2015-10-01 12:00 - Messages

Les pratiques de prévention des TMS dans l’économie sociale et solidaire

Les structures de l'économie sociale sont caractérisées par des métiers en contact avec un public en situation de difficultés sociales, de santé, d'autonomie, et par des financements très contraints liés aux politiques publiques. Ces spécificités ont un effet sur l'exposition des salariés au risque TMS.
Le projet « Prévenir les TMS dans les métiers de l'économie sociale » a été initié par CIDES, Chorum Initiatives pour le Développement de l'Economie Sociale, le centre de ressources et d'action de Chorum, afin de contribuer à l'accompagnement des branches professionnelles de l'économie sociale en matière de prévention des TMS.
L'enquête « Les pratiques de prévention des TMS dans l'ESS » a été lancée dans le cadre de ce projet. Son but était d'obtenir une vision qualitative des marges de manoeuvre et modalités d'action efficaces que les structures de l'ESS mettent en place. L'objectif est de bien identifier les capacités réelles des structures à s'engager dans des actions de prévention, et de ne pas construire des outils ou des démarches qu'elles ne pourraient pas mettre en oeuvre.
Sur cette base, nous avons pu identifier une diversité de pratiques, qui nous le souhaitons, représenteront un point d'appui pour les établissements qui souhaitent développer des démarches de prévention des risques professionnels incluant le risque TMS.

Source: http://www.anact.fr/portal/pls/portal/docs/1/17588385.PDF

Organizing workplace health literacy to reduce musculoskeletal pain and consequences

BACKGROUND: Despite numerous initiatives to improve the working environment for nursing aides, musculoskeletal disorders (pain) is still a considerable problem because of the prevalence, and pervasive consequences on the individual, the workplace and the society. Discrepancies between effort and effect of workplace health initiatives might be due to the fact that pain and the consequences of pain are affected by various individual, interpersonal and organizational factors in a complex interaction. Recent health literacy models pursue an integrated approach to understanding health behavior and have been suggested as a suitable framework for addressing individual, organizational and interpersonal factors concomitantly. Therefore, the aim of the trial is to examine the effectiveness of an intervention to improve health literacy (building knowledge, competences and structures for communication and action) at both the organizational and individual level and reduce pain among nursing aides. METHODS/DESIGN: The intervention consists of 2 steps: 1) Courses at the workplace for employees and management in order to organize a joint fundament of knowledge and understanding, and a platform for communication and action about pain prevention in the organization. 2) Organizing a fixed 3-weekly structured dialogue between each employee and her/his supervisor, with particular focus on developing specific plans to prevent and reduce pain and its consequences. This enables the workplace to generate knowledge about employee resources and health challenges and to act and convey this knowledge into initiatives at the workplace. DISCUSSION: Previous studies to improve health literacy have primarily targeted patients or specific deprived groups in health care or community settings. Recently the idea of the workplace as an arena for improving health literacy has developed emphasizing the organizational responsibility in facilitating and supporting that employees obtain basic knowledge and information needed to understand and take action on individual and occupational health concerns. The literature about workplace health literacy is very limited but points at the importance of educating employees to be able to access, appraise and apply health information and of organizing the infrastructure and communication in the organization. This study suggests a concrete operationalization of health literacy in a workplace setting. Results are expected published in 2016.

Source: Larsen AK, Holtermann A, Mortensen OS, et al. BMC Nursing, 2015, vol.14, No 46.

Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians

Randomized controlled trial
BACKGROUND: Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem. OBJECTIVES: This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements.
STUDY DESIGN: This trial uses a single-blind randomized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians. The trial "Implementation of physical exercise at the Workplace (IRMA09) - Laboratory technicians" was registered at ClinicalTrials.gov prior to participant enrolment.
SETTING: The study was conducted at the head division of a large private pharmaceutical company's research and development department in Denmark. The study duration was March 2014 (baseline) to July 2014 (follow-up).
METHODS: Participants (n = 112) were allocated to receive either physical, cognitive, and mindfulness group-based training (PCMT group) or a reference group (REF) for 10 weeks at the worksite. PCMT consisted of 4 major elements: 1) resistance training individually tailored to the pain affected area, 2) motor control training, 3) mindfulness, and 4) cognitive and behavioral therapy/education. Participants of the REF group were encouraged to follow ongoing company health initiatives. The predefined primary outcome measure was pain intensity (VAS scale 0 - 10) in average of the regions: neck, shoulder, lower and upper back, elbow, and hand at 10 week follow-up. The secondary outcome measure was stress assessed by Cohen s perceived stress questionnaire. In addition, an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress, respectively, as outcome measures.
RESULTS: A significant (P < 0.0001) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 (95%CI: -1.4 to -0.6). No significant effect on stress was observed (treatment by time P = 0.16). Exploratory analyses for each body region separately showed significant pain reductions of the neck, shoulders, upper back and lower back, as well as a tendency for hand pain.
Within the PCMT group, general linear models adjusted for age, baseline pain, and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week (-0.60 [95%CI -0.95 to -0.25]) and the number of mindfulness sessions (0.15 [95%CI 0.02 to 0.18]). No such associations were found with the change in stress as outcome.
LIMITATIONS: Limitations of behavioral interventions include the inability to blind participants to which intervention they receive. Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations.
CONCLUSIONS: We observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives. A higher dose of physical-cognitive training appears to facilitate pain reduction, whereas a higher dose of mindfulness appears to increase pain. Hence, combining physical training with mindfulness may not be an optimal strategy for pain reduction.

Source: Jay K, Brandt M, Hansen K, et al. Pain Physician, 2015; 18 (5): 459-71.

Occupational sitting time and risk of all-cause mortality among Japanese workers

Objectives: Prolonged sitting is a health risk for cardiovascular diseases and all-cause mortality, independent of moderate-to-vigorous physical activity. Epidemiological evaluation of occupational sitting has received little attention, even though it may have a potential impact on workers' health. We prospectively examined the association between occupational sitting time and all-cause mortality.
Methods: Community-dwelling, Japanese workers aged 50–74 years who responded to a questionnaire in 2000–2003 were followed for all-cause mortality through 2011. Cox proportional hazard models were employed to calculate hazard ratios (HR) of all-cause mortality among middle (1 to <3 hours/day) or longer (≥≥3 hours/day) occupationally sedentary subjects by gender or types of engaging industry (“primary industry” and “secondary or tertiary industry”).
Results: During 368 120 person-years of follow-up (average follow-up period, 10.1 years) for the 36 516 subjects, 2209 deaths were identified. Among workers in primary industry, longer duration of occupational sitting was significantly or marginally associated with higher mortality [HR 1.23, 95% confidence interval (95% CI) 1.00–1.51 among men; HR 1.34, 95% CI 0.97–1.84 among women]. No associations were found among secondary or tertiary industry workers (men: HR 0.87, 95% CI 0.75–1.01; women: HR 1.03, 95% CI 0.77–1.39).
Conclusions: Occupational sitting time increased all-cause mortality among primary industry workers, however similar relationships were not observed for secondary-tertiary workers. Future studies are needed to confirm detailed dose–response relationships by using objective measures. In addition, studies using cause-specific mortality data would be important to clarify the physiological underlying mechanism.

Source: Kikuchi H, Inoue S, Odagiri Y, Inoue M, Sawada N, Tsugane S. Scand J Work Environ Health, 2015.

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