Work routinization and implications for ergonomic exposure assessment

Jobs in many modern settings, including manufacturing, service, agriculture and construction, are variable in their content and timing. This prompts the need for exposure assessment methods that do not assume regular work cycles. A scheme is presented for classifying levels of routinization to inform development of an appropriate exposure assessment strategy for a given occupational setting. Five levels of routinization have been defined based on the tasks of which the job is composed: 1) a single scheduled task with a regular work cycle; 2) multiple cyclical tasks; 3) a mix of cyclical and non-cyclical tasks; 4) one non-cyclical task; 5) multiple non-cyclical tasks. This classification, based primarily on job observation, is illustrated through data from a study of automobile manufacturing workers (n = 1200), from which self-assessed exposures to physical and psychosocial stressors were also obtained. In this cohort, decision latitude was greater with higher routinization level (p < 0.0001), and the least routinized jobs showed the lowest self-reported exposure to physical ergonomic stressors. The job analysis checklist developed for non-routinized jobs is presented, and limitations of the task analysis method utilized in the study are discussed. A work sampling approach to job analysis is recommended as the most efficient way to obtain a comparable unbiased exposure estimate across all routinization levels.     

Pathomechanisms of work-related musculoskeletal disorders: conceptual issues

Work-related musculoskeletal disorders (WRMSDs) by definition are a subset of musculoskeletal disorders (MSDs) that arise out of occupational exposures. While traditional exposure assessment techniques have proved to be successful in identifying ergonomic exposures that are epidemiologically linked to these disorders, some are troubled by the lack of one-to-one correspondence between specific occupational exposure profiles and specific MSDs. In the absence of more sophisticated hypotheses that might explain the occurrence of WRMSDs in a variety of exposure patterns, the aetiologic relationships may (again) be called into question. Another unanswered question is whether specific types of WRMSDs have qualitatively different exposure-response relationships. A clearer understanding of the underlying pathomechanisms associated with specific WRMSDs could help future researchers better determine how and when various occupational exposure profiles become pathogenic. Such knowledge could also be used to design exposure assessment tools to capture exposure information more relevant to the risk of WRMSDs. The main goals of this paper are to summarize several recently described pathomechanisms, most of which have been discussed primarily in clinical and experimental literature that might not be widely read by occupational health scientists. Suggestions are made as to how future research could evaluate whether these phenomena are relevant to the effects of physical exposures and the underlying disease processes of common WRMSDs.     

Validity of fixed-interval observations for postural assessment in construction work

While observing six simulated construction tasks in the field, trained analysts recorded arm, trunk and leg postures categorically with two fixed-interval observational protocols. Observations were compared to measurements obtained with an electronic postural assessment system coupled with video analysis. The electronic postural assessment system consisted of electronic inclinometers to measure upper arm posture, knee flexion and trunk flexion, coveralls to house the inclinometer wiring, and an eletrogoniometric system to measure trunk lateral bending and twisting. Video analysis included frozen-frame analysis that corresponded to the moment of observation and simulated real-time analysis. Measurements were made on five male participants who each performed three tasks representative of construction laborers' work. Agreement among the observational and reference methods was generally high, although significant differences in measured frequency of exposure existed for knee flexion, trunk lateral bending and trunk twisting. The results suggest that, under appropriate conditions, discrete observations can be used to obtain reasonably accurate estimates of exposure frequency for broad categories of certain body postures.     

Physical ergonomic hazards in highway tunnel construction: overview from the Construction Occupational Health Program

This report provides an overview of physical ergonomic exposures in highway construction work across trades and major operations. For each operation, the observational method “PATH” (Posture, Activity, Tools and Handling) was used to estimate the percentage of time that workers spent in specific tasks and with exposure to awkward postures and load handling. The observations were carried out on 73 different days, typically for about 4 h per day, covering 120 construction workers in 5 different trades: laborers, carpenters, ironworkers, plasterers, and tilers. Non-neutral trunk postures (forward or sideways flexion or twisting) were frequently observed, representing over 40% of observations for all trades except laborers (28%). Kneeling and squatting were common in all operations, especially tiling and underground utility relocation work. Handling loads was frequent, especially for plasterers and tilers, with a range of load weights but most often under 15 pounds. The results of this study provide quantitative evidence that workers in highway tunnel construction operations are exposed to ergonomic factors known to present significant health hazards. Numerous opportunities exist for the development and implementation of ergonomic interventions to protect the health and safety of construction workers.     

Ergonomic stressors and upper extremity disorders in vehicle manufacturing: cross sectional exposure-response trends

Cisplatin, cis-diamminedichloroplatinum(II) (CDDP) is one of the most important anticancer agents, initially producing good responses in various tumors. However, resistance to this drug often develops in various tumors, and additional administration decreases its chemotherapeutic efficacy. The precise mechanism of acquisition of resistance to this drug is still uncertain. However in the present study, we established two CDDP-resistant sublines A431/CDDP1 and A431/CDDP2 from human epidermoid carcinoma cell line A431. These resistant sublines were constituted by exposing A431 cells to a gradually increasing dose of CDDP (A431/CDDP1), and by mutagenic induction with mutagen (A431/CDDP2). A431/CDDP1 and A431/CDDP2 have developed 3.1 and 2.7 times more resistance to CDDP than the original A431 cell in terms of IC50. The two CDDP-resistant sublines showed cross-resistance to the CDDP analogue, carboplatin (CBDCA), but not to other chemotherapeutic drugs such as Adriamycin (ADR) and 5-fluorouracil (5-FU). These CDDP-resistant sublines were transplanted into nude mice to demonstrate the resistance to CDDP treatment in vivo. According to the in vitro assay, the mechanism of resistance in A431/CDDP1 and A431/CDDP2 seems to be based on a reduction of intracellular accumulation of CDDP, because their platinum concentration, which is the major component of CDDP, significantly declined. The established CDDP-resistant sublines may be used in further trials to improve the understanding of the mechanisms of resistance to CDDP.     

Mutations in SOX9, the gene responsible for Campomelic dysplasia and autosomal sex reversal

Campomelic dysplasia (CD) is a skeletal malformation syndrome frequently accompanied by 46,XY sex reversal. A mutation-screening strategy using SSCP was employed to identify mutations in SOX9, the chromosome 17q24 gene responsible for CD and autosomal sex reversal in man. We have screened seven CD patients with no cytologically detectable chromosomal aberrations and two CD patients with chromosome 17 rearrangements for mutations in the entire open reading frame of SOX9. Five different mutations have been identified in six CD patients: two missense mutations in the SOX9 putative DNA binding domain (high mobility group, or HMG, box); three frameshift mutations and a splice-acceptor mutation. An identical frameshift mutation is found in two unrelated 46,XY patients, one exhibiting a male phenotype and the other displaying a female phenotype (XY sex reversal). All mutations found affect a single allele, which is consistent with a dominant mode of inheritance. No mutations were found in the SOX9 open reading frame of two patients with chromosome 17q rearrangements, suggesting that the translocations affect SOX9 expression. These findings are consistent with the hypothesis that CD results from haploinsufficiency of SOX9.     

Ergonomic evaluation of slide boards used by home care aides to assist client transfers

Home care aides risk musculoskeletal injury because they lift and move clients; the body weight of most adults exceeds the NIOSH recommended limit for lifting. Methods to reduce manual patient lifting in institutional settings are often technically or economically infeasible in home care. Our goal was to identify suitable, safe, low-technology transfer devices for home care use. Sixteen experienced home care aides performed client transfers from wheelchair to bed (upward) and bed to wheelchair (downward) in a simulated home care environment (laboratory), using four different slide boards and by hand without a device. Aides’ hand forces were measured during client transfers; aides also evaluated usability of each board. Hand forces exerted while using slide boards were mostly lower than in manual transfer, and forces were lower in downward versus upward transfers. Aides judged a board with a sliding mechanism easier to use than boards without a sliding mechanism.

Practitioner Summary: This paper provides quantitative biomechanical measurements showing that slide boards reduced the hand forces needed by home care aides to transfer clients from bed to wheel chair and vice versa, compared to manual lifting. Using a semi-quantitative usability survey, aides identified boards with a sliding mechanism easiest to use.     

Covariation between workplace physical and psychosocial stressors: evidence and implications for occupational health research and prevention.

There is increasing interest in distinguishing the effects of physical and psychosocial workplace stressors on the aetiology of work-related musculoskeletal disorders (MSD). Modest associations have been found between psychosocial stressors and MSD, such as intensive load, monotonous work and low job control. Interpretation of these results has been limited by likely covariation between physical and psychosocial stressors. This investigation examined exposure covariation among blue- and white-collar workers employed in a mass production manufacturing environment (N = 410). Physical stressors were assessed from questionnaire and accelerometry. Psychosocial stressors were assessed from questionnaire. Pearson and Spearman correlation coefficients were computed. An exploratory factor analysis procedure identified possible common factors linking specific physical and psychosocial stressors. Moderate to high correlations between some physical and psychosocial stressors showed evidence of covariation both across and within groups. Covariation was strongest among blue-collar production and low-status office workers. Factor analysis results showed considerable shared variance between some physical and psychosocial stressors, such as repetition and job control, suggesting that these disparate stressors manifest from common work organization factors that govern the structure of work. While recognizing the conceptual differences between physical and psychosocial stressors, these results call attention to the strong empirical relationships that can exist between some stressors in the workplace setting. To guard against ambiguous study findings that can occur when exposures are mixed, it is critical that future epidemiologic studies include information about the degree of association between task-level stressors. Future research on work organization determinants of task-level stressors, and their coincident occurrence in jobs with greater specialization, may provide promising new insights into the nature of risk for MSD and effective prevention strategies.     

University students' notebook computer use: lessons learned using e-diaries to report musculoskeletal discomfort

The objective of this pilot study was to identify if notebook accessories (ergonomic chair, desktop monitor and notebook riser) combined with a wireless keyboard, mouse and participatory ergonomics training would have the greatest impact on reducing self-reported upper extremity musculoskeletal discomfort in university students. In addition to pre-post computing and health surveys, the Ecological Momentary Assessment was used to capture change in discomfort over time using a personal digital assistant (PDA) as the e-diary. The PDA was programmed with a survey containing 45 questions. Four groups of university students were randomised to either intervention (three external computer accessories) or to control. Participants reported less discomfort with the ergonomic chair and notebook riser based on the pre-post survey data and the e-diary/PDA ANOVA analysis. However, the PDA data, adjusted for the effect of hours per day of computer use, showed no benefit of the chair and limited benefit from the riser. Statement of Relevance:University students' use of notebook computers has increased. This study found evidence of a positive effect of an adjustable chair or notebook riser when combined with ergonomic training on reducing discomfort. Daily notebook computer use of 4?h was confirmed as a risk factor. Without some form of ergonomic intervention, these students are likely to enter the workforce with poor computing habits, which places them on the road to future injuries as technology continues to play a dominant role in their lives.     

Medium- and long-term reproducibility of self-reported exposure to physical ergonomics factors at work

INTRODUCTION: The literature is sparse on reproducibility of self-reported exposure to physical ergonomics risk factors for musculoskeletal disorders (MSDs). Aims of this study were to evaluate, in a cohort of workers interviewed up to three times: 1-year test-retest reliability; and 5- and 6-year recall of physical exposures. We also examined whether reproducibility was influenced by the presence of UE MSD or by technological changes introduced between the last two surveys. METHODS: A cohort of automobile manufacturing employees was interviewed at baseline, one and six years later about work history, physical and psychosocial exposures at work, upper limb symptoms, injury and medical history, and demographics. Agreement between interviews was evaluated by intraclass correlation and Spearman coefficients. Differences in exposure between 1- and 6-year follow-up were analyzed by Wilcoxon matched-pairs signed-ranks test. RESULTS: Large and significant decreases in work pace and physical effort were observed from baseline, although an upper extremity composite index was quite stable in the total population. One-year test-retest reliability was fair to good for the composite exposure index (ICC=0.58), whole-body vibration, handling parts, and tool use, but poor for the other variables considered. Long-term reproducibility, from baseline or 1-year follow-up to 6-year follow-up, was poor for the composite index and almost all single items. UE MSD case status influenced 1-year test-retest reliability, with subjects who changed case status from baseline displaying higher reliability, but not reproducibility of recalled exposures. A strong regression to the mean effect was observed on exposures reported at follow-up surveys. CONCLUSIONS: Recalled ergonomics exposures could be employed in retrospective cohort studies as a somewhat reliable and unbiased estimate of the self-reported exposures that would have been obtained up to one year earlier, but not over a longer period (5-6 years). These longer-term results may have been limited by difficulty in matching jobs between interviews; also the regression to the mean effect likely contributed to reduce agreement. Changes in production technology and work organization produced a decrease in physical workload intensity and job pace, but did not have a substantial impact on an exposure index for the upper limb.