Acute physiological and functional effects of repetitive shocks on the hand-arm system: a pilot study on healthy subjects.

Objectives. Exposure to hand-transmitted shocks is a widespread phenomenon in the workplace. Separate risk assessments for shocks do not exist in current international hand-arm vibration regulations, leading to potential underestimation of associated health risks. Methods. In a pilot study approach, eight healthy males were exposed to sets of 3 × 5 min of repetitive shocks and 1 × 5 min of random vibration, controlled at a weighted vibration total value of 10 m/s2. Baseline and post-exposure measurements of vibration perception thresholds, finger skin temperature, maximal grip/pinch force and the Purdue pegboard test were conducted. Muscle activity was monitored continuously by surface electromyography. Results. Shock exposures evoked a temporary increase of vibration perception thresholds with high examination frequencies. A decrease of skin temperature was hinted for shocks of 1 and 20 s-1. Electromyographical findings indicated an additional load on two forearm muscles during shock transmission. Maximum grip force and manual dexterity were not affected, and pinch force only partially reduced after the exposures. Conclusion. Physiological effects from shock exposure conform to those described for hand-arm vibration exposure in principle, although some divergence can be hypothesized. Randomized designs are required to conclusively assess the need of occupational health concepts specifically for hand-transmitted shocks.

Healthy Mobile Work: The Relationship of a Participative Work Agreement and Workplace Health Management-Qualitative Results of a Longitudinal Study.

Mobile work is becoming increasingly common, and it has been, consequently, associated with new health-related hazards and resources. Our study examined health-related stresses, strains and resources of mobile work in a medium-sized company. The study aimed to generate implications for a work agreement and for workplace health management (WHM). For this, a multi-method longitudinal study (2019-20) was conducted, with 29 focus group and 6 individual interviews (absolute number of all participants N = 187). It was designed as a qualitative content analysis and theoretically based on the job demands-resources model (JD-R). Positive effects (e.g., increased work-life balance, higher concentration), as well as negative consequences (e.g., alienation in the team, communication effort), can be found. Numerous fields of action for both the work agreement and WHM could be identified. For example, the work agreement regulates the equipment for working from home with support from WHM in order to ensure occupational health-oriented selection and handling, or by fixing core working hours through the work agreement and supporting competence building for leaders in order to enable flexible work commitments for employees. Self-organised work at home can be supported both by rules in the service agreement and by building up self-management skills through the WHM's offers. The findings illustrate that a work agreement can make a relevant contribution to a healthy design of mobile work by systematically linking it with WHM. The synergies between work agreement, employee health and WHM become clear.

Association between mobile work and work ability: a longitudinal study under the impact of the COVID-19 pandemic.

OBJECTIVE: This study examines the effect of mobile work on work ability as direct predictor and as factor moderating workplace stressors and resources. Originally, the study focused on the effects of mobile work on work ability in a mobile test group compared to office workers. As the study period of 1 year collided with the beginning of the COVID-19 pandemic and lockdown restrictions, we can now explore the association of mobile work and work ability before and during the first year of the COVID-19 pandemic. METHODS: This longitudinal, exploratory study took place in a medium-sized company in the social insurance sector in Germany. We used a mixed-methods design (online survey and focus group interviews) with two survey dates 1 year apart (T0: summer/autumn 2019 (before COVID-19 pandemic), T1: summer 2020 (during COVID-19 pandemic, after first strict lockdown)). Quantitative data, which are reported here, were collected by means of an online questionnaire, which includes questions on mobile work and validated measures for work-related stressors and resources and work ability. Non-parametric tests, regression analysis, and logistic regression models were used for data analysis. RESULTS: The linked data set of both survey dates includes N = 102 persons (men: 37%, mean age: 41-50 years). Interestingly, we found an improvement in work ability over the course of the study (p = 0.007), although it included the first and most drastic COVID-19 restrictions in Germany. Before the pandemic, correlations between work ability and work-related stressors (e.g., work-privacy conflicts) and resources (e.g., sense of community) were evident. Some of these factors are moderated by mobile work. During the COVID-19 pandemic, mobile work was identified as independent factor for work ability. In addition, technology competence conviction gained importance as a personal resource in our cohort. CONCLUSIONS: Work ability can be influenced by many factors. Our study, which allowed for a comparison of work ability before and during COVID-19 pandemic, suggests that mobile work can be especially helpful to maintain work ability in times of change. Our findings support the notion that-under normal conditions-mobile work can influence work ability via work-related stressors and resources. In times of changes, it can have an independent effect on work ability. It must be assumed that the effects can be highly individual or context-specific.

Digitizing Social Counseling-Insights for Workplace Health Management.

Working digitally can lead to changes in work organization and social interactions, as well as work pace and workload. Online counseling is more and more integrated in social counseling. Research exists on employees' and users' attitudes towards online counseling as well as on the advantages and disadvantages of online counseling. There is a lack of studies on the stressors and strains caused by the increasing digitalization and the associated health consequences in this context. With an interview study, we investigated the general work situation of counselors, with a focus on stressors, strain, and resources caused by online counseling. Consecutively, we discuss the results in relation to their impact on workplace health management. Twenty-two explorative interviews with counselors from a German welfare organization were conducted in 2019 and 2020. Qualitative content analysis according to Mayring was used for analysis. Counselors' use of online devices depends on their own digital affinity and is likely to be used when advantages for clients are seen. Difficulties were mentioned in establishing a relationship of trust with the clients. Good teamwork and regular informal exchanges among colleagues contribute to job satisfaction. Overall, we found only few health-related effects. Results of the study suggest that digitization can have positive effects on the job satisfaction of counselors, if the associated changes are supported by organizational measures.

Occupational risk factors for meniscal lesions: a systematic review and meta-analysis.

BACKGROUND: Meniscal lesions are common and are associated with the development of knee osteoarthritis. Knee-straining activities at work such as kneeling or squatting cause high biomechanical stresses on the knee joints that can lead to acute or chronic injuries. The objective of this systematic review is to update the evidence on the potential relationship between occupational risk factors and meniscal lesions. METHODS: We searched the Medline, Embase and Web of Science databases until August 2021 to identify epidemiological observational studies on the association between occupational risk factors and meniscal lesions. Study selection, data extraction and risk of bias assessment were performed independently by two reviewers. Effect measures were extracted from individual studies and pooled with random effects meta-analysis. Heterogeneity analyses were conducted. We used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the overall quality of evidence. RESULTS: The database search resulted in 11,006 references, and 46 additional studies were identified through hand search. Twenty-two studies (represented in 25 publications) met the predefined eligibility criteria and nine records were included in the meta-analysis. There was only one study with an overall low risk of bias. Significant associations between occupational risk factors and the development of meniscal lesions were found for kneeling (effect size (ES) 2.15, 95% CI 1.67-2.76), squatting (ES 2.01, 95% CI 1.34-3.03), climbing stairs (ES 2.28, 95% CI 1.58-3.30), lifting and carrying weights ≥ 10 kg (ES 1.63, 95% CI 1.35-1.96), lifting and carrying weights ≥ 25 kg (ES 1.56, 95% CI 1.08-2.24), playing football on a professional level (ES 5.22, 95% CI 3.24-8.41), working as a hard coal miner (ES 5.23, 95% CI 2.16-12.69) and floor layers (ES 1.99, 95% CI 1.43-2.78). The overall quality of evidence according GRADE was moderate to low. CONCLUSION: We found consistent evidence of an increased risk of meniscal lesions by occupational knee-straining exposures. Our findings are important for the development of preventive strategies to reduce work-related knee disorders and work absence. TRIAL REGISTRATION: PROSPERO (registration no. CRD42020196279 ).

Psychosocial areas of worklife and chronic low back pain: a systematic review and meta-analysis.

BACKGROUND: The aim of this review was to synthesize the evidence on the potential relationship between psychosocial work factors from the Areas of Worklife (AW) model (workload, job control, social support, reward, fairness, and values) and chronic low back pain (CLBP; unspecific pain in the lumbar region lasting 3 months or longer). METHODS: We conducted a systematic literature search of studies in Medline, PsycINFO, Web of Science, and CINAHL (1987 to 2018). Three authors independently assessed eligibility and quality of studies. In this meta-analysis, we pooled studies' effect sizes using a random-effects model approach and report sample size weighted mean Odds Ratios (ORs). RESULTS: Data from 18 studies (N = 19,572) was included in the analyses. We found no studies investigating associations between fairness or values and CLBP. CLBP was significantly positively related to workload (OR = 1.32) and significantly negatively related to overall job control (OR = 0.81), decision authority (OR = 0.72), and two measures of social support (ORs = 0.75 to 0.78), even in prospective studies. Skill discretion and reward did not significantly relate to CLBP. Moderation analyses revealed several variables (e.g., exposure time, mean age and sex) affecting these relationships. CONCLUSIONS: Our results support employees' workload, job control, and social support as predictors of CLBP. In this line, these work factors should be considered when developing programs to prevent chronic low back pain. Future studies should apply measures of CLBP that are more precise, and investigate the full areas of work life (AW) factors in combination.

[Document management systems to support quality management systems at university hospitals - an interview-based study]. / Dokumenten-Management-Systeme zur Unterstützung des Qualitätsmanagements an Universitätskliniken ­ Eine interviewbasierte Studie.

In order to save and control the processes and quality of medical services, a suitable steering system of all relevant documents is essential from the point of view of clinical quality management. Systems supporting an automated steering system of documents are called document management systems (DMS), and they also enter the healthcare sector. The use of DMS in the German healthcare sector has hardly been investigated so far. To close this knowledge gap, interviews were carried out with German university hospitals over a six-month period and subjected to a qualitative content analysis according to Mayring. In total, 25 university hospitals agreed to participate in this study, 19 of which have been working with a digital DMS for about six years on average. There was a great variety among the IT systems used. Document management and usability of the DMS as well as its integration into existing IT structures were key decision-making criteria for the selection of a digital DMS. In general, the long-term usability of the DMS is supported by regular evaluation of one's own requirements for the system, administration and training programs. In addition, DMS have a positive effect on patient safety and the quality of medical care.

Combined exposures of whole-body vibration and awkward posture: a cross sectional investigation among occupational drivers by means of simultaneous field measurements.

OBJECTIVE: Multifactorial workloads such as whole-body vibration (WBV), awkward posture and heavy lifting are potential predictors for low back pain (LBP). In this study, we investigate the association between LBP and these exposures among 102 professional drivers. METHODS: The combined exposures of WBV and posture are measured at different workplaces. Health and personal data as well as information about lifting tasks are collected by a questionnaire. RESULTS: The daily vibration exposure value (odds ratio 1.69) and an index for awkward posture (odds ratio 1.63) show significant association with the occurence of LBP. Awkward posture and heavy lifting appear to be more strongly associated with sick leave than WBV exposure. Furthermore, a combination of the measurement results of WBV and awkward posture into one quantity also shows significant correlation to LBP. CONCLUSION: The combined exposure of WBV and awkward posture can be described in terms of the daily vibration exposure and the index for awkward posture. This facilitates work place assessments and future research in this area. Practitioner Summary: For the first time, quantitative measures combining whole-body vibration and awkward posture exposures have shown to correlate with the occurrence of low back pain significantly. This validates the proposed quantities and measurement methods, which facilitate workplace assessments and assist in the design of further studies which are necessary to establish a causal exposure-response relationship.

Influence of different safety shoes on gait and plantar pressure: a standardized examination of workers in the automotive industry.

OBJECTIVE: Working conditions, such as walking and standing on hard surfaces, can increase the development of musculoskeletal complaints. At the interface between flooring and musculoskeletal system, safety shoes may play an important role in the well-being of employees. The aim of this study was to evaluate the effects of different safety shoes on gait and plantar pressure distributions on industrial flooring. METHODS: Twenty automotive workers were individually fitted out with three different pairs of safety shoes ( "normal" shoes, cushioned shoes, and midfoot bearing shoes). They walked at a given speed of 1.5 m/s. The CUELA measuring system and shoe insoles were used for gait analysis and plantar pressure measurements, respectively. Statistical analysis was conducted by ANOVA analysis for repeated measures. RESULTS: Walking with cushioned safety shoes or a midfoot bearing safety shoe led to a significant decrease of the average trunk inclination (p<0.005). Furthermore, the average hip flexion angle decreased for cushioned shoes as well as midfoot bearing shoes (p<0.002). The range of motion of the knee joint increased for cushioned shoes. As expected, plantar pressure distributions varied significantly between cushioned or midfoot bearing shoes and shoes without ergonomic components. CONCLUSION: The overall function of safety shoes is the avoidance of injury in case of an industrial accident, but in addition, safety shoes could be a long-term preventive instrument for maintaining health of the employees' musculoskeletal system, as they are able to affect gait parameters. Further research needs to focus on safety shoes in working situations.

Factors affecting the perception of whole-body vibration of occupational drivers: an analysis of posture and manual materials handling and musculoskeletal disorders.

Due to the high cost of conducting field measurements, questionnaires are usually preferred for the assessment of physical workloads and musculoskeletal disorders (MSDs). This study compares the physical workloads of whole-body vibration (WBV) and awkward postures by direct field measurements and self-reported data of 45 occupational drivers. Manual materials handling (MMH) and MSDs were also investigated to analyse their effect on drivers' perception. Although the measured values for WBV exposure were very similarly distributed among the drivers, the subjects' perception differed significantly. Concerning posture, subjects seemed to estimate much better when the difference in exposure was significantly large. The percentage of measured awkward trunk and head inclination were significantly higher for WBV-overestimating subjects than non-overestimators; 77 and 80% vs. 36 and 33%. Health complaints in terms of thoracic spine, cervical spine and shoulder-arm were also significantly more reported by WBV-overestimating subjects (42, 67, 50% vs. 0, 25, 13%, respectively). Although more MMH was reported by WBV-overestimating subjects, there was no statistical significance in this study. PRACTITIONER SUMMARY: Self-reported exposures of occupational drivers are affected by many other cofactors, and this can result in misinterpretations. A comparison between field measurement and questionnaire was used to highlight the factors affecting the perception of drivers for whole-body vibration (WBV) exposure. Posture and musculoskeletal disorders influenced the perception of the similarly WBV-exposed drivers significantly.

[Tracing for arsenic exposure--a differentiation of arsenic compounds is essential for the health assessment]. / Der Arsenbelastung auf der Spur.

Arsenic is ubiquitous and harmful to health in occupation and environment. Arsenic exposure is measured through analysis of arsenic compounds in urine. The identification of several arsenic species is necessary to understand the hazardous potential of the arsenic compounds which differ highly in their toxicity. To estimate the extent of an occupational exposure to arsenic, arsenic species were evaluated for the first time by the working group "Setting of Threshold Limit Values in Biological Material" of the DFG Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area and Biologische Arbeitsstoffreferenzwerte (BAR) of 0.5 µg / L urine for arsenic (III), 0.5 µg / L urine for arsenic (V), 2 µg / L urine for monomethylarsonic acid (MMA) and 10 µg / L urine for dimethylarsinic acid (DMA) were set. If the reference value for total arsenic is exceeded, a further differentiation of arsenic species now enables to estimate the individual health risks taking into account special influences such as seafood consumption.

Do overweight workers profit by workplace health promotion, more than their normal-weight peers? Evaluation of a worksite intervention.

BACKGROUND: Worksite health promotion programs have been identified as strongly effective in decreasing body weight and increasing awareness and change in health behavior. Aim of this study is to determine the effects of a multi-component intervention in workplace health promotion. METHODS: In a controlled study trail, 1,573 workers of a logistics company had the chance to participate in a one year worksite health promotion program. Main elements of the multi-component intervention were physical activity training in combination with nutrition counseling. Employees completed a questionnaire at baseline and then again after twelve month. Main outcome variables were changes in body weight and health behaviors. Secondary outcomes were subjective health indicators. RESULTS: Our results showed preliminary improvements in physical activity and eating behavior among normal weight and overweight/obesity weight groups. No significant weight reduction could be found, only a minimal reduction of BMI. The reduction was larger in the overweight group. Workers considered overweight or obese showed significantly greater body weight loss and changes in eating behavior than workers with a normal weight status. Workers with obesity/overweight scored their general health status significantly lower than their colleagues with normal weight status. No significant improvements were found for overall perception of health status between baseline and follow-up in the BMI-groups. CONCLUSION: This 12-month intervention-control study suggests that a well-implemented multi-component workplace health promotion program may support substantial change in health behavior (e.g. nutrition and physical activity). It is indicated that overweight employees may especially profit from such worksite health promotion. An investigation of long-term effects of this multi-component intervention is strongly recommended.

Worksite Health Program Promoting Changes in Eating Behavior and Health Attitudes.

BACKGROUND: The aim of the present study was to evaluate the effectiveness of a worksite multicomponent health promotion intervention on eating behavior and attitudes, changes in body weight, and readiness to make eating behavior changes among workers over a 12-month intervention period. METHOD: A total of 3,095 workers of a logistic company participated in a quasi-experimental comparison group study design. The intervention group received a multicomponent health training. Two of the main elements of the multicomponent intervention were physical exercise training and nutrition counseling/training. During the pilot year, participants completed a survey at baseline and again after 12 months to assess physical activity-, health-, and diet-related factors. RESULTS: Results showed that participants' body weight did not significantly decrease in the intervention group. Mean weight loss in the intervention groups was 0.5 kg (body mass index = 0.1 kg/m(2)). Eating behaviors in the intervention group improved more than in the comparison group. Some positive intervention effects were observed for the cognitive factors (e.g., changes in eating attitudes). Baseline readiness to change eating behavior was significantly improved over time. CONCLUSIONS: We demonstrated initial results of a long-term multicomponent worksite health promotion program with regard to changes in body weight, eating behavior, and attitudes. This evaluation of a 12-month pilot study suggests that a worksite health promotion program may lead to improvements in nutritional health behaviors for a number of workers. An investigation of long-term effects of this multicomponent intervention is strongly recommended.

A technical support tool for joint range of motion determination in functional diagnostics - an inter-rater study.

BACKGROUND: The examination of joint range of motion (RoM) is part of musculo-skeletal functional diagnostics, used, for example, in occupational examinations. Various examination methodologies exist that have been optimized for occupational medical practice, which means they were reduced to the most necessary and feasible measures and examinations for efficiency and usability reasons. Because of time constraints in medical examinations in occupational settings, visual inspection is commonly used to quantify joint RoM. To support medical examiners, an inertial sensor-based measurement system (CUELA) was adapted for joint RoM examination in these settings. The objective of the present study was to evaluate the measurement tool in functional diagnostics under conditions close to clinical practice. METHODS: The joint RoM of twenty healthy subjects were examined by three physicians, who were simultaneously using the measurement tool. Physicians were blinded to the measurement results and the other physicians. Active RoM was examined on the cervical, thoracic and lumbar spine while passive RoM was examined on the shoulder, elbow, wrist, hip, and knee, resulting in a total of 40 joint examination angles. The means, standard deviations, intraclass correlation coefficients (I C C 3,k ), and Bland-Altman-Plots were calculated using MatLab for statistical analysis. RESULTS: Most measurement results were in accordance with expected joint RoMs. All examinations showed an acceptable repeatability. In active RoM examinations, the ICC of inter-rater reliability varied between 0.79 and 0.95. In passive RoM examination the ICC varied between 0.71 and 0.96, except examination angles at the elbow and knee extension (ICC: 0.0-0.77). CONCLUSION: The reliability and objectivity of active RoM examinations were improved by the measurement tool compared with examiners. In passive RoM examinations of upper and lower extremities, the increase of objectivity by the measurements was limited for some examination angles by external factors such as the individual examiner impact on motion execution or the given joint examination conditions. Especially the elbow joint examination requires further development to achieve acceptable reliability. A modification in the examination method to reduce the examiner impact on measurement and the implementation of a more complex calibration procedure could improve the objectivity and reliability of the measurement tool in passive joint RoM examination to be applicable on nearly the whole body.

Optimization of inertial sensor-based motion capturing for magnetically distorted field applications.

Inertial measurement units (IMU) are gaining increasing importance for human motion tracking in a large variety of applications. IMUs consist of gyroscopes, accelerometers, and magnetometers which provide angular rate, acceleration, and magnetic field information, respectively. In scenarios with a permanently distorted magnetic field, orientation estimation algorithms revert to using only angular rate and acceleration information. The result is an increasing drift error of the heading information. This article describes a method to compensate the orientation drift of IMUs using angular rate and acceleration readings in a quaternion-based algorithm. Zero points (ZP) were introduced, which provide additional heading and gyroscope bias information and were combined with bidirectional orientation computation. The necessary frequency of ZPs to achieve an acceptable error level is derived in this article. In a laboratory environment the method and the effect of varying interval length between ZPs was evaluated. Eight subjects were equipped with seven IMUs at trunk, head and upper extremities. They performed a predefined course of box handling for 40 min at different motion speeds and ranges of motion. The orientation estimation was compared to an optical motion tracking system. The resulting mean root mean squared error (RMSE) of all measurements ranged from 1.7 deg to 7.6 deg (roll and pitch) and from 3.5 deg to 15.0 deg (heading) depending on the measured segment, at a mean interval-length of 1.1 min between two ZPs without magnetometer usage. The 95% limits of agreement (LOA) ranged in best case from -2.9 deg to 3.6 deg at the hip roll angle and in worst case from -19.3 deg to 18.9 deg at the forearm heading angle. This study demonstrates that combining ZPs and bidirectional computation can reduce orientation error of IMUs in environments with magnetic field distortion.

The incremental effect of psychosocial workplace factors on the development of neck and shoulder disorders: a systematic review of longitudinal studies.

BACKGROUND: To systematically analyse evidence on the incremental effect of work-related psychosocial risk factors on the development of neck and shoulder disorders, as reported in longitudinal studies. METHODS: A systematic literature search was conducted in three data bases (MEDLINE, EMBASE, and PsychINFO) until May 2009. The quality assessment leading to a methodological quality score of the included studies was conducted by two independent reviewers using a standardised checklist. Criteria for the evaluation of evidence were established. Heterogeneity analyses were conducted. RESULTS: Altogether 18 prospective longitudinal studies were included in the analysis. Potential psychosocial risk factors were mainly based on the job demand control (support) model by Karasek (1998). Study results were too heterogeneous to deduce pooled risk estimates. But the weight of evidence was strong for an incremental effect of job demands, job control, social support, and job strain, on the development of neck and/or shoulder disorders. CONCLUSION: While we found evidence for an incremental effect of different psychosocial work factors (in addition to the effect of physical job factors), these results have to be interpreted carefully in order to support the notion that psychological factors can have an independent causal influence on the development of musculoskeletal disorders. Nevertheless, our findings are important for the development of preventive strategies, as they stress the need for preventive approaches that tackle both physical and psychosocial factors. Future research is warranted to consolidate and strengthen the results of this review.

Factors associated with self-assessed increase in tobacco consumption among over-indebted individuals in Germany: a cross-sectional study.

BACKGROUND: Over-indebtedness is an increasing phenomenon in industrialised nations causing individual hardship and societal problems. Nonetheless, few studies have explored smoking among over-indebted individuals. METHODS: A cross-sectional survey (n=949) on retrospectively assessed changes in tobacco consumption was carried out in 2006 and 2007 among clients of 84 officially approved debt and insolvency counselling centres in Germany (response rate 39.7%). Logistic regressions were performed to explore factors associated with reports of increased smoking after onset of over-indebtedness. RESULTS: 63% of all respondents stated daily or occasional tobacco consumption. Almost one fifth reported an increase in smoking after becoming over-indebted. Females were less likely to report increased smoking than men (aOR 0.66, 95% CI 0.44-0.99) whereas respondents who had been over-indebted for more than 10 years were more likely to report increased smoking than those who had been over-indebted for less than five years (aOR 1.66; 95%-CI 1.00-2.76). The odds of increased smoking were also elevated among those who reported that their families and friends had withdrawn from them as a consequence of their over-indebtedness (aOR 1.82; 95%-CI 1.06-3.14). CONCLUSIONS: The study identifies over-indebted individuals and particularly over-indebted men as a high-risk group of smokers. Low levels of social embeddedness/support were associated with a further increase in smoking after becoming over-indebted. Given recent increases of over-indebtedness, the findings highlight the need to develop appropriate public health policies.

Psychosocial work stressors as antecedents of musculoskeletal problems: a systematic review and meta-analysis of stability-adjusted longitudinal studies.

Although the relationship between psychosocial workplace conditions and musculoskeletal problems has been extensively studied, the causal impact of psychosocial workplace factors in the development of musculoskeletal problems remains unclear. The purpose of the present study was to conduct a systematic review of baseline-adjusted prospective longitudinal studies estimating the lagged effect of psychosocial risk factors on musculoskeletal problems in industrialized work settings. A literature review was conducted by searching the MEDLINE, EMBASE, and PsychINFO databases dated until August 2009. The authors classified studies into categories of psychological work stressors and musculoskeletal problems. Available effect sizes were converted to odds ratios (OR). ORs were then pooled for each stressor-problem relationship using a random-effects model. Additionally, the possibility of publication bias was assessed with the Duval and Tweedie nonparametric "trim and fill" procedure. In total, 50 primary studies fulfilled inclusion criteria. Within these studies at least five effect sizes were available for 23 of the 45 possible psychosocial work stress-musculoskeletal problems relationships, leaving 9 psychosocial variables and four musculoskeletal problem areas for analyses. Of these 23 relationships, pooled OR estimates were positive and significant ranging from 1.15 to 1.66 with the largest pooled OR estimating the relationship between highly monotonous work and lower back pain. The lagged effect of low social support on lower limb problems was the only effect size for which the statistical test for bias was significant. Most psychosocial stressors had small but significant lagged effects on the development of musculoskeletal problems. Thus, organizational interventions to minimize these stressors may be promising in reducing one risk factor for the development of employee musculoskeletal problems.

Thinking about giving up clinical practice? A gender-stratified approach to understanding junior doctors' choices.

PURPOSE: This study examined the association between workplace factors and thinking about leaving clinical care by junior doctors (i.e., doctors in postgraduate training) in Germany, and used a gender-stratified approach to address the so-called feminization of medicine. METHOD: In this cross-sectional questionnaire study, 1,494 German junior doctors working in patient care in Bavaria in 2006-2007 were sent a questionnaire about considering leaving patient care (outcome variable). Logistic regression analyses were used to calculate the predictive influence of workplace factors on the outcome variable (adjusted odds ratio [aOR], 95% confidence interval [95% CI]). RESULTS: Of the 637 responding junior doctors, altogether 52% (men 49.3%, women 54.2%) had thought about leaving clinical practice. Support of colleagues and superiors (men aOR 2.70, 95% CI 1.20-6.04; women aOR 3.46, 95% CI 1.67-7.17), performance feedback (women aOR 1.88, 95% CI 1.23-3.14), the availability of postgraduate training possibilities (men aOR 4.74, 95% CI 1.53-14.69), overtime (women aOR 1.82, 95% CI 1.02-3.25), weekend duty (men aOR: 3.58, 95% CI 1.86-6.88), and the medical specialty were found to be significant predictors for thinking about leaving clinical practice for both men and women. CONCLUSIONS: Workplace factors predict the wish for leaving clinical care for junior doctors. Male and female junior doctors seem to have different priorities in the workplace, which should be addressed in order to retain them in patient care.

Longitudinal evidence for the association between work-related physical exposures and neck and/or shoulder complaints: a systematic review.

BACKGROUND: Most existing reviews focus on evidence for the association between neck and/or shoulder complaints and physical exposures at the workplace gathered from cross-sectional studies. In comparison, this review summarizes existing evidence from longitudinal studies only. METHODS: A systematic literature research was conducted in Medline and EMBASE (1975-2009), and all studies were scanned by at least two researchers according to strict inclusion criteria. Levels of evidence were assigned according to the number of studies reporting similar findings, and according to the methodological quality of the included studies. RESULTS: Altogether 21 longitudinal studies (19 high-quality studies) met the inclusion criteria and were included in this review. In comparison with former reviews, we found strong evidence for an association between shoulder complaints and manual material handling (MMH) (range between Odds Ratio (OR) 1.4 and 4.9), vibration (range between OR 1.6 and OR 2.5), trunk flexion or rotation (range between OR 1.8 and OR 5.1), and working with hands above shoulder level (range between OR 1.1 and OR 1.8). Apart from that, the included studies confirmed existing knowledge on the association between physical exposures at the workplace and neck and/or shoulder complaints. CONCLUSIONS: This analysis of longitudinal studies allowed for new evidence with regard to four cause-effect chains between physical exposures at work and the development of shoulder, neck and neck/shoulder complaints. As outcome variables varied greatly among the included studies, harmonization in studies on musculoskeletal research is desirable.