Improvement of short-term outcomes with VR-based safety training for work at heights.

Serious games and virtual reality offer engaging learning opportunities and a cost-effective solution within an immersive and safe environment for safety training in construction. However, there have been few examples of safety training for work at heights developed using these technologies, especially commercial training. To fill this literature gap, a new VR-based safety training was developed and compared with lecture-based training across time. We conducted a quasi-experiment with a non-equivalent group design with 102 workers from six construction sites in Colombia. Learning objectives, observations from training centers, and national regulations were considered during the design of the training methods. Training outcomes were assessed using Kirkpatrick's model. We found that both training approaches were effective in improving knowledge test results and self-reported attitudes in the short-term; and risk-perception, self-reported behavior and safety climate in the long-term. In particular, participants of the VR-based training got significantly higher results in knowledge and reported higher attitudes (commitment and motivation) than participants of the lecture-based training. We suggest that safety managers and practitioners should invest in VR using serious games as an alternative to training programs based on short-term outcomes. Future work is needed to test VR for long-term outcomes.

Patterns of change of multisite pain over 1 year of follow-up and related risk factors.

BACKGROUND: Multisite musculoskeletal pain is common and disabling. This study aimed to prospectively investigate the distribution of musculoskeletal pain anatomically, and explore risk factors for increases/reductions in the number of painful sites. METHODS: Using data from participants working in 45 occupational groups in 18 countries, we explored changes in reporting pain at 10 anatomical sites on two occasions 14 months apart. We used descriptive statistics to explore consistency over time in the number of painful sites, and their anatomical distribution. Baseline risk factors for increases/reductions by ≥3 painful sites were explored by random intercept logistic regression that adjusted for baseline number of painful sites. RESULTS: Among 8927 workers, only 20% reported no pain at either time point, and 16% reported ≥3 painful sites both times. After 14 months, the anatomical distribution of pain often changed but there was only an average increase of 0.17 painful sites. Some 14% workers reported a change in painful sites by ≥3. Risk factors for an increase of ≥3 painful sites included female sex, lower educational attainment, having a physically demanding job and adverse beliefs about the work-relatedness of musculoskeletal pain. Also predictives were as follows: older age, somatizing tendency and poorer mental health (each of which was also associated with lower odds of reductions of ≥3 painful sites). CONCLUSIONS: Longitudinally, the number of reported painful sites was relatively stable but the anatomical distribution varied considerably. These findings suggest an important role for central pain sensitization mechanisms, rather than localized risk factors, among working adults. SIGNIFICANCE: Our findings indicate that within individuals, the number of painful sites is fairly constant over time, but the anatomical distribution varies, supporting the theory that among people at work, musculoskeletal pain is driven more by factors that predispose to experiencing or reporting pain rather than by localized stressors specific to only one or two anatomical sites.

The effectiveness of virtual safety training in work at heights: A literature review.

Virtual environment techniques are technologies that can be used for safety training, and deliver significant advantages (e.g. risk-free, immersive learning). However, no studies have assessed the effectiveness of this training for work at heights (WAH). This paper aimed to synthesize the outcomes criteria for measuring the effectiveness of virtual safety training of WAH in different work sectors. A total of 658 records were identified through an explorative search of relevant citations from 2010 onwards. Only 21 documents were considered and classified according to the training goal: improvement of knowledge, skills or attitudes. Outcomes criteria of virtual safety training were analyzed according to Kirkpatrick's model. The results support practitioners and safety managers by providing an inventory of training methods, evaluation indicators and evaluation effects. Further recommendations are made for the design of an effective training assessment.

Assessment of work-related hand and elbow workloads using measurement-based TLV for HAL.

Direct-measurement-based methods for assessing workloads of the hand or elbow in the field are rare. Aim of the study was to develop such a method based on the Threshold Limit Value for Hand Activity Level (TLV for HAL). Hence, HAL was quantified using kinematic data (mean power frequencies, angular velocities and micro-pauses) and combined with electromyographic data (root-mean-square values) in order to generate a measurement-based TLV for HAL (mTLV for HAL). The multi-sensor system CUELA including inertial sensors, potentiometers and a 4-channel surface electromyography module was used. For wrist and elbow regions, associations between mTLV for HAL and disorders/complaints (quantified by odds ratios (OR [95%-confidence interval])) were tested exploratively within a cross-sectional field study with 500 participants. Higher workloads were frequently significantly associated with arthrosis of distal joints (9.23 [3.29-25.87]), wrist complaints (2.89 [1.63-5.11]) or elbow complaints (1.99 [1.08-3.67]). The new method could extend previous application possibilities.

Associations of sickness absence for pain in the low back, neck and shoulders with wider propensity to pain.

OBJECTIVES: To explore the association of sickness absence ascribed to pain at specific anatomical sites with wider propensity to musculoskeletal pain. METHODS: As part of the CUPID (Cultural and Psychosocial Influences on Disability) study, potential risk factors for sickness absence from musculoskeletal pain were determined for 11 922 participants from 45 occupational groups in 18 countries. After approximately 14 months, 9119 (78%) provided follow-up information about sickness in the past month because of musculoskeletal pain, including 8610 who were still in the same job. Associations with absence for pain at specific anatomical sites were assessed by logistic regression and summarised by ORs with 95% CIs. RESULTS: 861 participants (10%) reported absence from work because of musculoskeletal pain during the month before follow-up. After allowance for potential confounders, risk of absence ascribed entirely to low back pain (n=235) increased with the number of anatomical sites other than low back that had been reported as painful in the year before baseline (ORs 1.6 to 1.7 for ≥4 vs 0 painful sites). Similarly, associations with wider propensity to pain were observed for absence attributed entirely to pain in the neck (ORs up to 2.0) and shoulders (ORs up to 3.4). CONCLUSIONS: Sickness absence for pain at specific anatomical sites is importantly associated with wider propensity to pain, the determinants of which extend beyond established risk factors such as somatising tendency and low mood. Better understanding of why some individuals are generally more prone to musculoskeletal pain might point to useful opportunities for prevention.

Determinants of international variation in the prevalence of disabling wrist and hand pain.

BACKGROUND: Previous research has indicated that wide international variation in the prevalence of disabling low back pain among working populations is largely driven by factors predisposing to musculoskeletal pain more generally. This paper explores whether the same applies to disabling wrist/hand pain (WHP). METHODS: Using data from the Cultural and Psychosocial Influences on Disability (CUPID) study, we focused on workers from 45 occupational groups (office workers, nurses and other workers) in 18 countries. Among 11,740 participants who completed a baseline questionnaire about musculoskeletal pain and potential risk factors, 9082 (77%) answered a further questionnaire after a mean interval of 14 months, including 1373 (15%) who reported disabling WHP in the month before follow-up. Poisson regression was used to assess associations of this outcome with baseline risk factors, including the number of anatomical sites other than wrist/hand that had been painful in the 12 months before baseline (taken as an index of general propensity to pain). RESULTS: After allowance for other risk factors, the strongest associations were with general pain propensity (prevalence rate ratio for an index ≥6 vs. 0: 3.6, 95% confidence interval 2.9-4.4), and risk rose progressively as the index increased. The population attributable fraction for a pain propensity index > 0 was 49.4%. The prevalence of disabling WHP by occupational group ranged from 0.3 to 36.2%, and correlated strongly with mean pain propensity index (correlation coefficient 0.86). CONCLUSION: Strategies to prevent disability from WHP among working populations should explore ways of reducing general propensity to pain, as well as improving the ergonomics of occupational tasks.

Whole-body vibration and back pain-related work absence among heavy equipment vehicle mining operators.

OBJECTIVE: To determine the association between several whole-body vibration (WBV) exposure estimates and back pain-related work absence. METHODS: Exposures (based on the weighted daily root mean square acceleration, A(8); the daily vibration dose value, VDV(8); and the daily equivalent static compression dose, Sed(8)) of 2302 workers during 4 years were estimated using each worker's monthly vehicle operation records and WBV measurements from 11 different types of heavy equipment vehicles in a large coal mine. Company payroll data provided work absence during the concurrent 4 years of exposure. Cox regression models estimated the associations between the different WBV metrics and time to first work absence related to back pain. An adjusted R2 statistic provided a measure of model fit. RESULTS: All estimated metrics of WBV exposures were positively and significantly associated with back pain-related absence. HRs varied from 2.03 to 12.39 for every 0.21 m/s2 increase in the A(8)-based exposures; from 1.03 to 1.18 for every 1.72 m/s1.75 increase in VDV(8)-based exposures; and from 1.04 to 1.07 for every 0.06 MPa increase in Sed(8)-based exposures. Models using the estimated VDV(8) metric for the z axis fit the data best as measured by the R2 statistic. CONCLUSION: Higher WBV exposures were associated with back pain-related absences in this population, which appears after a few years of follow-up. Introducing controls to lower exposure levels may help reduce back pain-related work absences.

Effect of Time Elapsed since Last Pruner Maintenance on Upper-Extremity Biomechanics during Manual Flower Cutting.

OBJECTIVE: Manual flower cutting imposes large biomechanical demands on workers' upper extremities. Solutions are required to reduce these demands. This study investigated the effect of time elapsed since the last pruner maintenance on the biomechanical demands of the upper extremities during flower-cutting operations. METHODS: Sixteen experienced workers were recruited. All workers performed flower cutting 1, 15, and 30 days after standard pruner maintenance, including cleaning, adjustment, and sharpening. The outcomes included kinematics of the wrist, elbow, and forearm; muscular activity of the extensor carpi radialis, extensor carpi ulnaris, flexor carpi radialis, flexor carpi ulnaris, biceps and medium deltoids of the dominant arm; and self-reported effort. RESULTS: On average across muscles, a 15-day delay (from 1 to 15 and from 15 to 30 days) in the execution of pruner maintenance increased over 8% the median recorded muscular activity as measured by the percentage of the maximum voluntary contraction of the root mean square signal. An increase in time since last pruner maintenance resulted in an increase in the 90th percentile pronation-supination posture (larger excursion toward pronation); the median and the 90th percentile velocity of the wrist and elbow; and the 90th percentile acceleration in the pronation-supination direction. There was an increase in perceived effort as measured by a Borg scale as time since last maintenance increased from 1 to 15 days. CONCLUSION: Increasing the frequency of pruner maintenance procedures can effectively reduce workers' mechanical exposures during manual flower-cutting operations. Companies should implement daily maintenance programs considering their implementation capacity and expected benefits.

Correctness of Self-Reported Task Durations: A Systematic Review.

Objectives: Duration of tasks in a job is an essential interest in occupational epidemiology. Such duration is frequently measured using self-reports, which may, however, be associated with both bias and random errors. The present systematic literature review examines the correctness of self-reported durations of tasks, i.e. the extent to which they differ from more valid reference data due to either systematic or random errors, and factors influencing this correctness, with particular emphasis on the assessment of exposures of relevance to musculoskeletal disorders. Methods: The search for relevant studies included the databases ISI Web of Science, MEDLINE, EBSCO HOST, Proquest, and Psycnet. Results: Thirty-two articles were identified; of which, 23 examined occupational tasks and 9 examined non-occupational tasks. Agreement between self-reports and a more correct reference was reported for, in total, 182 tasks. Average proportional errors were, for most tasks, between -50% (i.e. underestimations) and +100%, with a dominance of overestimations; 22% of all results considered overestimations of 100% or more. For 15% of the 182 reported tasks, the mean difference between the self-reported and the reference duration value was <5%, and 20% of the 182 mean differences were between 5 and 20%. In general, respondents were able to correctly distinguish tasks of a longer duration from shorter tasks, even though the actual durations were not correct. A number of factors associated with the task per se appeared to influence agreement between self-reports and reference data, including type of task, true task duration, task pattern across time (continuous versus discontinuous), and whether the addressed task is composed of subtasks. The musculoskeletal health status of the respondent did not have a clear effect on the ability to correctly report task durations. Studies differed in key design characteristics and detail of information reported, which hampers a formal aggregation of results. Conclusions: The correctness of self-reported task durations is, at the best, moderate at the individual level, and this may present a significant problem when using self-reports in task-based assessment of individual job exposures. However, average self-reports at the group level appear reasonably correct and may thus be a viable method in studies addressing, for instance, the relative occurrence of tasks in a production system. Due to the disparity of studies, definite conclusions on the quantitative effect on agreement of different modifiers are not justified, and we encourage future studies specifically devoted to understanding and controlling sources of bias in self-reported task durations. We also encourage studies developing decision support for when to apply or avoid self-reports to measure task durations, depending on study purpose and occupational setting.

Assessment of Whole-Body Vibration Exposure in Mining Earth-moving Equipment and Other Vehicles Used in Surface Mining.

This study characterized whole-body vibration exposures in a set of vehicles that operate in open-pit mines and compared three different daily exposure parameters based on the ISO 2631-1:1997 and ISO 2631-5:2004 standards. Full-shift, 6 to 12-hour, continuous whole-body vibration measurements were collected from 11 representative types of vehicles in terms of hours of operation and number of vehicles used. For each type of vehicle, the exposure parameters (A(8), VDV(8), and Sed(8)) were calculated for each axis (x, y, and z), and in addition, shear or horizontal (∑xy) and vector sum (∑xyx) whole-body vibration exposure. Findings showed that: (i) substantially higher shear and vector sum whole-body vibration exposures indicated relatively high levels of exposure on the non-predominant axis; (ii) the predominant axis of exposure varied across the different type of vehicles; (iii) there were differences in whole-body vibration exposure parameters regarding the standards-based predictions of potentially adverse health outcomes (the impulsive exposure parameters VDV(8) and Sed(8) were higher and reduced acceptable vehicle operation times by one-half to two-thirds relative to A(8) exposures); and (iv) based on the predominant exposures and the time to reach daily vibration action limits, the operation of most mining vehicles would be limited to less than 8 hours a day. Differences in whole-body vibration exposure parameters impact the prediction of potentially adverse health outcomes and may introduce some uncertainty regarding how to best characterize a vehicle operator's actual exposure.

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

OBJECTIVES: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). METHODS: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). RESULTS: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. CONCLUSIONS: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

Job rotation: Effects on muscular activity variability.

Job rotation strategies have been used for years as an administrative intervention to reduce the risk of musculoskeletal disorders. The benefits of job rotation have been hypothesized to occur via changes in muscular activity variability (MAV). However, the effect of job rotation on MAV has not been fully analyzed in a literature review. A wide search was conducted to identify studies testing the effect of different job rotation strategies on MAV. Twenty-six studies of acceptable quality were included. Several studies on different types of tasks supported the view that job rotation can increase muscular activity variability, particularly with strategies such as alternating tasks and pace changes. However, it remains uncertain whether such variability changes immediately translate into benefits for the worker because little evidence was found that showed simultaneous changes in different muscular groups. Additionally, variability was occasionally achieved at the expense of average activity in the assessed muscles.

Epidemiological Differences Between Localized and Nonlocalized Low Back Pain.

STUDY DESIGN: A cross-sectional survey with a longitudinal follow-up. OBJECTIVES: The aim of this study was to test the hypothesis that pain, which is localized to the low back, differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. METHODS: We analyzed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability, and potential risk factors, in 47 occupational groups (office workers, nurses, and others) from 18 countries. RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localized LBP in the past month, and 3820 (31.3%) nonlocalized LBP. Nonlocalized LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, nonlocalized LBP was differentially associated with risk factors, particularly female sex, older age, and somatizing tendency. There were also marked differences in the relative prevalence of localized and nonlocalized LBP by occupational group. CONCLUSION: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP that occurs in association with pain at other anatomical locations. LEVEL OF EVIDENCE: 2.

Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study.

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.

Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study.

IMPORTANCE: The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. OBJECTIVE: To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. EVIDENCE REVIEW: Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14,244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35,620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. FINDINGS: Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905.059 deaths; 95% UI, 810,304-998,125), diarrheal diseases among older children (38,325 deaths; 95% UI, 30,365-47,678), and road injuries among adolescents (115,186 deaths; 95% UI, 105,185-124,870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. CONCLUSIONS AND RELEVANCE: Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.

Classification of neck/shoulder pain in epidemiological research: a comparison of personal and occupational characteristics, disability, and prognosis among 12,195 workers from 18 countries.

To inform case definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association, and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability, and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The 1-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs 1.3) and poor mental health (PRR 1.3 vs 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs 61.7%). Our findings highlight important epidemiological distinctions between subcategories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain that is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.

Relación entre el dolor lumbar y los movimientos realizados en postura sedente prolongada: Revisión de la literatura / The relationship between low back pain and movements in prolonged sitting posture: Literature review

La evidencia científica muestra que existe asociación entre dolor lumbar y postura sedente prolongada y que una de las poblaciones más propensa a esta enfermedad es la de conductores, con una alta prevalencia. De igual manera, los movimientos posturales en la silla son la respuesta natural del cuerpo debida a la incomodidad percibida por el dolor lumbar, pero esta difiere en función de la historia previa. Con base en esto se realizó una revisión de los estudios relacionados con el dolor lumbar y el movimiento en postura sedente prolongada, incluyendo la población de conductores, con el fin de comprender esta relación. Se recuperaron 6226 artículos, de los cuales 16 fueron publicados entre 1970 y 2010; estos proporcionaron la información necesaria para contestar la pregunta de revisión. Se pudo constatar que ninguno de los estudios fueron realizados en actividades de conducir y la mayoría involucró sujetos voluntarios sin considerar si la población era trabajadora. El movimiento con dolor lumbar en postura sedente prolongada solo se pudo explicar desde el rango de movimiento lumbar, debido a que solo se encontró un artículo con estas características. También se encontró que los sintomáticos se mueven más, pero que el dolor lumbar no disminuye en función del tiempo, es decir que conocemos muy poco acerca de la paradoja movimiento y dolor en postura sedente prolongada.

Scientific evidence shows an association between low back pain and prolonged sitting posture, also one of the most sensitive populations to this disorder are the drivers with a high prevalence. Postural movements in the chair are body's natural response to perceived discomfort caused by back pain but this is different depending on each individual's background of back pain. Based on this, we perform a review of studies related to low back pain and movement in prolonged sitting posture, including the driver population, in order to understand this relationship. We retrieved 6226 articles, of which 16 matched the established criteria and provided the information necessary to answer the review question. We found that none of the studies considered were conducted in driving activities and most of them were done with volunteer subjects regardless if they were workers or not. The movement with low back pain in prolonged sitting posture could only be explained from the range of lumbar motion because only one article matched these characteristics, finding that symptomatic people move more but low back pain does not decrease as a function of time, proving that we know very little about the paradoxical between movement and pain in prolonged sitting posture.

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013.

BACKGROUND: The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. METHODS: Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. RESULTS: In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. CONCLUSIONS: Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

A time for action: Opportunities for preventing the growing burden and disability from musculoskeletal conditions in low- and middle-income countries.

Musculoskeletal (MSK) conditions cause an enormous global burden, and this is dramatically increasing in developing countries, particularly due to rapidly ageing populations and increasing obesity. Many of the global non-communicable disease (NCD) initiatives need to expand beyond the traditional 'top four' NCD groups by incorporating MSK diseases. It is critical that MSK initiatives in developing countries integrate well with health systems, rather than being stand-alone. A better inclusion of MSK conditions will avoid doubling of efforts and wasting of resources, and will help to promote a more streamlined, cost-effective approach. Other key opportunities for action include the following: ensuring the principles of 'development effectiveness' are met; strengthening leadership and commitment; building the research, information and evidence base; and reducing the incidence and disability of MSK conditions through better prevention. Each of these elements is necessary to mitigate and reduce the growing burden from the MSKs.

Ergonomía en floricultura en Colombia: resultados y lecciones / Ergonomics in Colombian Floriculture: Results and Lessons / Ergonomía em Floricultura na Colômbia: Resultados e lições

Introducción: el sector floricultor ha sido afectado por años por la alta ocurrencia de enfermedades músculo-esqueléticas entre sus trabajadores. Diversos esfuerzos han sido puestos en marcha para comprender la magnitud del problema, sus causas y sus posibles soluciones. Este manuscrito expone desde la perspectiva académica las lecciones y logros del modelo de actuación industria-academia para mejorar las condiciones ergonómicas de la población trabajadora de este importante sector industrial. Materiales y métodos: se hizo una recopilación de actas, comunicaciones, reportes y publicaciones científicas de los trabajos llevados a cabo desde el año 2007 con la participación del Centro de Estudios de Ergonomía del Departamento de Ingeniería Industrial de la Pontificia Universidad Javeriana. Un análisis retrospectivo de esta información buscó responder a preguntas sobre el origen de los trabajos, objetivos perseguidos, resultados alcanzados, beneficios obtenidos y lecciones aprendidas. Resultados: el modelo de trabajo fue participativo. El motor iniciador de los trabajos son las empresas productoras de flores que hacen explícitas sus necesidades a las aseguradoras del trabajo. El diseño global del estudio no fue encargado a la academia, sino construido con la academia; y, posteriormente, refinado con la agremiación de productores. Aunque el objetivo global del trabajo es la prevención de enfermedades, este se lleva a cabo a partir de proyectos que en la medida en que fue pasando el tiempo fueron asegurando fondos para la consecución de objetivos específicos relacionados con: la evaluación de las condiciones ergonómicas del trabajo, la caracterización de la población trabajadora y el desarrollo, implementación y prueba de soluciones. Conclusiones: el modelo de colaboración industria-academia presentada evidencia importantes resultados tanto de mejoras a las condiciones laborales como académicos. Aunque es necesario validar la visión de la industria sobre este tipo de modelos de trabajo colaborativo, se considera que este caso fue exitoso y, por lo tanto, debería ser replicado en otras industrias.

Introduction: The flower industry has been affected for years by the high occurrence of musculoskeletal disorders among workers. Various efforts have been done to understand the magnitude of the problem, its causes and possible solutions. This manuscript presents from the academic perspective the lessons and achievements of an industry-academics model of action to improve the ergonomic conditions of the working population of this important industry. Materials and methods: a review of minutes, communications, reports and scientific publications related to the ergonomics work done since year 2007 with the participation of the Center for Ergonomics Studies (CEE) of the Department of Industrial Engineering at Pontificia Universidad Javeriana was conducted. A retrospective analysis of the information sought to answer questions about the origin of the work, objectives, results, lessons learned and benefits gained. Results: The working model was participatory. Flower producers were the starters of the work. They made explicit their needs to workers' insurance companies. The overall study design was not just given but built with academics, and subsequently reined with the association of producers. Although the overall objective of the work was the prevention of musculoskeletal disease among workers, the work was carried out in time as funds were secured through studies with specific objectives related to: Workplace ergonomics evaluations, characterization of the working population, and the development, implementation and testing of solutions. Conclusions: The presented industry-academics collaboration model resulted in important improvements to working conditions and academic results. Although it is necessary to validate the view of the industry regarding this type of collaborative models, it is considered that this case was successful and therefore should be replicated in other industries.

Introdução: o setor floricultor tem sido afetado por anos por a alta ocorrência de doenças musculoesqueléticas entre seus trabalhadores. Diversos esforços têm sido postos em funcionamento para compreender a magnitude do problema, suas causas e suas possíveis soluções. Este manuscrito expõe desde a perspectiva acadêmica as lições e resultados do modelo de atuação indústria-academia para melhorar as condições ergonômicas da população trabalhadora deste importante setor industrial. Materiais e métodos: Se fez uma recopilação de atas, comunicações, reportes e publicações cientíicas dos trabalhos levados a cabo desde o ano 2007 com a participação do Centro de Estudos de Ergonomia do Departamento de Engenharia Industrial da Pontiicia Universidad Javeriana. Uma análise retrospectiva desta informação buscou responder a perguntas sobre a origem dos trabalhos, objetivos perseguidos, resultados alcançados, benefícios obtidos e lições aprendidas. Resultados: o modelo de trabalho foi participativo. O motor iniciador dos trabalhos são as empresas produtoras de flores que fazem explícitas suas necessidades às seguradoras do trabalho. A criação global do estudo não foi encarregada à academia, senão construído com a academia; e posteriormente refinado com a agremiação de produtores. Ainda que o objetivo global do trabalho é a prevenção de doenças, o trabalho se leva a cabo a partir de projetos, que na medida que foi passando o tempo, foram segurando fundos para a consecução de objetivos especíicos relacionados com: a avaliação das condições ergonômicas do trabalho, a caracterização da população trabalhadora e o desenvolvimento, implementação e prova de soluções. Conclusãos: o modelo de colaboração indústria-academia apresentada evidencia importantes resultados tanto de melhoras às condições laborais quanto acadêmicas. Ainda que é necessário validar a visão da indústria sobre este tipo de modelos de trabalho colaborativo, considera-se que este caso foi de sucesso e portanto deveria ser replicado em outras indústrias.