2009-08-01 12:00 - Messages

Red Flags/Green Lights: A Guide to Identifying and Solving Return-to-Work Problems
Most injured workers return to their jobs successfully. For a few, however, problems may arise that complicate their recovery and return to work. This guide, based on IWH research, is designed for such situations. It presents warning signs (or red lights) and helpful practices (or green lights) for those involved in the return-to-work, health-care, vocational rehabilitation or claims process.
Self-Management Strategies to Reduce Pain and Improve Function among Older Adults in Community Settings: A Review of the Evidence

Context. Self-management strategies for pain hold substantial promise as a means of reducing pain and improving function among older adults with chronic pain, but their use in this age group has not been well defined. Objective. To review the evidence regarding self-management interventions for pain due to musculoskeletal disorders among older adults. Design. We searched the Medline and Cumulative Index to Nursing and Allied Health Literature databases to identify relevant articles for review and analyzed English-language articles that presented outcome data on pain, function, and/or other relevant endpoints and evaluated programs/strategies that could be feasibly implemented in the community. Abstracted information included study sample characteristics, estimates of treatment effect, and other relevant outcomes when present. Results. Retained articles (N = 27) included those that evaluated programs sponsored by the Arthritis Foundation and other programs/strategies including yoga, massage therapy, Tai Chi, and music therapy. Positive outcomes were found in 96% of the studies. Proportionate change in pain scores ranged from an increase of 18% to a reduction of 85% (median = 23% reduction), whereas change in disability scores ranged from an increase of 2% to a reduction of 70% (median = 19% reduction). Generalizability issues identified included limited enrollment of ethnic minority elders, as well as non-ethnic elders aged 80 and above. Conclusions. Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time.

Source: http://www3.interscience.wiley.com/journal/120089378/abstract

Organisational change, job strain and increased risk of stroke? A pilot study

The objective of this pilot study was to explore whether organisational change and work-related stress, as measured by the Job Content Questionnaire, were associated with first-ever stroke among working people aged 30–65. Methods: In a case-control study a total of 65 consecutive cases, aged 30–65 years of age, with first-ever stroke were recruited from four hospitals in Sweden during 2000–2002. During the same period, 103 random population controls in the same age interval were recruited. Data on job-related stress and traditional medical risk factors were collected by a questionnaire. Results: In the multivariate analyses, organisational change (OR 3.38) increased the likelihood of stroke, while experiencing an active job (OR 0.37) decreased the likelihood of stroke. Regarding risk factors outside work, age (OR 1.11), low physical activity (OR 5.21), low education (OR 2.48) and family history of stroke (OR 2.59) were associated with increased likelihood of stroke. Conclusion: This study suggests an association between organisational change, work-related stress and stroke. The likelihood of stroke was lower for people in active job situations.

Source: http://iospress.metapress.com/content/x65731w32l143304/
Job characteristics and work organization factors associated with patient-handling injury among nursing personnel

The aim of this cross-sectional study was to explore the association of worker characteristics and work organization factors with prevalence of patient-handling injury among nursing personnel in an acute-care inpatient setting. Self-administered questionnaires (n = 585) captured worker characteristics and patient-handling injuries within the previous 6 months. Karasek's Job Content Questionnaire measured work organization factors, including job strain (high psychological demand, low decision latitude). We created a novel measure (job strain_{PHYSICAL}) reflecting high physical demand and low decision latitude, providing a more direct physiologic link to our outcome. Log-binomial regression was used to calculate prevalence ratios (PR) and 95% confidence intervals (CI). Patient-handling injuries were prevalent (35%), and incident reports were filed infrequently for injuries receiving medical care. Prevalence of injury was higher among aides compared to nurses [adjusted PR 1.4, 95%CI (1.1–1.8)] as well as among those with high [adjusted PR 1.6, 95%CI (1.2–2.4)] or mid [adjusted PR 1.9, 95%CI (1.4–2.7)] levels of job dissatisfaction. The novel definition of job strain (job strain_{PHYSICAL}: high physical demand, low decision latitude) was more strongly associated with patient-handling injury than the traditional definition of job strain (high psychological demand, low decision latitude). These findings add to a growing body of literature on the highly contextual nature of work organization factors.

Source: http://iospress.metapress.com/content/g32t01tx16wu1gj2/

Job strain and older workers: Can a reduction in job strain help to eliminate the Social Security drain?

Job strain is the psychological and physiological response to a lack of control or support in the work environment. It appears to be an important risk factor for continued employment throughout the lifespan. Reducing job strain earlier in a workers life has the potential to have substantial beneficial health effects throughout a workers life. Early screening for job strain should be implemented in known high risk or high strain jobs. This is particularly important since there a fewer younger workers entering the labor force and there will be a growing need for older workers to remain in the workforce. Furthermore, healthier workers will require less medical care and are likely to work longer if they are willing and able. Healthier older workers who are willing and able to work longer will defer receipt of retirement benefits while continuing to pay into the Social Security System. Further investigation of older individuals (1) willingness and motivation to work past the normal retirement age, (2) career and employment security, skills development, and reconciliation of working and non-working life, and (3) job strain and effects of reducing job strain is needed. The current job strain literature has been expanded to the Social Security System arena and suggests that reducing job strain has the potential to help eliminate the Social Security drain by increasing older worker labor force retention. 

Source: http://iospress.metapress.com/content/42267rv5k7v65362/

Age and Disability Employment Discrimination: Occupational Rehabilitation Implications

As concerns grow that a thinning labor force due to retirement will lead to worker shortages, it becomes critical to support positive employment outcomes of groups who have been underutilized, specifically older workers and workers with disabilities. Better understanding perceived age and disability discrimination and their intersection can help rehabilitation specialists and employers address challenges expected as a result of the evolving workforce. Methods Using U.S. Equal Employment Opportunity Commission Integrated Mission System data, we investigate the nature of employment discrimination charges that cite the Americans with Disabilities Act or Age Discrimination in Employment Act individually or jointly. We focus on trends in joint filings over time and across categories of age, types of disabilities, and alleged discriminatory behavior. Results We find that employment discrimination claims that originate from older or disabled workers are concentrated within a subset of issues that include reasonable accommodation, retaliation, and termination. Age-related disabilities are more frequently referenced in joint cases than in the overall pool of ADA filings, while the psychiatric disorders are less often referenced in joint cases. When examining charges made by those protected under both the ADA and ADEA, results from a logit model indicate that in comparison to charges filed under the ADA alone, jointly-filed ADA/ADEA charges are more likely to be filed by older individuals, by those who perceive discrimination in hiring and termination, and to originate from within the smallest firms. Conclusion In light of these findings, rehabilitation and workplace practices to maximize the hiring and retention of older workers and those with disabilities are discussed.

Source: http://www.springerlink.com/content/g4503070w2x75028/

A critical review of gender issues in understanding prolonged disability related to musculoskeletal pain: how are they relevant to rehabilitation?
Purpose. The purpose of this critical review is to describe the available theoretical models for understanding the gender issues in prolonged work disability related to persistent musculoskeletal (MSK) pain. Method. A critical literature review was conducted in medicine, health sciences, and social sciences databases (MEDLINE, CINHAL, PsychINFO and SOCINDEX) using specific keywords. After screening titles and abstracts, followed by methodological quality assessment, a total of 55 references were retained for content analysis. Results. Gender issues in disability related to persistent MSK pain show that men and women may experience pain and rehabilitation process in different ways. Three main themes were exftracted and further described: (1) the experience of distrust; (2) the self-identity process; and (3) the domestic strain. Each of these themes has a specific and potentially different impact on men and women, and we report that experiential differences may strongly impact the rehabilitation process and outcomes such as return to work. Conclusions. This critical review provides insight into gender issues in the process of rehabilitation and outcomes such as return to work. We suggest that work and family considerations are the two most important issues in the rehabilitation process and that differences between men and women are likely to occur.


Source: http://informahealthcare.com/doi/abs/10.3109/09638280903026572

Le travail temporaire : néfaste pour la santé mentale

Le travail temporaire : néfaste pour la santé mentale Une nouvelle recherche de McGill démontre que les emplois contractuels temporaires et à court terme engendrent détresse psychologique et dépression. Selon les données d'une recherche présentée à l'occasion de l'assemblée annuelle de l'Association américaine de sociologie, le 9 août, les employés occupant un poste soit temporaire, contractuel, occasionnel ou d'une durée déterminée sont davantage à risque de développer des problèmes de santé mentale. « Il semble que les travailleurs temporaires, qui ne peuvent compter sur un emploi stable à long terme, sont susceptibles de voir leur santé mentale décliner, et ce, aussi longtemps qu'ils continuent d'occuper des fonctions pouvant être perçues comme « jetables » ou « de deuxième classe », a souligné Amélie Quesnel-Vallée, sociologue médicale à l'Université McGill et chercheuse principale de l'étude. Intitulé «Contingent Work and Depressive Symptoms: Contribution of Health Selection and Moderating Effects of Employment Status » (Travail occasionnel et symptômes dépressifs : rôle du statut d'emploi sur la santé et les effets modérateurs), l'article a été rédigé par Suzanne DeHaney et Antonio Ciampi, tous deux de l'Université McGill. « Cette recherche démontre que le travail occasionnel entraîne des effets pernicieux sur la santé mentale des employés, ces derniers affichant davantage de symptômes de dépression et de détresse psychologique que les employés occupant des postes similaires, qui ne sont toutefois pas soumis aux conditions d'un travail à durée déterminée. Ces résultats présentent un intérêt particulier pour les employés qui sont à évaluer les conditions à long terme, de même que l'incidence, sur leur état de santé global, d'opter pour un travail occasionnel qui saura répondre à leurs besoins sur le plan professionnel, tant à l'heure actuelle qu'à l'avenir », a précisé Mme Quesnel-Vallée. En 2005, environ 4,1 pour cent de la main-d'oeuvre des États-Unis, soit 5,7 millions de travailleurs américains, occupait un poste jugé temporaire, selon les plus récentes données issues de L'Enquête sur l'état de la population. L'équipe affectée à la recherche a analysé un échantillonnage de données longitudinales colligées entre 1992 et 2002 issues de L'enquête longitudinale nationale sur les enfants et les jeunes des États-Unis réalisée en 1979. Menée auprès de sujets masculins et féminins nés entre 1957 et 1964, cette enquête a été réalisée sur une base annuelle entre 1979 et 1994, et à tous les deux ans par la suite. Les chercheurs ont évalué les critères suivants : statut professionnel occasionnel (temporaire), score symptomatique dépressif, niveau de pauvreté et d'instruction. Les résultats recueillis sont jugés comme représentatifs de la main-d'oeuvre américaine générale d'âge moyen.

Source: http://francais.mcgill.ca/newsroom/news/item/?item_id=107960

Beneficial and Limiting Factors Affecting Return to Work After Total Knee and Hip Arthroplasty: A Systematic Review

A large number of patients undergoing total knee (TKA) and hip (THA) arthroplasties are of working age at the time these procedures are performed. The objective of this study was to systematically review literature on the beneficial and limiting factors affecting return to work in patients undergoing TKA or THA. Method Pubmed and Embase were systematically searched to find studies that described factors that influence return to work (RTW) after surgery. The following inclusion criteria had to be met: (1) inclusion of patients with primary or revision TKA or THA; (2) description of return to work after surgery or employment status; and (3) description of a beneficial or restricting factor affecting return to work. Results Only three studies were found that fulfilled the three inclusion criteria. Three factors were discussed: (1) the mini-posterior approach compared to the two-incision approach; (2) patient movement restrictions after surgery compared to no restrictions; and (3) patient discharge based on guidelines compared to discharge without guidelines. Conclusions This systematic review revealed that knowledge is sparse regarding beneficial or limiting factors affecting return to work after TKA or THA. Despite that, the results suggests that the two-incision approach is beneficial, patient movement restrictions are limiting, and patient discharge guidelines have no effect on the time patients take to RTW.

Source: http://www.springerlink.com/content/l143860v5551x587/

Work Related Risk Factors for Neck, Shoulder and Arms Complaints: A Cohort Study Among Dutch Computer Office Workers

This study aims to investigate the relationship between work-related physical and psychosocial characteristics and complaints of the neck, shoulder and forearm/hands. Methods Data were used from a prospective Dutch cohort study among computer office workers with a follow-up period of 2 years. The study was conducted among 264 computer users. Physical and psychosocial risk factors were tested to predict the occurrence of neck, shoulder and forearm/hands complaints. Bivariate and multivariable logistic regression was used to identify the association between risk factors and outcome variables. The 2 year follow-up prevalence rates with 95% CI for neck complaints were 0.31 (0.28–0.37), for shoulder complaints 0.33 (0.27–0.39) and for forearm/hands complaints 0.21 (0.14–0.28). Four main predictors for the occurrence of neck and shoulder complaints were identified: (1) Irregular head and body posture [OR: 1.1 (1.0–1.2) P = 0.04]; (2) task difficulty (job demands) [OR: 1.2 (1.0–1.5) P = 0.01]; (3) number of working hours/day with the computer [OR: 1.20 (1.0–1.4) P = 0.03]; and (4) having had a previous history of complaints [OR: 7.2 (3.8–13.2) P = 0.01]. Two predictors were identified for forearm/hands complaints: time pressure (job demands) [OR: 1.20 (1.0–1.4) P = 0.03] and having had a previous history of complaints [OR: 7.1 (3.5–14.1) P = 0.06]. This longitudinal study suggests that risk factors of upper musculoskeletal complaints in computer workers consist of a mixture of physical and psychosocial characteristics.

Source: http://www.springerlink.com/content/p052wq661q1868p0/

High nerve injury pain predicts upper extremity disability

When people suffer nerve injuries of the shoulder, arm and hand, their degree of recovery is usually based on tests measuring their functioning. These tests measure how they feel and move (their sensory and motor functions). Patients' own accounts of how well they are doing are not usually assessed. This study aimed to learn more about self-reports of health and well-being among patients with upper extremity nerve injuries, and to find out if these reports predicted greater disability.


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