Artificial intelligence and the work-health interface: A research agenda for a technologically transforming world of work.

The labor market is undergoing a rapid artificial intelligence (AI) revolution. There is currently limited empirical scholarship that focuses on how AI adoption affects employment opportunities and work environments in ways that shape worker health, safety, well-being and equity. In this article, we present an agenda to guide research examining the implications of AI on the intersection between work and health. To build the agenda, a full day meeting was organized and attended by 50 participants including researchers from diverse disciplines and applied stakeholders. Facilitated meeting discussions aimed to set research priorities related to workplace AI applications and its impact on the health of workers, including critical research questions, methodological approaches, data needs, and resource requirements. Discussions also aimed to identify groups of workers and working contexts that may benefit from AI adoption as well as those that may be disadvantaged by AI. Discussions were synthesized into four research agenda areas: (1) examining the impact of stronger AI on human workers; (2) advancing responsible and healthy AI; (3) informing AI policy for worker health, safety, well-being, and equitable employment; and (4) understanding and addressing worker and employer knowledge needs regarding AI applications. The agenda provides a roadmap for researchers to build a critical evidence base on the impact of AI on workers and workplaces, and will ensure that worker health, safety, well-being, and equity are at the forefront of workplace AI system design and adoption.

Evaluation of vertical and multi-axial suspension seats for reducing vertical-dominant and multi-axial whole body vibration and associated neck and low back joint torque and muscle activity.

The primary aim of this laboratory-based human subject study was to evaluate the biomechanical loading associated with mining vehicles' multi-axial whole body vibration (WBV) by comparing joint torque and muscle activity in the neck and low back during three vibration conditions: mining vehicles' multi-axial, on-road vehicles' vertical-dominant, and no vibration. Moreover, the secondary aim was to determine the efficacy of a vertical passive air suspension and a prototype multi-axial active suspension seat in reducing WBV exposures and associated biomechanical loading measures. The peak joint torque and muscle activity in the neck and low back were higher when exposed to multi-axial vibration compared to the vertical-dominant or no vibration condition. When comparing the two suspension seats, there were limited differences in WBV, joint torque, and muscle activity. These results indicate that there is a need to develop more effective engineering controls to lower exposures to multi-axial WBV and related biomechanical loading. Practitioner Summary: This study found that mining vehicles' multi-axial WBV can increase biomechanical loading in the neck and back more so than on-road vehicles' vertical-dominant WBV. While a newly-developed multi-axial active suspension seat slightly reduced the overall WBV exposures, the results indicate that more effective engineering controls should be developed. Abbreviation: APDF: amplitude probability density function; Aw: weighted average vibration; BMI: body mass index; C7: The 7th cervical vertebra; EMG: electromyography; ES: erector spinae; IRB: institutional review board; ISO: International Organization for Standardization; L5/S1: the fifth lumbar vertebra (L5)/the first sacral vertebra(S1); MSDs: musculoskeletal disorders; MVC: maximum voluntary contraction; PSD: power spectral density; RVC: reference voluntary contraction; SCM: sternocleidomastoid; SD: standard deviation; SPL: splenius capitis; TRAP: trapezius; VDV: vibration dose value; WBV: whole body vibration.

Associations between a safety prequalification survey and worker safety experiences on commercial construction sites.

BACKGROUND: While assessment of subcontractors' safety performance during project bidding processes are common in commercial construction, the validation of organizational surveys used in these processes is largely absent. METHODS: As part of a larger research project called Assessment of Contractor Safety (ACES), we designed and tested through a cross-sectional study, a 63-item organizational survey assessing subcontractors' leading indicators of safety performance. We administered the ACES Survey to 43 subcontractors on 24 construction sites. Concurrently, we captured the safety climate of 1426 workers on these sites through worker surveys, as well as injury rates, for the duration of the project. RESULTS: At the worksite level, higher average ACES scores were associated with higher worker safety climate scores (P < .01) and lower rates of injury involving days away (P < .001). Within subcontracting companies, no associations were observed between ACES and worker safety climate scores and injuries. CONCLUSIONS: These results suggest the overall and collective importance of the construction project and its worksite in mediating worker experiences, perhaps somewhat independent of the individual subcontractor level.

An Integrative Total Worker Health Framework for Keeping Workers Safe and Healthy During the COVID-19 Pandemic.

OBJECTIVE: The aim was to recommend an integrated Total Worker Health (TWH) approach which embraces core human factors and ergonomic principles, supporting worker safety, health, and well-being during the COVID-19 pandemic. BACKGROUND: COVID-19 has resulted in unprecedented challenges to workplace safety and health for workers and managers in essential businesses, including healthcare workers, grocery stores, delivery services, warehouses, and distribution centers. Essential workers need protection, accurate information, and a supportive work environment with an unwavering focus on effective infection control. METHOD: The investigators reviewed emerging workplace recommendations for reducing workers' exposures to the novel coronavirus and the challenges to workers in protecting their health. Using a theoretical framework and guidelines for integrating safety and health management systems into an organization for TWH, the investigators adapted the framework's key characteristics to meet the specific worker safety and health issues for effective infection control, providing supports for increasing psychological demands while ensuring a safe work environment. RESULTS: The recommended approach includes six key characteristics: focusing on working conditions for infection control and supportive environments for increased psychological demands; utilizing participatory approaches involving workers in identifying daily challenges and unique solutions; employing comprehensive and collaborative efforts to increase system efficiencies; committing as leaders to supporting workers through action and communications; adhering to ethical and legal standards; and using data to guide actions and evaluate progress. CONCLUSION: Applying an integrative TWH approach for worker safety, health, and well-being provides a framework to help managers systematically organize and protect themselves, essential workers, and the public during the COVID-19 pandemic. APPLICATION: By using the systems approach provided by the six implementation characteristics, employers of essential workers can organize their own efforts to improve system performance and worker well-being during these unprecedented times.

The Current State of Surgical Ergonomics Education in U.S. Surgical Training: A Survey Study.

OBJECTIVE: The aim of this study was to characterize the current state of surgical ergonomics education in the United States. BACKGROUND: The burden of work-related musculoskeletal disorders (MSDs) in surgeons is high and no overarching strategy for redress exists. Twelve distinct specialties describe an unmet need for surgical ergonomics education (SEE). This study aimed to define the current state of SEE in U.S. surgical training programs. METHODS: We performed a descriptive analysis of a 20-item questionnaire of ACGME-certified program directors from 14 surgical and interventional medical specialties. Formal SEE was defined as any organized education module that reviewed the occupation-specific burden of common work-related MSDs and described a framework for prevention via occupation-specific applied ergonomics. Program directors were queried regarding SEE provision, characteristics, and perceived trainee attitude toward the education. RESULTS: Questionnaires were received from 130 of 441 (29.5%) program directors. Two (1.5%) provided formal SEE and 33 (25.4%) provided informal SEE, which consisted of unstructured intraoperative directives and isolated lectures. Two programs previously provided SEE but discontinued the effort due to lack of an evidence-based framework and instructors. Trainees appeared to think that learning surgical ergonomics skills was a worthwhile time investment in 100% and 76.7% of current formal and informal SEE, respectively. CONCLUSION: SEE is rarely provided in any capacity (25.4%), let alone in a consistent or evaluable fashion (1.5%). Impediments to sustainable SEE include lack of an evidence-based framework for education and instructors. An evidence-based, reproducible, and accreditation council-compliant SEE module would be a valuable resource for the surgical and interventional medical communities.

Paradoxical Impact of a Patient-Handling Intervention on Injury Rate Disparity Among Hospital Workers.

OBJECTIVES: To test whether a comprehensive safe patient-handling intervention, which successfully reduced overall injury rates among hospital workers in a prior study, was differentially effective for higher-wage workers (nurses) versus low-wage workers (patient care associates [PCAs]). METHODS: Data were from a cohort of nurses and PCAs at 2 large hospitals in Boston, Massachusetts. One hospital received the intervention in 2013; the other did not. Using longitudinal survey data from 2012 and 2014 plus longitudinal administrative injury and payroll data, we tested for socioeconomic differences in changes in self-reported safe patient-handling practices, and for socioeconomic differences in changes in injury rates using administrative data. RESULTS: After the intervention, improvements in self-reported patient-handling practices were equivalent for PCAs and for nurses. However, in administrative data, lifting and exertion injuries decreased among nurses (rate ratio [RR] = 0.64; 95% confidence interval [CI] = 0.41, 1.00) but not PCAs (RR = 1.10; 95% CI = 0.74,1.63; P for occupation × intervention interaction = 0.02). CONCLUSIONS: Although the population-level injury rate decreased after the intervention, most improvements were among higher-wage workers, widening the socioeconomic gap in injury and exemplifying the inequality paradox. Results have implications for public health intervention development, implementation, and analysis.

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.

Testing the associations between leading and lagging indicators in a contractor safety pre-qualification database.

BACKGROUND: Safety prequalification assessing contractors' safety management systems and safety programs lack validation in predicting construction worker injuries. METHODS: Safety assessments of leading indicators from 2198 construction contractors, including Safety Management Systems (SMS), Safety Programs (e.g., falls, hearing protection), and Special Elements (drug testing, return to work) scales as well as the history of citations from the Occupational Safety and Health Administration (OSHA) were compared to contractors' lagging indicators of recordable injury case rates (RC) and rates of injuries involving days away, restricted, or transferred (DART). RESULTS: Increased SMS scores were related to lower injury rates. Each one-point increase in SMS values was associated with 34% reduced odds of a recordable case rate greater than zero (Odds ratio (OR): 0.66, 95% Confidence Interval (CI): (0.57, 0.79)), and a 9% reduced recordable case rate, if one occurs (Risk Ratio (RR): 0.91, 95% CI: (0.88, 0.94)). A one-point increase in SMS was associated with 28% reduced odds of a DART (OR = 0.72, 95%CI (0.56, 0.91)), and 9% reduced DART rate, if one occurs (RR = 0.91, 95%CI (0.87, 0.95)). Safety programs did not show consistent associations with injury outcomes. Having additional Special Elements related to drug and alcohol programs was associated with lower injury rates while the Special Element related to return to work showed no consistent associations with injury. Having more OSHA Citations was associated with lower injury rates for companies with injuries. CONCLUSIONS: These results support pre-qualification methods based on SMS and suggest the need for safety management systems in contractors.

Going Short: The Effects of Short-Travel Key Switches on Typing Performance, Typing Force, Forearm Muscle Activity, and User Experience.

This study examined the effects of 4 micro-travel keyboards on forearm muscle activity, typing force, typing performance, and self-reported discomfort and difficulty. A total of 20 participants completed typing tasks on 4 commercially available devices with different key switch characteristics (dome, scissors, and butterfly) and key travels (0.55, 1.3, and 1.6 mm). The device with short-travel (0.55 mm) and a dome-type key switch mechanism was associated with higher muscle activities (6%-8%, P < .01), higher typing force (12%, P < .01), slower typing speeds (8%, P < .01), and twice as much discomfort (P < .05), compared with the other 3 devices: short-travel (0.55 mm) and butterfly switch design and long travel (1.3 and 1.6 mm) with scissor key switches. Participants rated the devices with larger travels (1.3 and 1.6 mm) with least discomfort (P = .02) and difficulty (P < .01). When stratified by sex/gender, these observed associations were larger and more significant in the female participants compared with male participants. The devices with similar travel but different key switch designs had difference in outcomes and devices with different travel were sometimes not different. The results suggest that key travel alone does not predict typing force or muscle activity.

The relationship between organizational policies and practices and work limitations among hospital patient care workers.

OBJECTIVE: We examined relationships between organizational policies and practices (OPPs) (safety practices, ergonomic practices, and people-oriented culture) and work limitations in a sample of hospital workers. METHODS: We used the 6-item Work Limitations Questionnaire (WLQ) to assess workers' perceptions of health-related work limitations. Self-reported OPPs and the WLQ were collected from workers in Boston, Massachusetts (n = 1277). We conducted random-intercept multi-level logistic regression models for each OPP using stepwise selection of covariates. RESULTS: As the unit-average ergonomic practice score increased by one, the odds of a worker reporting work limitations decreased by approximately 39% (P-value = 0.018), adjusted for job title, age, and body mass index. A similar relationship existed for people-oriented culture (P-value = 0.038). The association between safety practices and work limitations was similar, but not statistically significant. CONCLUSIONS: This study demonstrated the importance of workplace OPPs. OPPs that promote positive and supportive environments and that foster improvements in ergonomics may help reduce work limitations.

Lifting and exertion injuries decrease after implementation of an integrated hospital-wide safe patient handling and mobilisation programme.

OBJECTIVE: With increasing emphasis on early and frequent mobilisation of patients in acute care, safe patient handling and mobilisation practices need to be integrated into these quality initiatives. We completed a programme evaluation of a safe patient handling and mobilisation programme within the context of a hospital-wide patient care improvement initiative that utilised a systems approach and integrated safe patient equipment and practices into patient care plans. METHODS: Baseline and 12-month follow-up surveys of 1832 direct patient care workers assessed work practices and self-reported pain while an integrated employee payroll and injury database provided recordable injury rates collected concurrently at 2 hospitals: the study hospital with the programme and a comparison hospital. RESULTS: Safe and unsafe patient handling practice scales at the study hospital improved significantly (p<0.0001 and p=0.0031, respectively), with no differences observed at the comparison hospital. We observed significant decreases in recordable neck and shoulder (Relative Risk (RR)=0.68, 95% CI 0.46 to 1.00), lifting and exertion (RR=0.73, 95% CI 0.60 to 0.89) and pain and inflammation (RR=0.78, 95% CI 0.62 to 1.00) injury rates at the study hospital. Changes in rates at the comparison hospital were not statistically significant. CONCLUSIONS: Within the context of a patient mobilisation initiative, a safe patient handling and mobilisation programme was associated with improved work practices and a reduction in recordable worker injuries. This study demonstrates the potential impact of utilising a systems approach based on recommended best practices, including integration of these practices into the patient's plan for care.

Nurses' but not supervisors' safety practices are linked with job satisfaction.

AIMS: To test the associations of safety practices as reported by nurses and their respective unit supervisors with job satisfaction. BACKGROUND: Psychosocial workplace factors are associated with job satisfaction; however, it is unknown whether nurses and supervisors accounts of safety practices are differentially linked to this outcome. METHODS: Cross-sectional study design including nurses (n = 1052) nested in 94 units in two hospitals in Boston (MA, USA). Safety practices refer to the identification and control of occupational hazards at the unit. Safety practices were measured aggregating nurses' responses per unit, and supervisory levels. Individual's job satisfaction for each nurse was the response variable. RESULTS: Supervisors assessed safety practices more favourably than their unit nursing staff. Adjusted random intercept logistic regressions showed that the odds of higher job satisfaction were higher for nurses at units with better safety practices (OR: 1.67, 95% CI: 1.04, 2.68) compared with nurses at units that averaged lower safety practices. Supervisors' reports of safety practices were not correlated with the job satisfaction of their staff. CONCLUSIONS: Adequate safety practices might be a relevant managerial role that enhances job satisfaction among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing supervisors should calibrate their safety assessments with their nursing staff to improve nurses' job satisfaction.

Integrating worksite health protection and health promotion: A conceptual model for intervention and research.

There is increasing recognition of the value added by integrating traditionally separate efforts to protect and promote worker safety and health. This paper presents an innovative conceptual model to guide research on determinants of worker safety and health and to inform the design, implementation and evaluation of integrated approaches to promoting and protecting worker health. This model is rooted in multiple theories and the premise that the conditions of work are important determinants of individual safety and health outcomes and behaviors, and outcomes important to enterprises such as absence and turnover. Integrated policies, programs and practices simultaneously address multiple conditions of work, including the physical work environment and the organization of work (e.g., psychosocial factors, job tasks and demands). Findings from two recent studies conducted in Boston and Minnesota (2009-2015) illustrate the application of this model to guide social epidemiological research. This paper focuses particular attention on the relationships of the conditions of work to worker health-related behaviors, musculoskeletal symptoms, and occupational injury; and to the design of integrated interventions in response to specific settings and conditions of work of small and medium size manufacturing businesses, based on a systematic assessment of priorities, needs, and resources within an organization. This model provides an organizing framework for both research and practice by specifying the causal pathways through which work may influence health outcomes, and for designing and testing interventions to improve worker safety and health that are meaningful for workers and employers, and responsive to that setting's conditions of work.

Whole Body Vibration Exposures and Health Status among Professional Truck Drivers: A Cross-sectional Analysis.

Many professional truck drivers suffer from low back pain (LBP) which is thought to be associated with exposure to whole-body vibration (WBV). The objectives of this study were to: (i) characterize general health, regional body pain and WBV exposures, (ii) evaluate the associations between different WBV parameters and health outcomes, and (iii) determine whether there were factors which affect a truck driver's WBV exposures. This study analyzed WBV exposures from 96 long-haul truck drivers over their regular work shift (6-15h) per International Standards Organization (ISO) 2631-1 and 2631-5 WBV standards. This study also evaluated regional body pain (10-point scale), low back disability (the Oswestry Disability Index), and physical and mental health (the Short Form 12-item Health Survey). The results demonstrated that the daily vector sum WBV exposures [A(8), VDV(8) and Sed(8)] were above action limits while the predominant z-axis exposures were below action limits. Among all the musculoskeletal outcomes, LBP was the most prevalent (72.5%) with average LBP score of 2.9 (SD: 2.0). The SF-12 health scores demonstrated that truck drivers in general had lower physical health status than the general US population (P's < 0.04) and that physical health status decreased as WBV exposures increased (P = 0.03). In addition, the correlations between the WBV measures and health outcomes indicated that A(8) exposure measures had a stronger link to musculoskeletal (LBP) and other health outcomes than the VDV(8) and Sed(8) measures. Finally, seat manufacturer and seat age were two factors which had a strong influence on WBV exposures.

A Psychophysical Protocol to Develop Ergonomic Recommendations for Sitting and Standing Workstations.

OBJECTIVE: The aim of this study was to determine user self-selected setup for both sitting and standing computer workstations and identify major differences. BACKGROUND: No current ergonomic setup guideline for standing computer workstations is available. METHODS: Twenty adult participants completed four 45-min sessions of simulated office computer work with an adjustable sit-stand computer workstation. Placement and relative position of all workstation components, including a cordless mouse, a cordless keyboard, a height-adjustable desk, and a 22-inch monitor mounted on a mechanical-assisted arm were recorded during the four sessions, which alternated between sitting and standing for each session. Participants were interrupted four times within each session, and the workstation was "reset" to extreme locations. Participants were instructed to adjust the location to achieve the most comfortable arrangement and to make as many adjustments during the session to achieve this goal. RESULTS: Overall, users placed the keyboard closer to their body (sternum), set desk height lower than their elbow, and set the monitor lower relative to their eyes with a greater upward tilt while standing compared to sitting. During the 45-min sessions, the number of adjustments participants made became smaller and over the four sessions was consistent, suggesting the psychophysical protocol was effective and consistent. CONCLUSION: Users preferred different workstation setups for sitting and standing computer workstations. Therefore, future setup guidelines and principles for standing computer workstations may not be simply translated from those for sitting. APPLICATION: These results can serve as the first step toward making recommendations to establish ergonomic guidelines for standing computer workstation arrangement.

Effects of Epinephrine Auto-Injector Shape and Size on Human Factors Influencing Drug Delivery.

OBJECTIVE: The aim of this study was to assess the effects of (a) auto-injector form factor on maximum applied force capability and (b) auto-injector design and instructions on force production and orientation. BACKGROUND: Effective delivery of epinephrine through an auto-injector is the result of a multitude of design factors. At minimum, the design needs to allow the user to apply sufficient force for the needle to penetrate clothing and tissue. METHOD: Trainer devices for three commercially available epinephrine auto-injectors with different form factors (cylindrical, elliptical, prismatic) were tested in a laboratory-based repeated-measures experiment with 20 adults. Participants applied their maximum force onto a force plate positioned over their thigh and practiced an injection using the trainer device after viewing training videos. Participants also rated force confidence and preference. RESULTS: The maximum force varied significantly across devices. The greatest force observed was 64 newtons with the elliptical device, and the lowest force was 61 newtons with the cylindrical device. Participants reported the highest force confidence when using the elliptical and cylindrical devices, ranking the elliptical as their preferred device. CONCLUSION: Force capability results for the elliptical device suggest that it may be more successful in achieving the necessary force for drug delivery in a larger set of adult users. APPLICATION: Results suggest that the auto-injector with the elliptical form may enable more successful drug delivery among a larger set of users.

Office workers with high effort-reward imbalance and overcommitment have greater decreases in heart rate variability over a 2-h working period.

PURPOSE: High levels of workplace psychosocial factors have been associated with adverse cardiovascular outcomes, possibly through the pathway of increasing autonomic arousal. The purpose of this study was to investigate whether the workplace psychosocial factors of effort-reward imbalance (ERI) and overcommitment were associated with greater decreases in heart rate variability (HRV) across a 2-h working period in a cohort of office workers performing their own work at their own workplaces. METHODS: Measurements of HRV in 5-min time epochs across a 2-h morning or afternoon working period, as well as self-reports of ERI and overcommitment, were collected for 91 office workers. RESULTS: There was a negative and significant (p < 0.01) ERI*time interaction for the standard deviation of the interval between normal heart beats (SDNN), the square root of the mean squared differences of successive normal heart beats (RMSSD), and the power in the high-frequency range of the heart rate signal (HF power), and a positive and significant ERI*time interaction for the ratio of power in the low-frequency range of the heart rate signal divided by the HF power (LF/HF ratio). There was a positive and significant overcommitment*time interaction for the LF/HF ratio (p < 0.01) in the morning, and a negative and significant overcommitment*time interaction for SDNN, RMSSD, and HF power (p < 0.01) in the afternoon. CONCLUSIONS: The results indicate that participants exposed to high levels of ERI and overcommitment exhibited a more adverse cardiovascular response (a greater decrease in HRV throughout the 2-h measurement period) compared to their colleagues with lower levels of these factors.

Length of time spent working on a commercial construction site and the associations with worker characteristics.

BACKGROUND: Construction workers move frequently from jobsite to jobsite, yet little is documented about length of stay on-site and associations with worker characteristics. METHOD: Using cross-sectional data, we investigated associations between worker characteristics (including trade and musculoskeletal pain) and length of stay on-site (dichotomized as < 1 month, n = 554, and ≥ 1 month, n = 435). RESULTS: Approximately, 56% of workers remained on the worksite for at least 1 month. Length of stay was significantly associated with workers' race/ethnicity, union status, title, trade, and musculoskeletal pain (P-values < 0.05). Trades associated with longer length of stay included pipefitters and plumbers. Trades associated with shorter length of stay included operators and piledrivers. Workers with single-location pain had 2.21 times (95%CI: 1.52, 3.19) the odds of being short-term versus long-term, adjusting for trade, title, and race/ethnicity. CONCLUSION: The length of stay and associated characteristics provide important insight into how workers come and go on construction sites and the methodological challenges associated with traditional intervention evaluations.

Development and validation of a fatigue assessment scale for U.S. construction workers.

OBJECTIVE: To develop a fatigue assessment scale and test its reliability and validity for commercial construction workers. METHODS: Using a two-phased approach, we first identified items (first phase) for the development of a Fatigue Assessment Scale for Construction Workers (FASCW) through review of existing scales in the scientific literature, key informant interviews (n = 11) and focus groups (three groups with six workers each) with construction workers. The second phase included assessment for the reliability, validity, and sensitivity of the new scale using a repeated-measures study design with a convenience sample of construction workers (n = 144). RESULTS: Phase one resulted in a 16-item preliminary scale that after factor analysis yielded a final 10-item scale with two sub-scales ("Lethargy" and "Bodily Ailment"). During phase two, the FASCW and its subscales demonstrated satisfactory internal consistency (alpha coefficients were FASCW [0.91], Lethargy [0.86] and Bodily Ailment [0.84]) and acceptable test-retest reliability (Pearson Correlations Coefficients: 0.59-0.68; Intraclass Correlation Coefficients: 0.74-0.80). Correlation analysis substantiated concurrent and convergent validity. A discriminant analysis demonstrated that the FASCW differentiated between groups with arthritis status and different work hours. CONCLUSIONS: The 10-item FASCW with good reliability and validity is an effective tool for assessing the severity of fatigue among construction workers.

Association between perceived inadequate staffing and musculoskeletal pain among hospital patient care workers.

OBJECTIVE: To examine association between perceived inadequate staffing and musculoskeletal pain and to evaluate the role of work-related psychosocial and physical work factors in the association among hospital patient care workers. METHODS: A cross-sectional study was conducted among 1,572 patient care workers in two academic hospitals. Perceived inadequate staffing was measured using the "staffing adequacy subscale" of Nursing Work Index, which is a continuous scale that averages estimates of staffing adequacy by workers in the same units. Musculoskeletal pain (i.e., neck/shoulder, arm, low back, lower extremity, any musculoskeletal pain, and the number of area in pain) in the past 3 months was assessed using a self-reported Nordic questionnaire. Multilevel logistic regression was applied to examine associations between perceived inadequate staffing and musculoskeletal pain, considering clustering among the workers in the same units. RESULTS: We found significant associations of perceived inadequate staffing with back pain (OR 1.50, 95 % CI 1.06, 2.14) and the number of body area in pain (OR 1.42, 95 % CI 1.01, 2.00) after adjusting for confounders including work characteristics (job title, having a second job or not, day shift or not, and worked hours per week). When we additionally adjusted for physical work factors (i.e., use of a lifting device, and the amount of the time for each of five physical activities on the job), only the association between perceived inadequate staffing and back pain remained significant (OR 1.50, 95 % CI 1.03, 2.19), whereas none of the associations was significant for all of musculoskeletal pains including back pain (OR 0.96, 95 % CI 0.66, 1.41) when we additionally adjusted for work-related psychosocial factors (i.e., job demands, job control, supervisor support, and co-worker support) instead of physical work factors. CONCLUSIONS: Perceived inadequate staffing may be associated with higher prevalence of back pain, and work-related psychosocial factor may play an important role in the potential pathway linking staffing level to back pain among hospital workers.