job satisfaction, quality of care and work days lost. The resulting framework was built around seven principles of good practice that stakeholders can use to assist them in conducting economic evaluations of OHS programmes. CONCLUSIONS: Use of a framework resulting from this participatory action research approach may increase the quality of economic evaluations of OHS programmes and facilitate programme comparisons for evidence-based resource allocation decisions. The principles may be applicable to other service sectors funded from general taxes and more broadly to economic evaluations of OHS programmes in general.

Job demand and control interventions: a stakeholder-centered best-evidence synthesis of systematic reviews on workplace disability.

BACKGROUND: Physical and psychological job demands in combination with the degree of control a worker has over task completion, play an important role in reducing stress. Occupational stress is an important, modifiable factor affecting work disability. However, the effectiveness of reducing job demands or increasing job control remains unclear, particularly for outcomes of interest to employers, such as absenteeism or productivity. OBJECTIVE: This systematic review reports on job demand and control interventions that impact absenteeism, productivity and financial outcomes. METHODS: A stakeholder-centered best-evidence synthesis was conducted with researcher and stakeholder collaboration throughout. Databases and grey literature were searched for systematic reviews between 2000 and 2012: Medline, EMBASE, the Cochrane Database of Systematic Reviews, DARE, CINAHL, PsycINFO, TRIP, health-evidence.ca, Rehab+, National Rehabilitation Information Center (NARIC), and Institute for Work and Health. Articles were assessed independently by two researchers for inclusion criteria and methodological quality. Differences were resolved through consensus. RESULTS: The search resulted in 3363 unique titles. After review of abstracts, 115 articles were retained for full-text review. 11 articles finally met the inclusion criteria and are summarized in this synthesis. The best level of evidence we found indicates that multimodal job demand reductions for either at-work or off-work workers will reduce disability-related absenteeism. CONCLUSION: In general, the impacts of interventions that aim to reduce job demands or increase job control can be positive for the organization in terms of reducing absenteeism, increasing productivity and cost-effectiveness. However, more high quality research is needed to further assess the relationships and quantify effect sizes for the interventions and outcomes reviewed in this study.

Characteristics of work-related fatal and hospitalised injuries not captured in workers' compensation data.

OBJECTIVES: (1) To identify work-related fatal and non-fatal hospitalised injuries using multiple data sources, (2) to compare case-ascertainment from external data sources with accepted workers' compensation claims and (3) to investigate the characteristics of work-related fatal and hospitalised injuries not captured by workers' compensation. METHODS: Work-related fatal injuries were ascertained from vital statistics, coroners and hospital discharge databases using payment and diagnosis codes and injury and work descriptions; and work-related (non-fatal) injuries were ascertained from the hospital discharge database using admission, diagnosis and payment codes. Injuries for British Columbia residents aged 15-64 years from 1991 to 2009 ascertained from the above external data sources were compared to accepted workers' compensation claims using per cent captured, validity analyses and logistic regression. RESULTS: The majority of work-related fatal injuries identified in the coroners data (83%) and the majority of work-related hospitalised injuries (95%) were captured as an accepted workers' compensation claim. A work-related coroner report was a positive predictor (88%), and the responsibility of payment field in the hospital discharge record a sensitive indicator (94%), for a workers' compensation claim. Injuries not captured by workers' compensation were associated with female gender, type of work (natural resources and other unspecified work) and injury diagnosis (eg, airway-related, dislocations and undetermined/unknown injury). CONCLUSIONS: Some work-related injuries captured by external data sources were not found in workers' compensation data in British Columbia. This may be the result of capturing injuries or workers that are ineligible for workers' compensation, or the result of injuries that go unreported to the compensation system. Hospital discharge records and coroner reports may provide opportunities to identify workers (or family members) with an unreported work-related injury and to provide them with information for submitting a workers' compensation claim.

Population-based surveillance of asthma among workers in British Columbia, Canada.

INTRODUCTION: Population-based health databases were used for the surveillance of asthma among workers in British Columbia for the period 1999 to 2003. The purpose was to identify high-risk groups of workers with asthma for further investigation, education and prevention. METHODS: Workers were identified using an employer-paid health premium field in the provincial health registry, and were linked to their physician visit, hospitalization, workers' compensation and pharmaceutical records; asthma cases were defined by the presence of an asthma diagnosis (International Classification of Diseases [ICD]-9-493) in these health records. Workers were assigned to an ''at-risk'' exposure group based on their industry of employment. RESULTS: For males, significantly higher asthma rates were observed for workers in the Utilities, Transport/Warehousing, Wood and Paper Manufacturing (Sawmills), Health Care/Social Assistance and Education industries. For females, significantly higher rates were found for those working in the Waste Management/Remediation and Health Care/Social Assistance industries. CONCLUSION: The data confirm a high prevalence of active asthma in the working population of British Columbia, and in particular, higher rates among females compared to males and in industries with known respiratory sensitizers such as dust and chemical exposures.

Clinical validation of an Internet-based questionnaire for ascertaining hip and knee osteoarthritis.

OBJECTIVE: To evaluate the measurement properties of an Internet-based self-administered questionnaire in ascertaining cases of hip and knee osteoarthritis (OA). METHODS: Questionnaire data from 4269 Canadian subjects aged 45-85 were collected on hip and knee joint health including self-reported items on medically-diagnosed hip and knee OA and joint replacement. A sub-cohort of 100 subjects was recruited for clinical examination. The self-reported outcomes were evaluated using the American College of Rheumatology clinical classification criteria for hip and knee OA as the gold standard for clinical verification. Analysis was at the joint level (200 knees, 200 hips). Validity was examined using sensitivity, specificity, and predictive values; to account for correlated joints of the same subject, bootstrapping was performed to yield valid 95% confidence interval (CI's). RESULTS: Self-reported measures for a medical diagnosis of knee OA had a positive predictive value of 86%, negative predictive value 91%, sensitivity 73% and specificity 96% for correctly identifying clinical knee OA. For hip OA, the values were 61%, 98%, 81% and 94% respectively. CONCLUSION: Internet self-report of medically-diagnosed hip and knee OA in metro Vancouver residents correctly identified most cases and non-cases of clinical OA when compared with the ACR clinical classification criteria gold standard. In particular, specificity was very high, important in risk factor studies due to the profound effect of even small losses in specificity on the measure of association. The findings provide evidence that these questionnaire case definitions have utility for identifying hip and knee OA in community and population-based studies when the purpose is to link potential risk factors with knee and hip health.

Assessing whole body vibration exposure for use in epidemiological studies of back injuries: measurements, observations and self-reports.

Improved assessment of whole body vibration exposure is needed for epidemiological studies investigating the causes of low back disorders. Vibration was measured on 54 worker-days in five heavy industries, with data collected on observed and self-reported driving conditions, demographics, and vehicle characteristics. Variables significant at p < 0.1 in simple linear regressions (20 of 34) were retained for mixed effects multiple regressions to determine the best prediction of rms vibration level and 8-h equivalent vibration exposure. Vibration was measured, on average, for 205 min per work shift (SD 105). Means and standard deviations in m · s⁻² were: x-axis 0.35 (0.19); y-axis 0.34 (0.28); z-axis 0.54 (0.23); vector sum 0.90 (0.49); and 8-h equivalent vector sum 0.70 (0.37). The final three regression models retained only 2 or 3 of the 34 variables (driving speed (<20 km/h and/or 20-40 km/h) and industry and/or vehicle type and explained up to 60% of the variance (R² = 0.26-0.6). PRACTITIONER SUMMARY: The purpose of the project was to create a model that can predict whole body vibration exposure from a number of observed or self-reported variables. This could eliminate the need for costly and time-consuming field measurements of WBV in epidemiological studies. Despite a large number of variables included in the model (34) and 54 worker-days of WBV measurement, the final models contained only two or three variables, and explained 60% of the variance. While this is an improvement over use of job title in epidemiological studies, it still leaves a considerable amount of WBV variance unexplained.

Influence of lifetime hip joint force on the risk of self-reported hip osteoarthritis: a community-based cohort study.

OBJECTIVE: To investigate the influence of cumulative lifetime hip joint force on the risk of self-reported medically-diagnosed hip osteoarthritis (OA). DESIGN: Prospective cohort. SETTING: General population. PARTICIPANTS: Members of Canadian Association of Retired Persons, community-dwelling. MAIN OUTCOME: Health-professional diagnosed hip OA, self-reported. METHODS: Exposure data on lifetime physical activity type (occupational, household, sport) and dose (frequency, intensity, duration) was collected in 2005. Subjects were ranked in terms of a 'cumulative peak force index' (CFPI), a measure of lifetime mechanical hip joint force. Multivariable survival analyses were performed to obtain adjusted effects for mean lifetime exposure and during 5-year age periods. RESULTS: Of 2918 subjects aged 45-85, 176 (6.03%) developed hip OA during the 2-year follow up (43 men, 133 women). The highest quintile of mean lifetime hip CPFI (HR 2.32; 95% CI 1.31-4.12), and high hip force in three age periods (35-39, 40-44, 45-49) were independently associated with hip OA. Previous hip injury was an approximate five-fold risk for development of hip OA across all models. In analysis by activity domain (occupation, sport, household), there was a trend (non-significant) for the highest quintile of occupational force, but not sport or household, to be associated with hip OA. CONCLUSIONS: A newly proposed measure of lifetime mechanical hip force was used to estimate the risk of self-reported, medically-diagnosed hip OA. While there are important limitations, this prospective study suggests that lifelong physical activity is generally safe. Very high levels of lifetime force from all domains combined, and in particular from occupational forces, may be important in the etiology of hip OA.

Population-based asbestosis surveillance in British Columbia.

OBJECTIVES: To investigate the use of multiple health data sources for population-based asbestosis surveillance in British Columbia, Canada. METHODS: Provincial health insurance registration records, workers' compensation records, hospitalisation records, and outpatient medical service records were linked using individual-specific study identifiers. The study population was restricted to individuals > or = 15 years of age living in the province during 1992-2004. RESULTS: 1170 new asbestosis cases were identified from 1992 to 2004 for an overall incidence rate of 2.82 (men: 5.48, women: 0.23) per 100,000 population; 96% of cases were male and average (SD) age was 69 (10) years. Although the annual number of new cases increased by 30% during the surveillance period (beta = 2.36, p = 0.019), the observed increase in annual incidence rates was not significant (beta = 0.02, p = 0.398). Workers' compensation, hospitalisation and outpatient databases identified 23%, 48% and 50% of the total new cases, respectively. Of the new cases, 82% were identified through single data sources, 10% were only recorded in the workers' compensation records, and 36% only in each of the hospitalisation and outpatient records. 84% of hospitalisation cases and 83% of outpatient cases were not included in the workers' compensation records. The three data sources showed different temporal trends in the annual number of new cases and annual incidence rates. CONCLUSIONS: Single data sources were not sufficient to identify all new cases, thus leading to serious underestimations of the true burden of asbestosis. Integrating multiple health data sources could provide a more complete picture in population-based surveillance of asbestosis and other occupational diseases.

Quantifying tasks, ergonomic exposures and injury rates among school custodial workers.

A job exposure matrix of ergonomics risk factors was constructed for school custodial workers in one large school district in the province of British Columbia using 100 h of 1-min fixed-interval observations, participatory worker consensus on task durations and existing employment and school characteristic data. Significant differences in ergonomics risk factors were found by tasks and occupations. Cleaning and moving furniture, handling garbage, cleaning washrooms and cleaning floors were associated with the most physical risks and the exposure was often higher during the summer vs. the school year. Injury rates over a 4-year period showed the custodian injury rate was four times higher than the overall injury rate across all occupations in the school district. Injury rates were significantly higher in the school year compared with summer (12.2 vs. 7.0 per 100 full-time equivalents per year, p < 0.05). Custodial workers represent a considerable proportion of the labour force and have high injury rates, yet ergonomic studies are disproportionately few. Previous studies that quantified risk factors in custodial workers tended to focus on a few tasks or specific risk factors. This study, using participatory ergonomics and observational methods, systematically quantifies the broad range of musculoskeletal risk factors across multiple tasks performed by custodial workers in schools, adding considerably to the methodological literature.

Development and evaluation of an observational Back-Exposure Sampling Tool (Back-EST) for work-related back injury risk factors.

We developed and evaluated an observational Back-Exposure Sampling Tool. A literature review suggested 53 exposure variables; these were reduced to 20 following field trials. Kappas for agreement beyond chance between six observers assessing exposures in 72 photos ranged from 0.21 to 1.0, with the highest values for posture type, trunk angle, manual materials handling, hands on item, and load weight. Intraclass correlations for agreement between pairs observing 17 workers once per minute for a full-shift were >0.74 for most postural, trunk angle, and manual materials handling variables. In validity testing, the proportions of shifts in flexion/extension and lateral bending observed for 169 full-shifts were compared to inclinometer measurements. Pearson correlations were 0.42 for 45-60 degrees flexion and 0.9 for >60 degrees flexion, but only 0.11-0.19 for lateral bending and trunk flexion less than 45 degrees . When lower flexion angles were collapsed to include trunk extension, correlations increased to >0.5.

Working mothers and early childhood outcomes: lessons from the Canadian National Longitudinal Study on Children and Youth.

BACKGROUND: More mothers are choosing to return to work during the first 2 years of their child's life with an uncertain impact on early developmental outcomes. AIMS: To determine the association between duration of maternity leave and motor and social development of toddlers. STUDY DESIGN: Population-based, retrospective cohort study. SUBJECTS: The Canadian National Longitudinal Survey on Children and Youth (NLSCY) Cycle 3 provides data on the characteristics and life experience of Canadian children. For sampled households, the person most knowledgeable about the child completed a survey on demographics, parent characteristics and family environment. The analysis was limited to 6664 families with children up to 2 years. OUTCOME MEASURES: Logistic regression was used to assess the association between duration of maternity leave and impaired performance (<-1 SD below the mean) on the Motor and Social Development (MSD) scale adjusted for multiple covariates including maternal age, gender, breastfeeding and socioeconomic status. RESULTS: One month of maternity leave increased the odds of impaired performance on the MSD by 3% (OR 1.03, 95% CI 1.02, 1.04). This was also seen with categorized maternity leave duration. Being male (OR 1.53, 95% CI 1.35, 1.74) and having a younger mother (OR 1.48, 95% CI 0.98, 2.23) increased the risk of impaired performance on the MSD while being of higher SES reduced the risk (OR 0.96, 95% CI 0.93, 1.00). CONCLUSIONS: There is an association between duration of maternity leave and impaired performance in motor and social development in children up to 2 years.

Youth sexual behaviour in a boomtown: implications for the control of sexually transmitted infections.

BACKGROUND: Northeastern British Columbia, Canada, is undergoing rapid in-migration of young, primarily male, workers in response to the "boom" in the oil/gas industries. Chlamydia rates in the region exceed the provincial average by 32% (294.6 cases per 100 000 persons compared with 213.3). Evidence indicates that sociocultural and structural determinants of young people's sexual health are key to consider in the design of interventions. OBJECTIVES: To investigate how sociocultural and structural features related to the oil/gas boom are perceived to affect the sexual behaviour of youth in a Northeastern "boomtown". METHODS: The study included ethnographic fieldwork (8 weeks) and in-depth interviews with 25 youth (ages 15-25 years) and 14 health/social service providers. RESULTS: Participants identified four main ways in which the sociocultural and structural conditions created by the boom affect sexual behaviours, fuelling the spread of sexually transmitted infections (STIs): mobility of oil/gas workers; binge partying; high levels of disposable income and gendered power dynamics. CONCLUSIONS: The sociocultural and structural conditions that are fostered by a resource-extraction boom appear to exacerbate sexual health inequalities among youths who live and work in these rapidly urbanising, remote locales. To meet the needs of this population, we recommend STI prevention and testing service delivery models that incorporate STI testing outreach to oil/gas workers and condom distribution. Global, national and local STI control efforts should consider the realities and needs of similar subpopulations of young people.

The impact of obstructive sleep apnea and daytime sleepiness on work limitation.

BACKGROUND: Many patients with obstructive sleep apnea (OSA) participate in the work force. However, the impact of OSA and sleepiness on work performance is unclear. METHODS: To address this issue, we administered the Epworth Sleepiness Scale (ESS), the Work Limitations Questionnaire (WLQ), and an occupational survey to patients undergoing full-night polysomnography for the investigation of sleep-disordered breathing. Of 498 patients enrolled in the study, 428 (86.0%) completed the questionnaires. Their mean age+/-standard deviation (SD) was 49+/-12 years, mean body mass index (BMI) was 31+/-7 kg/m(2) mean apnea hypopnea index (AHI) was 21+/-22 events/h, and mean ESS score was 10+/-5. Subjects worked a mean of 39+/-18 h per week. The first 100 patients to complete the survey were followed up at two years. RESULTS: In the group as a whole, there was no significant relationship between severity of OSA and the four dimensions of work limitation. However, in blue-collar workers, significant differences were detected between patients with mild OSA (AHI 5-15/h) and those with severe OSA (AHI>30/h) with respect to time management (limited 23.1% of the time vs. 43.8%, p=0.05) and mental/personnel interactions (17.9% vs. 33.0%, p=0.05). In contrast, there were strong associations between subjective sleepiness (as assessed by the ESS) and three of the four scales of work limitation. That is, patients with an ESS of 5 had much less work limitation compared to those with an ESS 18 in terms of time management (19.7% vs. 38.6 %, p<0.001), mental-interpersonal relationships (15.5% vs. 36.0%, p<0.001) and work output (16.8% vs. 36.0%; p<0.001). Of the group followed up, 49 returned surveys and 33 who were using continuous positive airway pressure (CPAP) showed significant improvements between the initial and second follow-up in time management (26% vs. 9%, p=0.0005), mental-interpersonal relationships (16% vs. 11.0%, p=0.014) and work output (18% vs. 10%; p<0.009). CONCLUSION: We have demonstrated a clear relationship between excessive sleepiness and decreased work productivity in a population referred for suspected sleep-disordered breathing. Screening for sleepiness and sleep-disordered breathing in the workplace has the potential to identify a reversible cause of low work productivity.

Work-related repetitive strain injury and leisure-time physical activity.

OBJECTIVE: To investigate the relationship between leisure-time physical activity and work-related repetitive strain injury (RSI), adjusted for sociodemographic characteristics and work-related physical and stress factors. METHODS: The data source was the 2003 Canadian Community Health Survey, a national cross-sectional survey of 134,072 respondents. The analysis was limited to a sample of the survey population reporting full-time work during the past 12 months (n = 58,622). The outcome of interest was work-related RSI of the upper body. Multiple logistic regression was used to examine the relationship between the outcome and leisure-time physical activity level, adjusted for sociodemographic, health, and occupational characteristics. The potential effect of leisure-time physical activity with a high upper-body load was investigated in a secondary analysis. RESULTS: The prevalence of upper-body work-related RSI was 5.9% in the Canadian population in 2003. An active lifestyle during leisure time was associated with a lower prevalence of work-related upper-body RSI (odds ratio 0.84, 99% confidence interval 0.75-0.95), after adjustment for work physical demands and other covariates. Female sex, obesity, smoking, age, work-related stress, and work physical demands were associated with RSI. In the secondary analysis, we did not find that participating in leisure-time activities with a high upper-body load was a risk factor for RSI. CONCLUSION: Our study results indicate that being physically active during leisure time is associated with a decreased risk of upper-body occupational RSI, adding another potential health benefit to participation in leisure-time physical activity.