Background: Work-related asthma (WRA) is under-recognized and early detection is associated with improved outcomes. The Work-related Asthma Screening Questionnaire (Long-version) (WRASQ(L)) is a 14-item tool designed to increase the detection of WRA in primary care. Purpose: The purpose of this study was to assess whether the WRASQ(L) provided additional and reliable information on a patient’s likelihood of WRA, beyond what is collected in standard care, to explore the relationship of WRASQ(L) responses to clinical actions and to assess the use of the WRASQ(L) in the primary care setting. Methods: This was an intervention study involving two Ontario Primary Care Asthma Program (PCAP) sites assigned the WRASQ(L). Standard care for asthma patients in PCAP sites involved completing the Asthma Care Map (ACM), a clinical pathway which included seven WRA screening items. Consent to participate in this study involved completing an electronic WRASQ(L) at each visit for participants and prompted care providers to record details related to WRA investigations. Results: The study sample (N=37) was predominantly female (73.0%), with a mean age of 46.3 years (SD, 10.9). Use of the WRASQ(L) identified work-related symptoms, exposures and high- risk past occupations in 38% and 60% and 47% of participants, respectively, that were not identified in standard care. Two participants were newly-suspected cases of WRA during this study period. WRASQ(L) items demonstrated fair to moderate reproducibility, but estimates may have been subject to measurement error. Incorporation of the electronic WRASQ(L) in clinical care was limited by time constraints and technical factors, such as ease of use and flexibility of the application. Conclusions: The WRASQ(L) provided added information about possible WRA over standard care. Use of the questionnaire’s results by care providers in this study was limited due to barriers encountered in incorporating the use of the WRASQ(L) in clinical practice. Future directions include the validation of this tool in relation to WRA diagnosis. The WRASQ(L) has the potential to increase recognition of WRA, improving long-term health outcomes for those with WRA. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-09-27 21:16:28.59

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Tidigare forskning beskriver att stress är en riskfaktor för ohälsa och det är ett arbetsmiljöproblem. Ohälsa bland unga kvinnor ökar i dagens samhälle. Syftet med studien var att finna olika kvalité i stresskänsla hos unga kvinnor och hur deras arbetssituation kan inverka på deras arbetsrelaterade stressupplevelse. För att få mer kunskap kring ämnet stress, har det undersökts hur kvinnor berörs av stress i deras arbetssituation och hur kvinnorna hanterar sin stressupplevelse på deras arbetsplats. Åtta kvinnor som dagligen upplevde arbetsrelaterad stress samt arbetat minst i sex månader, intervjuades. Kravet för att delta i studien var att de hade arbetat minst i sex månader.  Analysen resulterade i temana känslor, ohälsa, känsla av tidsbrist och hanteringsstrategier. Magknip, ångest, hög arbetsbörda och tidsbrist kunde vara orsaker till stressupplevelse. Med hjälp av planering, strukturering, ventilera med kollegor och listor kunde kvinnorna hantera sin stresskänsla. Stress som uppstår på arbetet kan beröra kvinnornas hälsa negativt.

Arbetsmarknadens förändringar i form av högre arbetstakt, tillfälliga anställningar och krav på flexibla arbetsvillkor, gör att allt fler upplever stress i arbetslivet. Långvarig stress medför stora hälsorisker för individen. Eftersom många av dagens sjukskrivningar beror på stressrelaterade sjukdomar, såsom depression och utmattning är det viktigt att studera metoder för stresshantering på arbetsplatsen. Beröring i form av massage kan minska stress hos individer samt fungerar som ett komplement i behandlingen för stressrelaterade sjukdomar. Ett fältexperiment med 28 tjänstemän utfördes för att undersöka om en kortvarig massage på arbetstid kunde inverka positivt på den arbetsrelaterade stressen jämfört med en avslappningsövning och vanlig rast. Studien visade signifikant minskning av stressnivån efter massageinterventionen. Resultatet ger en antydan om att upplevelsen av stress går att reducera med hjälp av fysisk beröring. Stickprovets storlek samt förväntnings- effektens inverkan på resultatet diskuteras.

Introduction: Work-related ill-health and resulting sickness absence is detrimental to the employees themselves, the employer and the national economy as a whole. To reduce the risk of work on health, information about causal factors and sectors at risk must first be gathered. General practice had been referred to as the ‘blind spot’ in occupational health as so little was known about work-related ill-health seen by GPs. The principal aim of this thesis was to estimate the incidence of work-related ill-health in the UK/GB as determined in general practice, to critically compare general practice reporting with other data sources and to evaluate the incidence and sickness absence burden of work-related ill-health. Methods: Data on incident cases of work-related ill-health and sickness absence were collected from GPs reporting to a UK-wide surveillance scheme (The Health and Occupation Reporting network in General Practice (THOR-GP)), and compared to information from other sources. To enable the calculation of incidence rates, THOR-GP population denominator information was gathered and characterised using Census information based on patient and practice postcode. Results were presented as a series of four peer-reviewed published papers and an additional chapter exploring the calculation of incidence rates.Results: The work-related ill-health diagnoses reported by GPs were mainly musculoskeletal (53%) and mental ill-health (30%). Overall, half the cases were issued with sickness certification. The proportion of cases issued with sickness certification differed by diagnosis; 79% of psychological cases had certified time away from work and these conditions were responsible for the majority of sickness absence days certified (56%) however these cases were rarely referred to secondary care (1%). Industries operating within the public and financial sectors had the highest incidence rates of work-related mental ill-health and correspondingly the highest rates of sickness absence. Industries with the highest proportions of self-employment had the lowest rates of sickness absence. When compared to reports from occupational physicians (OPs), GP information was more representative of the employed population of the UK, whereas OP data concentrated on industries covered by occupational health services. Incidence rates based on clinical specialists’ reports were much smaller than GP rates and biased by severity and referral patterns. Rates based on self-reported (SWI) data were higher than GP rates due to greater inclusivity; however diagnoses were unsubstantiated by medical opinion. The THOR-GP population denominator was characterised using approximately a million patient postcodes (and linking these to Census data) from over a hundred GPs. These population estimates compared well with those based on the practice postcode and enabled the calculation of incidence rates of work-related ill-health for this and (with weighting methods) the GB population. Rates of work-related ill-health were highest for those employed within construction and agriculture.Conclusion: This thesis has shown how the systematic collection of work-related ill-health data from GPs adds to the knowledge base about the distribution and determinants of work-related ill-health (and sickness absence) within the UK/GB workforce. This work also contributes to knowledge relating to the ‘primary care denominator problem’ in calculating rates of incidence from general practice.

Work-related musculoskeletal disorders (WMSDs) continue to present a substantial personal and economic burden. Biomarkers, in providing objective measures of physiological changes, may offer advantages over current tools for WMSD risk assessment. Existing work has identified biomarkers of cartilage and muscle damage, and demonstrated responsiveness to various forms of physical activity and biomechanical loading. Here, three studies were complete to further assess the occupational relevance/utility of three selected biomarkers: Cartilage Oligomeric Matrix Protein (COMP), Interleukin-6 (IL6), and Creatine Kinase (CK). First, the effects of age, obesity, gender, and diurnal variation was investigated. Significant effects of time, age, and gender were evident, as well as some interactive effects, for COMP and CK, but not IL6. Second, biomarker levels were compared between individuals in occupations having relatively high and low WMSD risk. IL6 levels were greater in the high-risk group, while COMP levels demonstrated an oscillatory pattern, and CK levels did not vary between groups. Third, physical demands were imposed on the lumbar spine during a repetitive flexion/extension task, under conditions with different loading and frequency. IL6 levels varied significantly over time and between added load levels, while CK levels varied over time and was influenced by load and frequency. These studies demonstrate important features of biomarkers; that personal confounding factors need to be considered, that select biomarkers may be sensitive to occupational risk factor exposure, and particularly to task parameters in lifting activities involving the lower back. Further, these studies reveal important information concerning the relevance of the selected biomarkers, favorable time points for biomarker collection, and approximate biomarker levels expected between occupations and exposure to common risk factors. These results support the use of biomarkers in occupational settings for assessing exposure and WMSD risk imposed by common risk factors. Sensitivity to exposure levels is an important precursor to risk prediction, however prospective work is needed to verify predictive validity. / Ph. D.

Arbetsrelaterad känsla av sammanhang (KASAM), empowerment och psykosocial arbetsmiljö (PSAM) är väletablerade begrepp. Det finns begränsad forskning om deras inbördes relation, dock har tidigare forskning konstaterat att höga nivåer av KASAM och empowerment är relaterad till god upplevelse av anställdas PSAM. Studiens syfte var att undersöka relationen och variationen mellan PSAM, KASAM och empowerment. Detta besvarades genom fyra frågeställningar och tre hypoteser. I studien ingick 130 deltagare (74 kvinnor och 56 män). Datainsamlingen skedde på två separata arbetsplatser. Enkäten inkluderade fem bakgrundvariabler och tre skalor. Materialet analyserades med korrelationer och regressionsanalyser. Analyserna visade att KASAM och empowerment kompletterar varandra med att förklara variationen i PSAM. Korrelationerna indikerade att högre upplevelse av KASAM och empowerment är kopplade till en högre skattning av PSAM. Utöver detta korrelerade KASAM och empowerment med varandra. Slutsatsen som drogs var att arbetsplatser måste undersöka dessa tre delar tillsammans för att få en överblick över hur anställda upplever sin PSAM.

The Master's thesis deals with work-related stress in its context; preventing and managing it; and compares approaches to preventing and managing work-related stress in the Czech Republic and the Nordic countries. Work-related stress may have a negative impact on physical and mental health or overall quality of life of an individual and it may bring negative implications for an organization. The thesis follows theoretical basis for work- related stress, its factors and consequences from the point of view of an individual as well as an organization. The attention is concentrated on the approaches to preventing and managing work-related stress in organizations in regard to the nature of a work activity, the management level or particular activities carried out by human resources management. It is focusing on stress management precautions taken on the European and national level and describes the process conducted during the development of a programme for preventing and managing work-related stress and its effectivity evaluation. The thesis deals with an analysis of the approaches to preventing and managing work-related stress in the Czech Republic in comparison to those employed in the Nordic countries. The analysis and the follow-up comparison pursues situation in handling the matter in the Czech...

Hairdressers’ exposure to work-related musculoskeletal disorders (WMSDs) appears to be insufficiently described in the literature. Knowledge regarding musculoskeletal disorders in this group is also sparse. The purpose of the research was to investigate the status of work-related musculoskeletal disorder cases found in Taiwanese hairdressers and to develop user-centred, strategic solutions to prevent the accumulation of musculoskeletal disorders in this group, especially newcomers to the industry. The study involved a series of investigations into the status of WMSDs for hairdressers in Taiwan as a first step towards their prevention. A hairdresser-oriented, musculoskeletal questionnaire was used to discover the risk factors associated with WMSDs and a validated, on-line, rapid, upper-limb assessment tool was used to identify critical hairdressing working postures. Improvements to the main critical hairdressing working postures identified by the first stage of the research have been addressed by an ergonomics training programme. The effectiveness of this is validated using 3D-motion analysis based on a pre- and post-test evaluation of awkward movements. A scientific approach to 3D-motion analysis has been achieved specifically by the study of the awkward working postures of the upper extremity during hair-blow-waving and hair-straightening activities. The relationship between working postures and WMSDs in various body regions is discussed. In this regard, poor posture and movement can lead to local mechanical stress on the muscles, ligaments and joints, resulting in discomfort in the musculoskeletal system, particularly the neck, back, shoulder and wrist. This research has provided a WMSDs prevention framework as a strategic method of securing a continuous improvement in the awkward working postures adopted during various hairdressing activities. Topics for further studies are suggested.