Neurocognitive differences,self cohesion,and incoherent self narratives

This paper attempts to develop a framework through which the concepts of neurocognitive delays or deficits (generally referred to as learning disabilities) may be integrated into psychodynamic theory. The impact of these delays or deficits on the developmental dialogue is discussed. The child who suffers from such delays or deficits experiences the world in a unique way forming representations that encode personal meanings. These meanings are integrated into self narratives that have elements of incoherence in them. The incoherences in the self narratives result in the absence of self cohesion.Faculty, Continuing Education and Certificate Program, Smith College School for Social Work; in private practice.     

Psychosocial factors and low back pain among college students

OBJECTIVE AND PARTICIPANTS: The authors evaluated psychosocial factors of stress and their effects on the prevalence of low back pain (LBP) among a population of college students in a major university in Colorado. METHODS: This was a nested cross-sectional study of 973 respondents who completed the National College Health Assessment survey. The authors evaluated a subset of questions pertaining to psychosocial stressors against the presence of LBP. RESULTS: The annual prevalence of LBP among the population studied was 42.8%. The stressful psychosocial variables of feeling very sad, exhausted, and overwhelmed were associated with the prevalence of LBP. CONCLUSIONS: The prevalence of LBP among this younger population is significant and understudied.     

Immune responses to low back pain risk factors

$\underline{Objective}$: Investigate effects of interactions between biomechanical, psychosocial and individual risk factors on the body's immune inflammatory responses. $\underline{Background}$: Current theories for low back pain causation do not fully account for the body's response to tissue loading and tissue trauma. $\underline{Methods}$: Two groups possessing a preference for the sensor or intuitor personality trait performed repetitive lifting combined with high or low mental workload on separate occasions. Spinal loading was assessed using an EMG-assisted subject-specific biomechanical model and immune markers were collected before and after exposure. $\underline{Results}$: Mental workload was associated with a small decrease in AP shear. Both conditions were characterized by a regulated time-dependent immune response making use of markers of inflammation, tissue trauma and muscle damage. Intuitors' creatine kinase levels were increased following low mental workload compared to that observed in Sensors with the opposite trend occurring for high mental workload. $\underline{Conclusions}$: A temporally regulated immune response to lifting combined with mental workload exists. This response is influenced by personality and mental workload.     

Work-related factors contributing to chronic disability in low back pain

Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.     

The costs of job accommodations for employees with low back pain

Accommodations are interventions designed to reduce exposure to factors that limit the activities of an impaired individual. The process incurs costs due to job analysis, implementation and follow up. This theoretical paper expands a model of the ergonomic intervention process and provides data on costs of accommodating individuals with musculoskeletal disorders, particularly low back pain. Accommodations begin with evaluation and documentation of exposure to risk factors. The methods depend on the budget and clinical utility of the data. A full hazard analysis may require 1-hour managerial time plus 1-hour employee time per job. Studies by the Department of Labor and others indicate that at least a quarter of problem jobs could be addressed faster and for less than US dollars 500. Follow-up incurs variable employee and managerial time; an ergonomist may be required in 15% of cases. The benefit is expected mainly from reducing compensation costs. Universal solutions could increase the benefits.     

The etiology of low back pain in military helicopter aviators: prevention and treatment

Low back pain (LPB) is a major health problem among military rotary-wing aircrews worldwide. In order to define the etiology and propose remedies to LBP in helicopter aviators a review and critique of the literature was conducted. In-flight sitting posture and vibration generated by the aircraft were identified as high risk factors for LBP. Consequently, researchers recommended ergonomic modifications to the crew stations. The efficacy of these technical interventions has not been proven. As well, these design changes are not financially practical. Following an in depth kinesiological analysis of the physical demands of this type of flying, and preliminary experimentation, an alternative aeromedical approach focusing on the aircrew rather than the craft is presented. The authors propose a set of flight-specific exercises that might effectively deal with this problem. A thorough testing of this approach is envisioned.     

The effect of ergonomic intervention on neck/shoulder and low back pain

The aim of this study was to examine the effect of two types of ergonomic intervention on pain and pain-related disability in the neck/shoulder and low back regions. A cohort of 492 subjects of various occupations with non-specific neck/shoulder or low back pain was followed over a five to six year period. The study subjects were classified into four intervention groups: no ergonomic intervention, educational worksite intervention, workplace intervention, and combined workplace and educational worksite intervention. The group with no ergonomic intervention was used as the reference group. The changes in pain intensity and pain-related disability from baseline to follow-up in each of the three groups with intervention were compared to the changes in the reference group. During the follow-up, 39% of the subjects had received ergonomic intervention. The average change in pain intensity and pain-related disability was smaller in the educational worksite intervention group than in the reference group. The average reduction of pain intensity and pain-related disability did not differ between the two other intervention groups and the reference group. Thus, for subjects still at work, ergonomic intervention seemed to be ineffective for reducing neck/shoulder and low back pain and pain-related disability.     

Effect of low back pain on social and professional life of drivers of Kolkata

Abstract Occupational driving has often been associated with a high prevalence of back pain. Buses constitute the backbone of the local transportation; so many people are engaged in the profession. The present study was to investigate the prevalence of low back pain (LBP) and due to that problem whether their social and professional life hampers or not. The present study was undertaken among 160 government undertaking male bus drivers. Modified Nordic musculoskeletal questionnaire was performed with physical assessment. Then Oswestry Low Back Pain Disability Questionnaire (QLBPDQ) was performed to evaluate the extent to which social and professional life is restricted by back pain. Afterwards, the sit-and-reach test and investigation of sitting postures was done. From the analysis of questionnaire it was revealed that drivers had to spend 8-10 hours daily for 6 days in a shift. It was further observed that all of them mainly suffering from LBP. From the QLBPDQ analysis it was found that LBP restricted their social and professional life. Sit and reach test and posture analysis also support this finding. This result is an absolute reflection of the alarming situations of the Kolkata bus drivers. It can be concluded that the bus drivers are highly stressed due to the hazardous working conditions, which in turn may additionally affects their health and overall work performance in the long run.     

The economic evaluation of a Participatory Ergonomics programme to prevent low back and neck pain

This study was an economic evaluation conducted alongside a cluster randomised controlled trial with a follow-up of 12 months. The aim was to evaluate the cost-effectiveness and cost-benefit of the Stay@Work Participatory Ergonomics programme (PE) compared to a control group (no PE). In total, 37 departments (n=3047 workers) were randomised into either the intervention (PE) or control group (no PE). During a meeting, working groups followed the steps of PE, and composed and prioritized ergonomic measures aimed to prevent low back pain (LBP) and neck pain (NP). Working groups had to implement the ergonomic measures within three months in their department. Cost data included those directly related to LBP and NP. Cost-effectiveness analyses (CEA) and cost-benefit analyses (CBA) were performed. After 12 months, health care costs and costs of productivity losses were higher in the intervention group than in the control group (the mean total cost difference was $/euro$127; 95% CI $/euro$-164 - $/euro$418). From a societal perspective, the CEA showed that PE was not cost-effective compared to control for LBP and NP prevalence, work performance, and sick leave. The CBA from a company perspective showed a monetary loss of $/euro$78 per worker. The PE programme was neither cost-effective nor cost-beneficial on any of the effect measures.     

Factors contributing to work related low back pain among personal care workers in old age

This study aims to preliminary explore the work related and individual factors that contributed to the occurrence of low back pain (LBP) that affected work activities of Personal Care Workers (PCWs). A cross-sectional study was conducted to 36 PCWs in an old age home of Hong Kong. The study is divided into three parts: 1) a questionnaire to document the workload exposure factors and the musculoskeletal symptoms survey of the PCWs, 2) work posture evaluation; and 3) an evaluation of the physical fitness and lifting capacity of the PCWs. Univariate analyses were used to explore the risk factors associated with LBP that affected work activities. The results indicated that individual physical profile and lifting capacities did not contribute to occurrence of low back pain at work. For the work demand factors, the perceived physical demands in lifting and lowering heavy objects, awkward sustain neck and back postures, loading on the back, and perceived effort of cleaning task contributed to the occurrence of LBP. For the physical environment factors, thermal stress and improper ventilation were associated with the occurrence of LBP cases. For the individual factor, LBP cases were associated with workers' self perceived muscular effort, and perceived risk of mental illness in response to work requirements.     

Proper manual handling techniques to prevent low back pain, a Cochrane systematic review

Training and provision of assistive devices are considered major interventions to prevent and treat low back pain (LBP) among workers exposed to manual material handling (MMH). To establish the effectiveness of training and provision of assistive devices in preventing and treating LBP an update of a Cochrane literature review was performed to November 2010. Randomised controlled trials (RCTs) and cohort studies with a concurrent control group (CCTs) were included. Nine RCTs (20.101 employees) and nine CCTs (1280 employees) were included for prevention: six more than in the previous version. No study on treatment was found. None of the included RCTs and CCTs provided evidence that training and provision of assistive devices prevented LBP when compared to no intervention or another intervention.     

Participatory ergonomic intervention for prevention of low back pain: assembly line redesign case

This paper gives an overview of a participatory ergonomic intervention aimed at reducing low back pain cases in the dispatch department of a catalogue and e-commerce retail company. Based on the findings of the ergonomic analysis and design committee, the company's own employees redesigned the assembly line's layout. As a result of these changes two job tasks that involved manual material handling of boxes, identified by the revised NIOSH equation as posing an increased risk for lifting-related low back pain, were totally eliminated, and the employees responsible for moving boxes from the end of the assembly line to pallets on the ground were given more control over their jobs, and these jobs were also enriched with a new, less heavy task. These results demonstrate that participatory ergonomic interventions are a viable and effective strategy to reduce the exposure to work-related physical and psychosocial risk factors for low back pain.     

Looking back from loss: views of the self in Alzheimer's disease

This article examines the narrative construction of Alzheimer's disease in three autobiographies. Two of them use traditional linear structure, which demands a coherent, consistent “self” as narrator. The third is structured as a journal, allowing the reader to experience more fully the disjointed nature of the disease. All three create a clear sense of “self,” which contrasts strongly the idea that Alzheimer's disease entails a loss of “self”.     

Occupational lifting tasks as a risk factor in low back pain: a case-control study in a Mexican population

The objective of this study was to quantify and assess whether lifting tasks in the workplace are a risk factor in lumbar spondyloarthrosis etiology. A case-control study was performed with 231 workers, 18-55 years old, insured by the Mexican Social Security Institute (IMSS, according to its designation in Spanish). A multivariate analysis using conditional logistical regression showed that lifting tasks, combined with driving tasks, are associated with this illness (OR = 7.3; 95% CI 1.7-31.4). The daily frequency of lifting as it interacts with work as a driver resulted in a greater risk (OR = 10.4; 95% CI 2.0-52.5). The load weight, daily task-hours and cumulative time showed a dose-response relationship. The attributable risk for lifting tasks was 0.83, suggesting that 83% of lumbar spondyloarthrosis development could be prevented if risk factors were eliminated by ergonomic redesign of the task.     

Factors contributing to low back pain among professional drivers: a review of current literature and possible ergonomic controls

It is suggested that professional drivers are at an increased risk for low back pain and injury due to a variety of factors such as whole body vibration, prolonged sitting, awkward postures, lifting and carrying, and psychosocial issues. Ergonomics can play an important role in the reduction of risk of injury to the professional driver by implementing modifications to the work place (engineering controls), changes in administrative and management practice (administrative controls), and education of the worker (work practice controls). A review of the literature of the etiology of low back pain and injury among professional drivers is presented, and possible ergonomic controls have been recommended.