The overall aim of this thesis was to gain new knowledge of factors and interventions that improve work ability and return to work (RTW) among women on long-term sick leave from human service organizations (HSOs). The specific aims of the studies were: to evaluate the associations between the self-rated Work Ability Index (WAI) and Work Ability Score (WAS), and the relationship with prospective sick leave, symptoms, and health (Paper I); to investigate whether intervention with myofeedback training or intensive muscular strength training could decrease pain and increase work ability among women with neck pain (Paper II); to examine the associations between workplace rehabilitation and the combination of supportive conditions at work with work ability and RTW over time (Paper III); and to explore experiences, views, and strategies in the rehabilitation process for RTW (Paper IV). This thesis is based on a prospective cohort study (n=324) and a randomized controlled study (RCT) (n=60, participants with neck pain). Both quantitative and qualitative methods were used. The data collection consisted of questionnaires, laboratory-observed data, register-based data, and interviews. The results showed a very strong association between WAI and WAS, and results predicted future sick leave degree, health-related quality of life, vitality, neck pain, self-rated general health, self-rated mental health, behavioral stress, and current stress (Paper I). In the RCT (Paper II), individuals in the myofeedback intervention group increased their vitality and work ability over time and individuals in the intensive musculoskeletal strength training group increased their WAI, WAS, and mental health over time. WAI, WAS, and RTW increased over time among individuals provided with workplace rehabilitation and supportive conditions at work (Paper III) such as a sense of feeling welcome back at work, influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community, and work satisfaction. Women described (Paper IV) how they were striving to work and how they had different views, strategies, and approaches in the rehabilitation process for RTW. They expressed a desire to work, their goals for work, and their wishes for work. In the rehabilitation process for RTW they described their interaction with stakeholders as either controlling the interaction or struggling in the interaction. They described strategies to cope with RTW in terms of yo-yo (fluctuating) working: yo-yo working as a strategy or yo-yo working as a consequence. This thesis identifies factors of importance in improving work ability and RTW among women on long-term sick leave from HSOs. For women with neck pain, the intervention study showed feasibility of the intervention and demonstrated improved work ability and decreased pain (Paper II). The intensive muscular strength training program, which is easy for the individual to learn and perform at home, was associated with increased work ability. The results regarding rehabilitation highlight the importance of integrating workplace rehabilitation with supportive conditions at work to increase work ability and improve RTW (Paper III). Women expressed that they were striving to work and that they wanted to work (Paper IV). These women were “going in and out” of work participation (yo-yo working) as a way to handle the rehabilitation process. For assessing the status and progress of work ability among women on long-term sick leave, the single-question WAS may be used as a compliment to the full WAI as a simple indicator (Paper I). / <p>Akademisk avhandling som för avläggande av medicine doktorsexamen vid Sahlgrenska akademin, Göteborgs universitet, kommer att offentligen försvaras i hörsal Hamberger, Medicinaregatan 16 A, Göteborg, måndagen den 6 oktober 2014, klockan 09.00</p>

L’objectif de cette recherche est double. Etudier les causes et conséquences du Burnout des soignants, dans un premier temps, et comprendre l’effet de la présence d’un jardin dans un secteur gériatrique hospitalier dans un second temps. Les infirmiers et aides-soignants de neuf services de gériatrie ont répondu à un questionnaire construit à partir des théories et échelles de Karasek et Theorell (1990), Siegrist (1996), Shirom (2004) et Kurorinka (1987). Ainsi, le Burnout est confronté aux facteurs psychosociaux, à la Vigueur (bien être) et aux douleurs physiques pour extraire les causes et conséquences de ce trouble psychologique. Ces mêmes équipes ont également participé à des entretiens de type « focus groups » et à des entretiens individuels semi-dirigés afin de s’exprimer sur leurs conditions de travail, ainsi que sur leur vécu et leur ressenti de la présence ou l’absence d’un jardin aménagé ou non aménagé dans leur environnement de travail. Ces équipes de soins appartenaient à trois types de services gériatriques : unité cognitivo-comportementale, soins palliatifs, soins de réadaptation. Les résultats principaux du questionnaire mettent en cause le manque de soutien de la hiérarchie comme aspect augmentant les risques de Burnout. Ce résultat est par la suite confirmé par les entretiens. De plus, le Burnout semble moins présent dans les services avec jardin que sans jardin, et il existe également une amplification de ce bénéfice dans les jardins thérapeutiques. On observe une sensation de Vigueur, tant physique que psychologique, plus importante dans les services avec jardin, et une tendance à l’augmentation des T.M.S. dans les services avec jardin thérapeutique. Cette constatation amène à s’interroger sur l'ergonomie du travail dans ce type d'environnement. En conclusion, le jardin apparaît comme un dispositif systémique favorable aux interactions de travail dans un lieu spécifiquement aménagé, permettant par là-même de combattre les sources de Burnout et de défendre la Vigueur. Il favorise l’épanouissement des soignants et la réduction du Burnout mettant tout de même en lumière un principe de précaution sur la charge physique et l’ergonomie de ce lieu à explorer / The aim of this research was twofold. Study the causes and consequences of Burnout caregivers, initially, and understand the effect of the presence of a garden in a hospital geriatric sector in a second time. Nurses and caregivers of nine geriatric services answered a questionnaire constructed from the theories and scales of Karasek and Theorell (1990), Siegrist (1996), Shirom (2004) and Kuorinka (1987). So, the Burnout is faced with psychosocial factors, the vigor (wellness) and physical pain to extract the causes and consequences of this psychological disorder. These same teams also participated in such conversations "focus groups" and semi-structured individual interviews to speak about their working conditions, as well as their experience and felt the presence or absence a arranged garden or undeveloped in their work environment. These care teams belonged to three types of geriatric services: cognitive behavioral unit, palliative care, rehabilitation care. The main results of the questionnaire involve lack of support from the hierarchy appearance as increasing the risk of Burnout. This result is confirmed by interviews. In addition, Burnout was a lesser incidence of Burnout in care services with a garden that those without a garden, and and there is also with an amplification of the benefit with specially-designed gardens. The feeling of strength, both physical and psychological, was less present when the care services did not have a therapeutic garden. A trend toward an increase in musculoskeletal disorders in services with a therapeutic garden versus no garden was observed. Upon analyzing the results, the authors recommend particular attention in the designing of hospital gardens in order to facilitate the ergonomics of nursing work. In conclusion, the overall results advocate the use of the garden as a systemic structure conducive to work interactions in a specially designed area by allowing the same to combat the sources of Burnout and defend Vigor. It encourages the development of nursing and reducing Burnout highlighting a precautionary principle on the physical load and ergonomics of this place to explore.

Dans le cadre professionnel, les maladies professionnelles telles que les troubles musculo-squelettiques et les maladies psychiques constituent la première cause d'entrée dans le régime d'invalidité en France. Leur singularisme se situe dans leur étiologie complexe qui échappe au système d'indemnisation. Ces maladies dont le travail est une cause mais ne peut être avec certitude la cause ne sont quasiment pas prises en charge.Leur réparation se fonde encore principalement sur une loi compromissoire entre patronat et salariés centenaire, sur laquelle se sont empilés des mécanismes réparatoires législatifs et jurisprudentiels, et leur prévention nécessiterait un bouleversement dans le rapport au travail. Dans la fonction publique, cette mauvaise prise en charge n'est pas sans créer des disparités entre agents, selon leur régime statutaire ou la reconnaissance effective de la maladie au service.Le système de réparation actuel qui laisse à la charge de la sécurité sociale des maladies pourtant liées au travail ne peut perdurer. Cependant de nouvelles modalités d'indemnisation ne sont possibles que si le coût est supportable. Or l'inexistence de chiffres permettant d'estimer le nombre de maladies reconnues ou sous-déclarées et de ce fait la part des maladies multifactorielles, rend l'estimation de ce coût impossible.La base de données (année 2008) qui a été constituée dans ce travail permet d'évaluer le nombre d'agents touchés par une maladie multifactorielle et laisse à penser que seule une réparation partielle assortie d'une prévention incitative est susceptible de prendre en charge de manière acceptable et pérenne les maladies multifactorielles dans la fonction publique. / In the working environment, multifactorial disorders such as musculoskeletal and mental disorders are the main cause of officially recognized disability in France. Their particularity lies in their complex etiology, which makes claims for compensation difficult. They can be caused in part by working conditions, but other factors are involved, with no single clearly identifiable cause. Their compensation mechanisms are mainly based on hundred-year-old employment arbitration law, to which other legislative and jurisprudential compensation mechanisms have been added. These disorders can only be prevented by a complex shift in attitudes to work and in the perception of proper working conditions. For civil servants, the current system causes disparities between agents, due to differences in their legal status and recognition of the disorder in each department.Under the current system of compensation, the cost of these work-related disorders is covered by social security, which is untenable, but any new form of compensation must be cost-efficient. However, as there are no figures available to estimate the number of recognised occupational disorders and hence the proportion of multifactorial diseases, it is not possible to estimate their cost. From the data collected in this study for the year 2008 it is possible to calculate the number of agents affected by multifactorial diseases. The results indicate that the only long-term and appropriate way to deal with this problem in the civil service is through partial compensation combined with incentives to prevent these disorders.

Playing a musical instrument requires hours of exposure to a fixed position and a performance of greatly repeated movements. This excessive physical load in combination with other factors can often result in playing-related musculoskeletal disorders (PRMD). This thesis specifies the definition of PRMD, clarifies the idea of musician's medicine as a fairly new specialization, titles the most commonly occurring medical conditions and risk factors in musicians with an emphasis on guitarists (classical and electric guitar players) and pianists. It also offers recommendations on how to play these instruments with respect to the ergonomics. The aim of practical part of the thesis was to find the possible relation between PRMD and instrument playing among guitarists and pianists in the last 12 months. It was composed of three parts: questionnaire of musculoskeletal disorders, clinical examination and video-analysis of instrument playing. The study surveyed 401 guitarists and pianists without specified instrumental level. 19 of these participated in the clinical examination. The analysis of questionnaire data revealed PRMD in 55,6 % musicians mainly localized in neck (19,8 %); more specifically, in pianists in neck and both hands (equally 27,4 %); however, in guitarists in left hand (18,6 %). Asymmetry has...

Factores como la repetición de movimientos, la aplicación de sobreesfuerzos durante sus actividades y las posturas incómodas debido al diseño disergonómico de las estaciones de trabajo; afectan en su rendimiento laboral y exponen a los trabajadores del proceso de envasado de GLP a riesgos de trastornos musculo esqueléticos. Estos factores generan una eficiencia del 62% en el proceso, un indicador bajo comparado con el 78.4% del sector. Debido a las causas que originan el problema, esta investigación tiene por motivo el análisis ergonómico de las estaciones de trabajo. El resultado es el rediseño ergonómico de la estación de pintado e inyectado basado en los principios de la antropometría, economía de movimientos y el estudio de posturas logrando reducir la fatiga muscular de los operarios. Gracias a los ajustes se consiguió un aumento en la eficiencia de 81% en el proceso de envasado. / Factors such as the repetition of movements, the application of overexertion during their activities and uncomfortable postures due to the dysergonomic design of the workstations affect their work performance and expose workers in the LPG packaging process to the risk of musculoskeletal disorders. These factors generate an efficiency of 62% in the process, a low indicator compared to 78.4% in the sector. Due to the causes that originate the problem, the purpose of this research is the ergonomic analysis of the workstations. The result is the ergonomic redesign of the painting and injection station based on the principles of anthropometry, economy of movements and the study of postures, reducing the muscular fatigue of the operators. Thanks to the adjustments, an 81% increase in efficiency was achieved in the packaging process. / Trabajo de investigación

Made available in DSpace on 2016-06-02T20:19:13Z (GMT). No. of bitstreams: 1 2990.pdf: 616602 bytes, checksum: 829531461b37752a48aecf7166676fda (MD5) Previous issue date: 2010-03-17 / Universidade Federal de Sao Carlos / Background: Musculoskeletal disorders have been recognized as a worldwide health problem. One of the measures for controlling these disorders is workplace exercise, either at the workstation or in a separate environment within the company. However, there is controversy regarding the effectiveness and means of applying these interventions. Objectives: To assess and provide evidence of the effectiveness of workplace exercise in controlling musculoskeletal pain. Methods: The following databases were searched: PubMed, MEDLINE, Embase, Cochrane, PEDro and Web of Science. Two independent reviewers selected the elegible studies. Possible disagreements were solved by consensus. All randomized controlled clinical trials that evaluated exercise interventions in the workplace musculoskeletal pain relief were included. The PEDro scale (range=0-10 points) was used to rate the quality of the studies included in this review. Results and Conclusion: The electronic search yielded a total of 8680 references published in English. At the end of the selection process, 18 studies were included. Strong evidence was found to support the effectiveness of physical exercise in controlling neck pain among workers who performed sedentary tasks in offices or administrative environments, while moderate evidence was found for low back pain relief among healthcare and industrial workers who performed heavy physical tasks. These positive results were reported when the training periods were longer than 10 weeks, the exercises were performed against some type of resistance and the sessions were supervised. None of the studies evaluating sedentary workers reported positive results for controlling musculoskeletal shoulder pain. Further randomized controlled trials are needed to comparatively evaluate, among other aspects, the effects of light and heavy training for shoulder pain relief. / As disfunções musculoesqueléticas representam um problema de saúde mundial. Dentre o conjunto de medidas para controle dessas alterações está a prática de exercício físico em ambiente ocupacional, que pode ser realizada no próprio setor de trabalho ou em ambientes à parte, mas dentro da empresa. Entretanto, há controvérsias quanto à efetividade e à forma de aplicação desse tipo de intervenção.Objetivos: Avaliar a efetividade e fornecer evidências a respeito da prática de exercício físico no ambiente ocupacional para o controle da dor musculoesquelética. Métodos: As seguintes bases bibliográficas foram consultadas: PubMed, MEDLINE, Embase, Cochrane, PEDro e Web of Science. Dois revisores independentes selecionaram os estudos pertinentes, e as eventuais discordâncias foram solucionadas por consenso. Foram incluídos no estudo os ensaios clínicos randomizados controlados que realizaram intervenção no local de trabalho envolvendo exercício e avaliaram a dor musculoesquelética. A escala PEDro, que tem pontuação de 0-10, foi utilizada para avaliação da qualidade dos estudos incluídos nesta revisão. Resultados e Conclusões: A busca eletrônica resultou em um total de 8680 referências publicadas em inglês. Ao final do processo de seleção, 18 estudos foram incluídos. Forte evidência foi encontrada para a efetividade do exercício físico no controle de dor cervical em trabalhadores que realizavam atividades em escritórios ou setores administrativos, descritos como sedentários enquanto evidência moderada foi encontrada para a região lombar daqueles que realizavam atividades envolvendo manuseio de pacientes ou materiais na indústria, desde que os treinamentos fossem aplicados por períodos superiores a dez semanas, incluíssem exercícios realizados com algum tipo de resistência e fossem supervisionados. Nenhum estudo avaliando trabalhadores sedentários relatou resultados positivos para o controle da dor musculoesquelética em ombros. Novos estudos randomizados controlados são necessários para avaliar, dentre outros aspectos, o efeito comparado de treinos leves e pesados para ombros.

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Thèse de doctorat à mi-chemin entre la recherche fondamentale et appliquée. Les champs disciplinaires sont principalement la biomécanique, l'ergonomie physique ou encore l'anatomie. Réalisé en cotutelle avec le professeur Paul Allard et Mickael Begon. / An occupation that requires handling loads combined with large elevation of the arms is associated with the occurrence of shoulders musculoskeletal disorder. The analysis of these joint movements is essential because it helps to quantify the stress applied to the musculoskeletal structures. This thesis provides an innovative model which allows the estimation of the shoulder complex kinematics and used it to analyze the joints kinematics during lifting tasks. It is organized into three sub-objectives. The first aim is the development and validation of a kinematic model the most representative as possible of the shoulder complex anatomy while correcting soft tissue artifacts through the use of global optimization. This model included a scapulothoracic closed loop, which constrains a scapular dot contact to be coincident with thoracic gliding plane modeled by a subject-specific ellipsoid. In the validation process, the reference model used the gold standard for direct measurements of bone movements. In dynamic movements, the closed loop model developed generates barely more kinematic errors that errors obtained for the study of standard movements by existing models. The second aim is to detect and quantify the shoulder articular movements influenced by the combined effects of two risk factors: task height and load weight. The results indicate that many peaks of joint angles are influenced by the interaction of height and weight. According to the different initial and deposits heights when the weight increases, the kinematics changes are substantial, in number and magnitude. The kinematic strategies of participants are more consistent when the weight of load increase for initial height lift at hips level compared to shoulders level, and for a deposit at eye level compared to shoulders. The third aim is to investigate the magnitude and temporality of the maximum peak vertical acceleration of the box. The significant joints movements are characterized with a principal component analysis of joint angle values collected at this instant. In particular, this study highlights that elbow flexion and thoraco-humeral elevation are two correlated invariant joint movements to all lifting tasks whatever the initial and deposit height, and weight of the load. The realism of the developed shoulder model and kinematics analyzes open perspectives in occupational biomechanics and contribute to risk prevention efforts in health and safety. / Une activité professionnelle qui exige de manipuler des charges combinée à de grandes élévations des bras augmente les chances de développer un trouble musculo-squelettique aux épaules. L’analyse de ces mouvements articulaires est essentielle car elle contribue à quantifier les contraintes appliquées aux structures musculo-squelettiques. Cette thèse propose un modèle innovant qui permet l’estimation de la cinématique du complexe de l’épaule, et l’utilise ensuite afin d’analyser la cinématique de levers de charge. Elle s’organise en trois sous-objectifs. Le premier concerne le développement et la validation d’un modèle cinématique le plus représentatif possible de l’anatomie du complexe de l’épaule tout en corrigeant les artéfacts des tissus mous par une optimisation multi-segmentaire. Ce modèle avec une fermeture de boucle scapulo-thoracique, impose à un point de contact scapulaire d’être coïncident au plan de glissement thoracique modélisé par un ellipsoïde mis à l’échelle pour chaque sujet. Le modèle qui a été utilisé comme référence lors des comparaisons du processus de validation bénéficie du « gold standard » de mesures directes des mouvements osseux. Le modèle développé en boucle fermée génère à peine plus d’erreurs cinématiques lors de mouvements dynamiques que les erreurs obtenues par les modèles existants pour l’étude de mouvements standards. Le second identifie et quantifie les mouvements articulaires de l’épaule influencés par la combinaison des effets de deux facteurs de risques : les hauteurs importantes d’agencement de la tâche (hauteurs de saisie et de dépôt) et les masses de charges (6 kg, 12 kg et 18 kg). Les résultats indiquent qu’il existe de nombreux pics d’angles articulaires qui sont influencés par l’interaction des deux effets. Lorsque la masse augmente, les modifications cinématiques sont plus importantes, en nombre et en amplitude, selon les différentes hauteurs de saisies et de dépôts de la charge. Les participants varient peu leur mode opératoire pour une saisie à hauteur des hanches en comparaison des épaules, et pour un dépôt à hauteur des yeux en comparaison aux épaules avec une charge plus lourde. Un troisième s’intéresse au pic maximal d’accélération verticale de la charge dans son intensité et sa temporalité. Basée sur une analyse en composante principale des valeurs d’angles articulaires à cet instant, elle permet de caractériser les mouvements articulaires significatifs. Cette étude met notamment en évidence que la flexion du coude et l’élévation thoraco-humérale sont deux mouvements articulaires corrélés invariants à toutes les tâches de lever en hauteur quelles que soient la hauteur de dépôt et la masse de la charge. Le souci de réalisme du modèle développé et les analyses cinématiques menées ouvrent des perspectives en biomécanique occupationnelle et participent à l’effort de prévention des risques en santé et sécurité.