Ergonomic exposures and control measures associated with mass fatality decedent handling in morgues and body collection points in a New York healthcare system during COVID-19: A case series.

INTRODUCTION: In April 2020, novel coronavirus SARS-CoV-2 (COVID-19) produced an ongoing mass fatality event in New York. This overwhelmed hospital morgues necessitating emergent expansion of capacity in the form of refrigerated trucks, trailers, and shipping containers referred to as body collection points (BCPs). The risks for musculoskeletal injury during routine and mass fatality mortuary operations and experiences of decedent handlers throughout the "first wave" of COVID-19 are presented along with mitigation strategies. METHODS: Awareness of the high rates of musculoskeletal injury among health care workers due to ergonomic exposures from patient handling, including heavy and repetitive manual lifting, prompted safety walkthroughs of mortuary operations at multiple hospitals within a health system in New York State by workforce safety specialists. Site visits sought to identify ergonomic exposures and ameliorate risk for injury associated with decedent handling by implementing engineering, work practice, and administrative controls. RESULTS: Musculoskeletal exposures included manual lifting of decedents to high and low surfaces, non-neutral postures, maneuvering of heavy equipment, and push/pull forces associated with the transport of decedents. DISCUSSION: Risk mitigation strategies through participatory ergonomics, education on body mechanics, development of novel handling techniques implementing friction-reducing aides, procurement of specialized equipment, optimizing BCP design, and facilitation of communication between hospital and system-wide departments are presented along with lessons learned. After-action review of health system workers' compensation data found over four thousand lost workdays due to decedent handling related incidents, which illuminates the magnitude of musculoskeletal injury risk to decedent handlers.

Effect of Manual versus Robotic-Assisted Total Knee Arthroplasty on Cervical Spine Static and Dynamic Postures.

This study compared surgeon cervical (C) spine postures and repetitive motions when performing traditional manual total knee arthroplasty (MTKA) versus robotic-assisted TKA (RATKA). Surgeons wore motion trackers on T3 vertebra and the occiput anatomical landmarks to obtain postural and repetitive motion data during MTKA and RATKA performed on cadavers. We assessed (1) flexion-extension at T3 and the occiput anatomical landmarks, (2) range of motion (ROM) as the percentage of time in the flexion-extension angle, (3) repetition rate, defined as the number of the times T3 and the occiput flexion-extension angle exceeded ±10°; and (4) static posture, where T3 or occiput postures exceed 10° for more than 30 seconds. The average T3 flexion-extension angle for MTKA cases was 5-degree larger than for RATKA cases (19 ± 8 vs. 14 ± 8 degrees). The surgeons who performed MTKA cases spent 15% more time in nonneutral C-spine ROM than those who performed RATKA cases (78 ± 25 vs. 63 ± 36%, p < 0.01). The repetition rate at T3 was 4% greater for MTKA than RATKA (14 ± 5 vs. 10 ± 6 reps/min). The percentage of time spent in static T3 posture was 5% greater for overall MTKA cases than for RATKA cases (15 ± 3 vs. 10 ± 3%). In this cadaveric study, we found differences in cervical and thoracic ergonomics between manual and robotic-assisted TKA. Specifically, we found that RATKA may reduce a surgeon's ergonomic strain at both the T3 and occiput locations by reducing the time the surgeon spends in a nonneutral position.

A primary care team approach to secondary prevention of work-related musculoskeletal disorders: Physical therapy perspectives.

BACKGROUND: Among work-related conditions in the United States, musculoskeletal disorders (MSDs) account for about thirty-four percent of work absences. Primary care physicians (PCPs) play an essential role in the management of work-related MSDs. For conditions diagnosed as work-related, up to seventeen percent of cases are PCP managed; within these conditions, up to fifty-nine percent are diagnosed as musculoskeletal. Negative factors in treatment success confronting PCPs include time constraints and unfamiliarity with work-related MSDs. A multidimensional team approach to secondary prevention, where PCPs can leverage the expertise of allied health professionals, might provide a useful alternative to current PCP practices for the treatment of work-related MSDs. OBJECTIVE: Provide the structure of and rationale for an "extended care team" within primary care for the management of work-related MSDs. METHODS: A systematic literature search, combining medical subject headings and keywords, were used to examine eight peer-reviewed literature databases. Gray literature, such as government documents, were also used. RESULTS: An extended care team would likely consist of at least nine stakeholders within primary care. Among these stakeholders, advanced practice orthopedic physical therapists can offer particularly focused guidance to PCPs on the evaluation and treatment of work-related MSDs. CONCLUSIONS: A multidimensional approach has the potential to accelerate access and improve quality of work-related outcomes, while maintaining patient safety.

MODIFIED PATH METHODOLOGY FOR OBTAINING INTERVAL-SCALED POSTURAL ASSESSMENTS OF FARMWORKERS.

Agricultural workers perform tasks that frequently require awkward and extreme postures that are associated with musculoskeletal disorders (MSDs). The PATH (Posture, Activity, Tools, Handling) system currently provides a sound methodology for quantifying workers' exposure to these awkward postures on an ordinal scale of measurement, which places restrictions on the choice of analytic methods. This study reports a modification of the PATH methodology that instead captures these postures as degrees of flexion, an interval-scaled measurement. Rather than making live observations in the field, as in PATH, the postural assessments were performed on photographs using ImageJ photo analysis software. Capturing the postures in photographs permitted more careful measurement of the degrees of flexion. The current PATH methodology requires that the observer in the field be trained in the use of PATH, whereas the single photographer used in this modification requires only sufficient training to maintain the proper camera angle. Ultimately, these interval-scale measurements could be combined with other quantitative measures, such as those produced by electromyograms (EMGs), to provide more sophisticated estimates of future risk for MSDs. Further, these data can provide a baseline from which the effects of interventions designed to reduce hazardous postures can be calculated with greater precision.

Methodological concerns related to response bias in migrant and seasonal farmworkers.

BACKGROUND: The original objective was to measure the impact of kneepads on musculoskeletal pain in migrant and seasonal farmworkers (MSFWs). Secondary analyses were conducted to quantify the extent to which response bias may have skewed the study's results. METHODS: Surveys were used to collect data on baseline pain and post-intervention pain, the amount of time participants spent wearing kneepads, and their overall ratings of the intervention. RESULTS: Participants did not experience significantly less pain with kneepads, and wore them for considerably less than the prescribed amount of time. However, subjects rated them very favorably. Given the strong suspicion of response bias, no firm conclusions could be drawn regarding the intervention. CONCLUSIONS: Unique survey methodologies must be used with MSFWs, who tend to have low research literacy and are particularly susceptible to response bias. Objective study outcomes are particularly favorable in this population in order to minimize dependence on self-reported measures. Am. J. Ind. Med. 59:1112-1119, 2016. © 2016 Wiley Periodicals, Inc.

Access to properly fitting personal protective equipment for female construction workers.

BACKGROUND: Previous literature suggests that most personal protective equipment (PPE) for construction is designed for males and does not accommodate female anthropometry. We conducted a pilot study to identify whether female construction workers currently have adequate access to properly fitting PPE. METHODS: Semi-structured focus group interviews were conducted with union female carpenters, laborers, and ironworkers. Researchers coded focus group transcriptions and extracted major themes using thematic framework analysis. RESULTS: Participants (n = 23) had a mean of 15.1 years of construction experience (range 3-34.5 years). A majority reported fit problems for many types of PPE (gloves, harnesses, safety vests, work boots, outerwear), generally noting that the equipment provided by contractors was too large. Other emergent themes included female workers purchasing their own PPE, exposure to various safety hazards from poorly fitted PPE, and perceived indifferent safety culture. CONCLUSIONS: Female construction workers continue to have difficulty accessing properly fitting PPE. Am. J. Ind. Med. 59:1032-1040, 2016. © 2016 Wiley Periodicals, Inc.

A qualitative study of health problems, risk factors, and prevention among Emergency Medical Service workers.

BACKGROUND: Risk factors among Emergency Medical Service (EMS) workers are difficult to characterize and inconsistencies remain about their main health problems. OBJECTIVES: To identify main work-related health problems among EMS workers in the United States; identify risk factors at the organizational, task, and exposure level; identify prevention strategies; examine these issues between participants (EMS workers and supervisors). METHODS: Two types of qualitative research methods based on grounded theory were used: in-depth interviews with emergency medical technicians/paramedics (EMS workers) and focus groups (EMS workers and supervisors). RESULTS: Most participants reported similar health problems (musculoskeletal injuries) and the task related to these injuries, patient handling. Participants also reported similar physical exposures (ascending stairs with patients and patient weight). For organization/psychosocial factors, participants agreed that fitness, wages, breaks, and shift scheduling were linked with injuries, but overall, perceptions about these issues differed more than physical exposures. Lack of trust between EMS workers and supervisors were recurrent concerns among workers. However, not all organizational/psychosocial factors differed. EMS workers and supervisors agreed pre-employment screening could reduce injuries. Participants identified micro- and macro-level prevention opportunities. CONCLUSIONS: The grounded theory approach identified workers' main health problems, and the organizational factors and exposures linked with them. Perceptions about work organization/psychosocial exposures appeared more diverse than physical exposures. Prevention among all participants focused on mechanized equipment, but EMS workers also wanted more organizational support.

Mobile input device type, texting style and screen size influence upper extremity and trapezius muscle activity, and cervical posture while texting.

This study aimed to determine the effects of input device type, texting style, and screen size on upper extremity and trapezius muscle activity and cervical posture during a short texting task in college students. Users of a physical keypad produced greater thumb, finger flexor, and wrist extensor muscle activity than when texting with a touch screen device of similar dimensions. Texting on either device produced greater wrist extensor muscle activity when texting with 1 hand/thumb compared with both hands/thumbs. As touch screen size increased, more participants held the device on their lap, and chose to use both thumbs less. There was also a trend for greater finger flexor, wrist extensor, and trapezius muscle activity as touch screen size increased, and for greater cervical flexion, although mean differences for cervical flexion were small. Future research can help inform whether the ergonomic stressors observed during texting are associated with musculoskeletal disorder risk.

Effect of an office ergonomic randomised controlled trial among workers with neck and upper extremity pain.

BACKGROUND: Office computer workers are at increased risk for neck/upper extremity (UE) musculoskeletal pain. METHODS: A seven-month office ergonomic intervention study evaluated the effect of two engineering controls plus training on neck/UE pain and mechanical exposures in 113 computer workers, including a 3-month follow-up period. Participants were randomised into an intervention group, who received a keyboard/mouse tray (KBT), touch pad (TP) for the non-dominant hand and keyboard shortcuts, and a control group who received keyboard shortcuts. Participants continued to have available a mouse at the dominant hand. Outcomes were pain severity, computer rapid upper limb assessment (RULA), and hand activity level. Prevalence ratios (PRs) evaluated intervention effects using dichotomised pain and exposure scores. RESULTS: In the intervention group, the dominnt proximal UE pain PR=0.9, 95% CI 0.7 to 1.2 and the dominant distal UE PR=0.8, 95% CI 0.5 to 1.3, postintervention. The non-dominant proximal UE pain PR=1.0, 95% CI 0.8 to 1.4, while the non-dominant distal UE PR=1.2, 95% CI 0.6 to 2.2, postintervention. Decreases in non-neutral postures were found in two RULA elements (non-dominant UE PR=0.9, 95% CI 0.8 to 0.9 and full non-dominant RULA PR=0.8, 95% CI 0.8 to 0.9) of the intervention group. Hand activity increased on the non-dominant side (PR=1.4, 95% CI 1.2 to 1.6) in this group. CONCLUSIONS: While the intervention reduced non-neutral postures in the non-dominant UE, it increased hand activity in the distal region of this extremity. To achieve lower hand activity, a KBT and TP used in the non-dominant hand may not be the best devices to use.

Perceived discrimination from management and musculoskeletal symptoms among New York City restaurant workers.

BACKGROUND: Compared with other restaurant hazards, organizational stressors are an understudied topic. Among organizational stressors, discrimination from management (DFM) appears widespread. OBJECTIVE: Objectives were to assess the prevalence and links between musculoskeletal symptoms (MSSs) in three anatomical regions and five sources of DFM. METHODS: A cross-sectional, interviewer-administered survey among restaurant workers was used. Participants were randomly selected by type and geographic distribution. RESULTS: Eighty-four percent of workers reported having MSSs in at least one anatomical region. The prevalence of severe MSSs was 24·9%. The strongest association between DFM and frequency of MSSs was "upper extremities." The strongest association between DFM and severity of MSSs was "any anatomical location." Thirty-four percent of restaurant workers reported DFM; age was the most prevalent source of DFM. CONCLUSIONS: In general, associations between DFM and MSSs were stronger by frequency than severity. The largest number of significant associations by sources of DFM was language and age.

Aging, sex, and cost of medical treatment.

OBJECTIVE: Association between medical cost from workplace injuries and aging and its effect modification by sex were examined. METHODS: Medical costs reimbursed from workers' compensation between 2003 and 2009 were used. A multiple zero-truncated negative binomial regression predicted percent changes in medical cost. Cubic regression spline smoothers tested effect modification. RESULTS: Reimbursed medical costs comprised 3452 claims. Medical costs increased with aging; however, the trends differ by sex. Medical cost increase after 10 years of age increase was 27% among men (95% CI = 17% to 38%) and was 15% among women (12% to 22%). Medical cost spent among the youngest women was higher than that for the oldest men. The ratio of cost between the oldest women and oldest men was double. CONCLUSIONS: Prioritizing controls for injuries in hospitals should focus on women and aging workers.

Patient handling and musculoskeletal disorders among hospital workers: analysis of 7 years of institutional workers' compensation claims data.

OBJECTIVES: Musculoskeletal disorders (MSDs) are the most common occupational injuries and illnesses among hospital workers in the United States. To date, there is little in the literature examining the principal effect of patient handling on MSDs. The primary objective of this study was to investigate and confirm the principal effect of patient handling on hospital worker MSDs. METHODS: Workers' Compensation (WC) claims related to MSDs filed during 2003-2009 by employees in a large US healthcare system were classified using ICD-9. Patient handling, demographic, work, and injury characteristics were obtained. Two multivariable Poisson regression models were compared to evaluate association between risk factors and MSDs. One model contained all risk factors, excluding patient handling; the other model included patient handling. RESULTS: Among 3,452 claims from 24,824 FTEs, 76% were MSDs. About half of the MSDs involved patient handling. In the regression model without patient handling, EMS workers, women, 50-59 years of age, union members, evening shift workers, and fulltime workers showed associations with MSDs. However, all the observed associations disappeared when patient handling was included in the second regression model; patient handling was the only factor showing an association with MSDs, although the effect was not strong (RR = 1.2, 95% CI = 1.2-1.3). CONCLUSIONS: All the observed associations of risk factors disappeared and were further away from patient handling on the causal pathway to MSDs. Patient handling involves numerous work elements and dynamic physical activities. Understanding the work elements of patient handling and conducting interventions based on specific patient handling tasks can substantially reduce MSDs among hospital workers.

Dangerous dining: health and safety in the New York City restaurant industry.

OBJECTIVE: We characterized the health and safety conditions of New York City restaurant workers, a population comprising largely of immigrants and people of color. METHODS: We conducted an anonymous questionnaire survey of 502 New York City restaurant workers, addressing working conditions, benefits, demographic factors, psychosocial exposures, and medical symptoms and conditions. RESULTS: Restaurant workers reported fast-paced, repetitive, and physically demanding jobs that sometimes involve chemical exposures. Despite their youth, they experience a high prevalence of musculoskeletal and traumatic injuries. Few receive job benefits despite significant symptoms. Job-related injuries are positively associated with practices that pose a danger to consumers. CONCLUSIONS: New York City restaurant workers have stressful jobs, experience significant injury, and illness but receive few job benefits. A healthier work organization and greater access to benefits for restaurant workers would improve their health and public health.

Ulnar neuropathy at the elbow in computer keyboard operators.

OBJECTIVE: This case series sought to determine the prevalence of ulnar neuropathy at the elbow (UNE) by using electrophysiologic criteria among all computer keyboard operators (CKOs) referred over a four-year period (1995-1999) for electrodiagnosis (EDX) due to clinical suspicion of focal upper limb neuropathies. PARTICIPANTS: All CKOs referred to an EDX laboratory for suspicion of focal upper limb neuropathies primarily from private practice physicians, mostly hand surgeons, and an occupational medicine clinic. METHODS: All 148 CKOs underwent NCV studies of the upper limbs, which included segmental studies of the ulnar nerve and were questioned for the presence and distribution pattern of paresthesias in the symptomatic upper limb(s). The CKOs provided the electromyographer with subjective descriptions of their workstation configuration, layout, and basic office equipment. RESULTS: Focal ulnar neuropathy at the elbow (UNE) was identified in 105 out of 148 CKOs referred to an EDX laboratory for clinical suspicion of upper limb focal neuropathies. CONCLUSIONS: Compared with the more prevalent diagnosis of carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow should also be considered among CKOs referred for EDX testing because of suspicion of focal upper limb neuropathies. Clinicians evaluating CKOs for suspicion of focal upper limb neuropathies should routinely ask about symptoms of ulnar neuropathy.

Skin temperature in the dorsal hand of office workers and severity of upper extremity musculoskeletal disorders.

OBJECTIVE: This study aimed to examine the suitability of using mean dorsal (hand) skin temperature (MDT) before and after a short typing task as an indicator of upper extremity musculoskeletal disorder (UEMSD) severity. In addition, MDT reproducibility in controls was assessed for a pre-typing and three post-typing time periods over three trials. METHODS: Asymptomatic office workers (n = 10) and office workers with distal UEMSD symptoms (n = 35) typed for 9 min at three ambient temperatures (18, 22, and 26 degrees C). Pre- and post-trial MDT was measured by infrared thermography. UEMSD severity was defined anamnestically by symptoms and by a physical examination and symptom-derived case definition. RESULTS: Good to excellent reproducibility (intra-class correlation coefficients = 0.46-0.85) for MDT was found in controls at 22 degrees C. At 18 and 22 degrees C, pre-typing MDT differed between controls and cases by number of symptom sites marked on a hand-arm diagram (ANOVA, P

Workers' compensation experiences of computer users with musculoskeletal disorders.

BACKGROUND: Computer-related musculoskeletal disorders (MSDs) are of concern as computer use continues to increase. While MSDs are among the most disabling conditions in the United States, the workers' compensation (WC) experiences of individuals with these occupational disorders are not well described. METHODS: We conducted a study among 149 adults with work-related MSDs of the neck, upper back, or upper extremity related to computer use. Questionnaires were used to obtain information on subjective experiences with WC and economic issues. RESULTS: Seventy-four percent filed for WC. Twenty-five percent of all participants reported major financial difficulties after developing their MSD, though the majority filed for WC. Despite filing for WC, a large proportion relied partially on government, employer, or personal financial sources. Sixty-two percent reported that overall satisfaction with the WC insurer was poor. CONCLUSIONS: Findings indicate that a majority of participants filed for WC. Despite filing for WC financial difficulties after developing their MSD were considerable.