Thesis (M.P.H.M (Primary Health Care Management))--Mahidol University, 2005.

Computer technology has advanced rapidly in the past few decades and computers have become a very important and powerful tool in our everyday lives. Prolonged computer use by office workers has been reported to result in an increased risk of developing Work-related Neck and Upper Limb Disorders (WRNULD) (Bernard et al.. 1994: Faucett & Rempel. 1994: Tittiranonda et al.. 1999). The occupational risk factors associated with prolonged computer use include static posture and the speed and force of keyboard operation. Past studies have examined different aspects of these risk factors through measuring muscle electrical activity (EMG), kinematics and keyboard forces. However, most of these studies have been conducted on healthy painfree subjects and even the few Case-Control studies have not clearly established any direct relationships between the risk factors and WRNULD. The present research project consisted of a series of three studies aimed at investigating whether there were intrinsic differences among different individuals in response to different physical stressors. These intrinsic differences may have important implications to help explain why some individuals would develop WRNULD while others do not. The individuals' responses to the demands of three physical stressors: static posture, speed and force of keyboard operation were assessed. The internal exposure measures of kinematics, EMG, keyboard dynamics and subjective discomforts were used to evaluate the inter-individual differences. Study I was a field investigation comparing the neck-shoulder kinematics between symptomatic ("Case", n=8) and asymptomatic ("Control", n=8) office workers. Results showed trends for consistently greater head tilt and neck flexion angles, and greater ranges of movements in the Case Group than the Control Group. / The Case Group also exhibited a trend for increased acromion protraction compared to the Control Group. The Case Group also reported significantly greater discomfort scores compared to the Control Group. Neither the discomforts nor the kinematics displayed any significant changes over a working day. Study 2 was a laboratory study comparing the responses of Case and Control Groups in terms of EMG, kinematics and subjective discomforts, while a standardised computer task was performed continuously for one hour. The responses of Case (n=23) and Control (n=20) Groups were compared to examine the effects of static posture. The results showed similar trends to those in Study I, with increased neck flexion mean angles and ranges of movements in the Case Group compared to the Control Group. In terms of EMG results, there were trends for EMG amplitude differences in the right upper trapezius (UT) and cervical erector spinae (CES) muscles between Case and Control Groups. These trends became statistically significant when the Case subjects were sub-divided into the High (n=15) and Low (n=8) Groups based on their mean discomfort scores. Study 3 was also a laboratory study to compare the Case (n=21) and Control (n=20) Groups when they were challenged by the physical stressors of speed and force of keyboard operation. In this study, each subject's EMG and discomforts were examined in three typing conditions of normal speed and force, increased typing speed and increased typing force. The Case Group showed trends for higher increases in both UT and CES muscle activities than the Control Group, and when divided into the High-Low Groups, the High Group (n=8) showed trends for much higher muscle activities in all three conditions. / Beside muscle activity changes, the High Group subjects also demonstrated a trend for much higher within-subject Speed and Force Variabilities in their keystroke performance, compared to the Low Group and the Control Group. This result implied that the High Group subjects had a more erratic motor control of the keystroke actions. Based on these results, conceptual models were developed to describe the relationships among the physical stressors, internal exposure responses and discomforts. The Altered Motor Control Model refers to the programmed changes in motor control strategies involving muscle recruitment and joint movement patterns, and these changes were closely related to the subjects' musculoskeletal discomforts. The Heightened Sensitivity Model describes the higher sensitivity levels of individuals with more severe discomforts, in response to the demands of physical stressors. These models are closely related and heightened sensitivity may be an 'effect-modifier" of the motor control mechanisms and the perception of discomforts or pains within the individual. In conclusion, the present research has identified important differences between individuals on the basis of their motor control strategies which may contribute to the development of WRNULD. While the present research has mainly examined the individual responses to three physical stressors, it is possible that the models developed may be applicable to other physical stressors. These findings may also have important implications for future ergonomic research, emphasising the need to address interindividual differences in ergonomic interventions to workers. Further research should be directed towards better understanding of these intrinsic individual differences in both physical and non-physical factors that contribute to the development of WRNULD.

Low back pain (LBP) remains one of the most common and challenging primary care issues in the developed world. Manual occupations such as nursing are known to involve a high risk of occupational LBP, which is associated with enormous health care expenditure as well as indirect work and disability-related costs. Despite extensive efforts to reduce LBP in nurses, evidence supporting the efficacy of any specific intervention to prevent LBP is limited. / The majority of LBP prevention strategies are directed at occupational risk factors in working nurses. However, as there is some evidence that LBP is already a significant problem in nurses prior to commencing full time employment, it is proposed that nursing students should be the focus of prevention interventions. This would require prevention interventions targeting personal rather than occupational LBP risk factors. As the best personal predictor of future LBP is currently a previous history of LBP, further investigation of modifiable personal LBP risk factors is required. Consequently, the aim of this doctoral research was to identify modifiable personal characteristics that predict LBP in nursing students. / Firstly, a large survey was conducted on undergraduate nursing students and recently graduated nurses to determine patterns of LBP prevalence. Results from this study indicated that LBP prevalence was very high at the commencement of undergraduate training. Prevalence of LBP did not significantly change during nursing training, but did increase further in the first year of commencing work as a nurse. This increase may be partly explained by the reported increase in occupational exposure to bending and lifting. Age was consistent across the undergraduate year groups and did not influence these findings. It was concluded that nursing students would provide a sufficient number of new-onset LBP episodes (and thus sufficient statistical power) for a prospective study design. Further, as these nursing students were not yet exposed to the occupational LBP risk factors of working nurses, a clearer indication of the influence of modifiable personal factors on the development of LBP could be determined by examining a student cohort. / A cross-sectional study investigating the influence of personal physical, psychological and social/lifestyle factors was then conducted on nursing students. Preliminary analysis revealed clear gender differences across multiple domains. Therefore, the focus of further analysis was on the larger female sample. / In Part 1 of the cross-sectional study, an investigation of regional differences in lumbar spine posture and movement was undertaken. Analysis of spinal kinematics in this study supported and extended previous literature that has found global lumbar spine kinematics do not accurately reflect the kinematics of the upper lumbar or lower lumbar spinal regions in common postures and movements. Rather, these two regions have a degree of functional independence. This finding has implications for interpretation of measures of spinal posture, motion and loading. Further, body mass index influenced regional lumbar posture and movement, possibly representing adaptation due to load. It was concluded that regional rather than global lumbar spine measures needed to be investigated in further analyses of this doctoral research. / In Part 2 of the cross-sectional study, personal characteristics associated with LBP were investigated. Approximately one third of all subjects reported significant LBP in the 12-months preceding the study. Analysis of factors associated with LBP supported the biopsychosocial nature of LBP. Higher stress levels and use of passive coping strategies, increased physical activity levels, holding the lower lumbar spine further from end-range flexion during functional tasks and increased age, all contributed independently to the presence of LBP. These findings supported the hypothesis that modifiable personal characteristics were associated with LBP. / The importance of identifying sub-groups of LBP patients has become widely accepted. In Part 3, further exploratory analysis was conducted on this crosssectional data to determine if differences in physical and psychological characteristics were evident in two defined sub-groups of female nursing students with LBP. These sub-groups were based on O’Sullivan’s mechanism based classification system. Results indicated that two sub-groups of LBP subjects had differing physical and psychological characteristics associated with their LBP. Further, control subjects could be distinguished from each of these two sub-groups by different factors. These findings add validity to O’Sullivan’s LBP classification system. Further, the findings may suggest that different combinations of psychological and physical factors are linked to LBP in different sub-groups in this population, and therefore may require different intervention approaches based on these factors. / In the final stage of this doctoral research, the cohort of female nursing students was followed prospectively for 12-months. The focus of further analysis was on identifying modifiable personal predictors in a sub-group of subjects with new-onset LBP. The results of this study strongly supported that personal factors from multiple domains are predictors of new-onset LBP. After controlling for previous LBP, age and body weight, regression analysis identified that smoking, increased physical activity levels (both exercise and spinal loading), higher stress levels, reduced back muscle endurance, greater posterior pelvic tilt in slump sitting and more accurate spinal repositioning in sitting were all independent predictors of new-onset LBP. These findings have implications for the development of prevention and management interventions for LBP in nurses. / Results from this doctoral investigation support the multi-factorial and biopsychosocial nature of LBP. The important distinction of this research when compared to previous work is the selection of a cohort at the beginning of their working life, with a focus on modifiable personal, rather than occupational factors, associated with LBP. Factors from physical, psychological and social/lifestyle domains were all independently associated with significant new-onset LBP in female nursing students. Interventions utilising a prevention approach that targets modifiable characteristics, such as those identified in this cohort of nursing students, may have the potential to reduce the impact of occupational LBP in this group. These preliminary findings have important implications for future LBP research and clinical interventions.

A survey was distributed to teachers in the East Tennessee Tri-Cities area to determine impact of occupational risk factors including voice use, work related factors and common practices of teachers’ everyday lives on the presence or absence of voice problems. Preliminary results regarding voice problems and potential factors are discussed.

Visuomenės sveikata (Sveikatos ekologija) NAKVYNĖS NAMŲ DARBUOTOJŲ PROFESINĖS RIZIKOS VEIKSNIŲ SĄSAJOS SU SUBJEKTYVIAI VERTINAMA SVEIKATA Diana Mačiulienė Mokslinė vadovė lekt. dr. Jolita Kirvaitienė Lietuvos sveikatos mokslų universitetas, Medicinos akademija, Visuomenės sveikatos fakultetas, Aplinkos ir darbo medicinos katedra. Kaunas; 2013. 56 p. Darbo tikslas. Įvertinti nakvynės namų darbuotojų profesinės rizikos veiksnių sąsajas su subjektyviai vertinama sveikata. Tyrimo metodika. Tyrime dalyvavo 145 Vilniaus, Kauno ir Klaipėdos miestų nakvynės namų darbuotojai. Analizei buvo tinkamos 126 anketos. Darbuotojų apklausai naudota vienmomentinė anketa. Statistinė duomenų analizė buvo atlikta naudojant statistinį programų paketą SPSS 17.0 for Windows ir Microsoft Office programinio paketo skaičiuokle Microsoft Excel. Duomenys, kurių paklaidos tikimybė p>0,05 nebuvo naudoti tyrime, kadangi skirtumas laikomas statistiškai nereikšmingas. Rezultatai. Nakvynės namų darbuotojai daţniausiai susiduria su klientų grasinimais (41,3 proc.), keiksmaţodţiais (64,3 proc.), psichologine įtampa (78 proc.), nesaugumo jausmu (53 proc.). Dauguma darbuotojų (70,6 proc.) per pastaruosius 6 mėnesius pajuto sveikatos sutrikimus. Beveik pusė apklaustųjų (42,9 proc.) savo sveikatos sutrikimus sieja su darbu. Savo sveikatos sutrikimus respondentai sieja su: miego sutrikimais (36,5 proc.), irzlumu (22,2 proc.), nerimu (20,6 proc.), įtampa bei stresu (34,9 proc.), arterinė hipertenzija (19,8 proc.)... [toliau žr. visą tekstą] / Public health (Health ecology) HOSTEL STAFF OCCUPATIONAL RISK FACTORS AND THEIR LINKS WITH THE SUBJECTIVE EVALUATION OF HEALTH Diana Mačiulienė Scientific tutor lecturer dr. Jolita Kirvaitienė Lithuanian University of Health Sciences, Medical Academy, Faculty of Public Health, Department of Environmental and Occupational Medicine. Kaunas; 2013. 56 p. The aim of a project. To evaluate Hostel Staff Occupational Risk Factors and Their Links with the Subjective Evaluation of Health. Research methodology. 145 workers from Vilnius, Kaunas and Klaipėda hostels staff were involved in the study. 126 questionnaires were suitable for analysis. A cross-sectional questionnaire was used in the survey. The statistical analysis was performed using the statistical software package SPSS 17.0 for Windows and Microsoft Office software package Microsoft Excel spreadsheet. Data with bias probability p>0,05 were not used in the research, because the difference is considered statistically insignificant. Results of the research. Mostly, workers of hostels have to deal with threats of clients (41,3 pct.), vituperation (64,3pct.), psychological stress (78 pct.), insecurity (53 pct). In the last 6 months the majority of employees felt health disorders. Almost half of the respondents (42,9 pct.) relate their health problems with the work. Were mentioned following health disorders: sleep disorders (36,5 pct.), irritability (22,2 pct.), anxiety (20,6 pct), tension and stress (34,9 pct.), arterial... [to full text]

<p>Carpal tunnel syndrome (CTS) is one of the most prevalent work-related musculoskeletal disorders of the upper extremity yet its etiology remains elusive. Nerve hypervascularization has been proposed as a pathophysiological change in CTS and can be measured using high resolution sonography of intraneural blood flow. The purpose of this study was to determine the effects of deviated wrist postures and fingertip force on the intraneural blood flow velocity of the median nerve proximal to the wrist crease. Ten participants experiencing the classic symptoms of CTS and nine healthy volunteers were recruited and underwent qualitative assessments (Phalen’s test, Katz hand diagram, Levine’s CTS questionnaire). Intraneural blood flow velocity was measured in five wrist postures (flexion 30°, flexion 15°, neutral, extension 15°, extension 30°) with and without a middle digit fingertip press (0N, 6N). A control (N=9) group and a CTS symptomatic (N=9) group were determined, in addition to a CTS individual (N=1) that required a separate analysis. A significant main effect of force was found (F_1,16= 28.039, p < 0.0005) with the mean peak velocity being greater with force (3.56 cm/s) than without force (2.81 cm/s). Wrist posture had a main effect (F_4,64= 3.163, p < 0.020) with flow velocity as neutral (2.87 cm/s) was significantly lower than flexion 30° (3.37 cm/s), flexion 15°(3.27 cm/s) and extension 30° (3.29 cm/s). There was no significant difference in peak blood flow velocity between the two experimental groups, CTS symptomatic (3.34 cm/s) and control (3.03 cm/s) (F_1,16= 4.121, p < 0.059). The results suggest that both force and non-neutral wrist postures may acutely induce vascular changes previously associated with CTS. The quantification of reactive median nerve hypervascularity should be investigated further as it has potential to be both a reliable diagnostic technique and a non-invasive assessment of CTS risk.</p> / Master of Science in Kinesiology

Os estudos epidemiológicos relativos ao denominado câncer ocupacional têm como objetivo o estudo do câncer em populações trabalhadoras e a identificação de fatores causais. O número de agentes que comprovadamente causam câncer em seres humanos é ainda pequeno, cerca de trinta. A estes fatores podem ser agregados algumas atividades ocupacionais e processos industriais onde agentes potencialmente cancerígenos existem mas não foram ainda identificados. A quase totalidade dos estudos epidemiológicos buscando relacionar ocupação e câncer foram realizados nos países desenvolvidos, com processos de industrialização mais antigos e consolidados. Nesta investigação o objetivo é estudar a relação trabalho e câncer no contexto de um país subdesenvolvido e recentemente industrializado. O estudo explora os riscos ocupacionais determinantes da neoplasia pulmonar na Região Metropolitana de São Paulo (RMSP). O trabalho está dividido em duas partes. Na primeira são discutidos aspectos relativos ao câncer com particular destaque ao carcinoma broncogênico e à aplicação da metodologia epidemiológica na área da saúde do trabalhador, em especial para o estudo do câncer relacionado à ocupação. A segunda parte contempla a descrição do estudo de caso-controle construído para atingir os objetivos definidos. Os dados do estudo foram levantados no período de 1º de julho de 1990 a 31 de janeiro de 1991 em quatorze hospitais que concentram o atendimento a pacientes com câncer de pulmão na RMSP. Um total de 316 casos e 536 controles, emparelhados com os casos por sexo e idade, foram selecionados para análise. Tabagismo, tabagismo passivo, história migratória, outros cânceres na família e estrato sócio-econômico, além de sexo e idade, foram as outras variáveis estudadas. A análise univariada permitiu identificar as variáveis que estavam interferindo na relação principal estudada. Posteriormente, utilizou-se as técnicas de análise estratificada e de regressão logística para controlar as variáveis tabagismo, referência à carcinoma de pulmão na família, sexo e idade. Os resultados revelam que os trabalhadores que estiveram ligados por tempo prolongado aos setores de produção, de ramos de atividades industriais nos quais há maior probabilidade de exposição à substâncias cancerígenas, têm cerca de duas vezes o risco de desenvolverem carcinoma broncogênico em relação aos trabalhadores com menor probabilidade de exposição a substâncias cancerígenas como os que referiram nunca terem trabalhado fora de casa. / Epidemiological studies on occupational cancer have as their objective the study of cancer in working populations and the distribution of causal factors. The number of agents proved to cause cancer in humans is still rather small, about thirty. It could be added some occupational activities and industrial processes where hazardous agents are known to exist, but have not been identified. Almost all epidemiological studies to evaluate the relationship between occupation and cancer were carried out in developed countries, where industrialization process is older and more structured. In this investigation the objective is to study the association between occupation and cancer in a developing and newly industrialized country context. In this sense, the study explores occupational risks for lung cancer in the Metropolitan Region of São Paulo (MRSP). This work is split in two parts. Firstly it was introduced a review of some aspects on cancer, particularly lung cancer, and the use of epidemiologic methodology related to worker\'s health, particularly cancer. In the second part it was described the hospital-based case-control study carried out to reach defined objectives. This research was conducted between 1st July 1990 and 31st January 1991 in fourteen hospitais which concentrate lung cancer cases in the MRSP. It has been selected a total of 316 cases and 536 controls, matched by hospital, sex and age with cases. Smoking, passive smoking, migratory history, cancer in the family and socio-economic status, besides sex and age, were other variables studied. Univariate analysis identified variables that could interfere in the main studied associatian. Through stratification and logistic regression approaches the variables gender and age, smoking and reference to lung neoplasy in family, were controlled. The results showed that workers linked to the production sectors of industries where there are higher risk of exposure to carcinogenic products have about two fold the risk of developing lung cancer rather than those workers with the lowest risk of exposure to carcinogens.

Os distúrbios osteomusculares relacionados ao trabalho (DORT) representam mais de 30% das doenças ocupacionais no mundo. A fim de organizar as ações estratégicas que serão desenvolvidas para prevenção de DORT, é fundamental analisar previamente as situações peculiares dos diferentes setores de um local de trabalho. Os objetivos deste trabalho foram verificar a prevalência de queixas musculoesqueléticas em trabalhadores de uma indústria de porte médio, comparando seus setores entre si, e investigar a influência de fatores ocupacionais e não ocupacionais no aumento das queixas. Foram aplicados o questionário nórdico para avaliação de sintomas musculoesqueleticos e questionários sobre hábitos de vida e condições relacionadas ao trabalho em 185 trabalhadores distribuidos em três setores de uma indústria (fábrica microeletrônica, escritório e logística). Constatou-se que há prevalência massiva de queixas osteomusculares (85.4%) nessa população, com variação das regiões afetadas em cada setor analisado. Os fatores ocupacionais que mais influenciaram as queixas de dores em diferentes regiões do corpo foram: trabalhar na fábrica, sofrer de estresse/pressão/prazos curtos no trabalho, ter histórico de DORT, ter sido afastado por DORT e considerar o trabalho arriscado. Quanto aos fatores não ocupacionais: ser mulher, ser cuidadora de criança em idade pré-escolar, ter baixa escolaridade e sofrer de insônia/descanso inadequado foram os mais influentes. Conclui-se que as regiões do corpo mais afetadas por dores diferem para cada setor desta indústria e há fatores individuais e ocupacionais que influenciam a alta prevalência das queixas osteomusculares. Programas que abordem esses aspectos podem contribuir para o controle de DORT. / Work-related musculoskeletal disorders (WMSDs) comprise more than 30% of occupational diseases in the world. This study aimed to determine the prevalence of musculoskeletal complaints among workers in a medium-sized industry by comparing its different sectors and investigate the influence of occupational and non-occupational factors in complaints increase. 185 industry workers divided in three sectors (factory, office and logistics) were assessed using the Nordic Musculoskeletal Questionnaire and lifestyle and work-related conditions questionnaires. Massive prevalence of musculoskeletal complaints (85.4%) was detected in this population, with different affected body parts in each sector. The most influential occupational factors were: working at the factory, job strain, pre-existing history of MSD and considering the job risky. Being female, low education level and inadequate rest were the most influential non-occupational factors. The body parts most affected by musculoskeletal complaints differ among each sector and are influenced by individual and occupational factors. Programs addressing these aspects can contribute to control WMSDs.

Notre avons étudié le rôle de la profession et des expositions professionnelles aux solvants pétroliers et chlorés dans deux études épidémiologiques sur les facteurs de risque professionnels des cancers du sein chez l'homme et chez la femme. A l’inverse du cancer du sein féminin (50000 nouveaux cas par an en France), le cancer du sein chez l’homme est un cancer rare (<500 cas par an). Il constitue cependant un modèle intéressant pour l’étude des expositions professionnelles qui sont généralement plus élevées chez l’homme que chez la femme. Chez les hommes, nos résultats suggèrent un risque de cancer augmenté chez les mécaniciens de véhicules à moteur et un rôle cancérogène des solvants tels que le benzène et le trichloréthylène. Chez les femmes, malgré des risques élevés mais non significatifs dans plusieurs professions, aucune association avec les expositions aux solvants n’était mise en évidence pour les faibles niveaux d’exposition observés. / We have investigated the role of the occupation and of occupational exposures to petroleum and chlorinated solvents using the data of two epidemiological studies on occupational risk factors of breast cancers in men and in women. Unlike female breast cancer (50,000 new cases per year inFrance), cancer of male breast cancer is a rare disease (<500 cases per year). It should be seen as an interesting model for studying the effects of occupational exposures in the disease as these exposure are generally much higher in men than in women. For men, our results suggest that the risk of cancer is increased among motor vehicle mechanics and support the hypothesis of a carcinogenic effect of solvents such as benzene and trichloroethylene in disease occurrence. In women, several occupations were at increased risk of breast cancer, but results were generally not statistically significant. No association of female breast cancer incidence with exposure to solvents was observed.

<p>Low back pain (LBP) is a significant problem among the nursing population worldwide. Manual lifting and shifting of heavy objects and patients are primary contributing factors. Nurses are supposed to be knowledgeable about the risk factors and preventive measures and effectively apply it into practice to prevent them from sustaining back injuries. Strategies to reducing the incidences of LBP in nurses have been previously implemented but with little outcomes. The purpose of this study was to explore the relationship between occupational risk factors and the prevalence of LBP in nurses at MOI, Tanzania. Therefore, the study examined / the prevalence of LBP amongst nurses, work-related risk factors contributing to LBP, knowledge and effectiveness of back care techniques, and barriers to effective back care techniques in clinical nurses.</p>