Evidence-based exposure criteria for work-related musculoskeletal disorders as a tool to assess physical job demands

Despite worldwide attention, musculoskeletal disorders (MSDs) remain a substantial concern at work. To support ergonomists to assess the work-related risk factors for MSDs, several instruments are available. Unfortunately, many of these instruments are not supported by evidence-based exposure criteria for particular MSDs. For effective prevention of MSDs, it is important to know to what extent work-related risk factors are present in the work situation. The Netherlands Center for Occupational Diseases (NCOD) develops evidence-based criteria documents for the assessment of work-related MSDs. The exposure criteria of these documents can be used on a group level to support ergonomists in their assessment of the physical job demands that are associated with work-related MSDs. At the moment the NCOD has exposure criteria for the assessment of 22 work-related MSDs, for instance on the work-relatedness of upper extremity disorders, non-specific low back pain or patellar tendinopathy. The use of these exposure criteria enables ergonomist to better assess the work-related risks of MSDs as a starting point for effective prevention.     

Prevention of MSD by means of ergonomic risk assessment (tools) in all phases of the vehicle development process

In industrialized countries musculoskeletal disorders (MSD) play an import role and are often responsible for almost one third of the total sick leave. The changes in the demographic profiles, i.e. aging work forces might even worsen this situation in the future. For a highly productive and sustainable use of human resources in production systems, ergonomics offers high potentials. In the recent years the authors have developed several ergonomic risk assessment tools, especially for the use in automotive industries. These methods may be used during the planning phases in the Tech Centers as well as during the production phase at shop floor level. The tools might also be used for a standardized communication in between the Tech Center and the plants to improve the effects of "lessons learned" for the design and layout of workstations and processes and the optimization of vehicle components. This paper describes suitable risk assessment tools as well as the integration of these tools into the vehicle development process. It introduces a comprehensive management approach for the integration of ergonomics into the management of production systems.     

Are maternal and community risk factors associated with the presence of asthma among children placed in foster care?

Objective

The occurrence of pediatric asthma has been associated with exposure to chronic stress. This study examined the relationship between maternal and community risk factors and asthma in a sample of maltreated children in foster care.

Method

Interviews were conducted with 365 maltreated children in foster care. Measures included youth/caregiver reports of asthma, an index of maternal risk based on data abstracted from child welfare records and community violence exposure.

Results

After controlling for demographic variables, maternal risk was associated with the presence of asthma (OR = 1.314, 95% CI = 1.09–1.58). Community violence exposure, however, was not related to the presence of asthma.

Conclusion

Maternal risk factors were significantly associated with the presence of asthma in a foster care population. Physicians who care for maltreated children in foster care should be particularly attuned to the presence of these additional risk factors that may place high-risk children at increased risk for chronic health problems.     

Screening of risk from patient manual handling with MAPO method

International standards highlight the steps required by risk assessment and involving first hazard identification, then risk evaluation and finally, if necessary, risk assessment. To check approach appropriateness to "risk evaluation" from manual patient handling through MAPO, a cross study was carried out in view of checking relationship between this new risk assessment model and occurrence of acute low back pain. After proper training the MAPO screening method was assessed in 31 wards, 411 exposed subjects of geriatric hospitals. At the same time health data were collected on occurrence of low back pain episodes during the last year both in the exposed subjects' group and the external reference group (n?237). Risk and clinical assessment data were tutored and checked by EPM research unit. The logistic analysis was used as a method to evaluate the relationship between risk index and acute low back pain. Investigating relationship between acute low back pain episodes and levels of MAPO screening index, carried out only with the people exposed who claimed to work for at least 30 hours per week (n = 178), showed definitely positive trends. The study results indicate that MAPO screening may represent a useful tool to estimate the risk from manual handling patients.     

IEA/WHO toolkit for WMSDs prevention: criteria and practical tools for a step by step approach

When studying WMSDs, several determinants and their interrelationship are considered as relevant. Hence the necessity of an "holistic" approach to prevention, especially when preparing technical rules and strategic plans. There is a strong request, from OSH agencies and operators, for developing "simple" tools for risk assessment and management. In this context WHO asked IEA to develop a "Toolkit for WMSD prevention". The paper presents one of the main contribution to this WHO project, focused on selecting tools at different level for hazard identification, risk estimation and management. Proposals are based on two essential criteria: Acting on a step-by-step approach; Taking into account the presence of multiple influencing factors. The proposals consider: A Basic Step devoted to hazard identification by operative "key-enter" questions, that can be operated also by non-experts. A First Step, (quick assessment), for identifying 3 possible conditions: acceptable; high risk present; more detailed analysis (via tools presented at second step) necessary. This step can be operated by non-experts with only some specific training. A Second Step, where recognized (i.e. from international standards or guidelines) tools for risk estimation are used. This step can be operated only by persons with some specific training.     

Exposure assessment in different occupational groups at a hospital using Quick Exposure Check (QEC) - a pilot study

In order to test the feasibility and sensitivity of the ergonomic exposure assessment tool Quick Exposure Check (QEC), a pilot-study was conducted. The aim was to test QEC in different occupational groups to compare the exposure in the most common work task with the exposure in the work task perceived as the most strenuous for the neck/shoulder region, and to test intra-observer reliability. One experienced ergonomist observed 23 workers. The mean observation time was 45 minutes, waiting time and time for complementary questions included. The exposure scores varied between the different occupational groups as well as between workers within the occupational groups. Eighteen workers rated their most common work task as also being the most strenuous for the neck/shoulder region. For the remaining five workers, the mean exposure score were higher both for the neck and shoulder/arm in the most common work task. Intra-observer reliability shows agreement in 86% of the exposure interactions in the neck and in 71% in the shoulder/arm. QEC seems to fulfill the expectations of being a quick, sensible and practical exposure assessment tool that covers physical risk factors in the neck, upper extremities and low back.     

How are nurses at risk?

The effectiveness of occupational health and safety management systems (OHSMS) can be understood through analysis of surveys such as the experiences of exposure to occupational hazards by Australian nursing occupations. How effectively OHSMS are implemented in the Australian health industry is unclear as few studies describe current hazard exposure patterns or the impact of OHSMS in the Australian health industry. This paper concludes from the analysis of an Exposure Survey of Australian nursing occupations that nursing occupations perceive themselves to be "at risk" of injury and/or management of OHS risk in work duties is affected by the patterns of hazard exposure, occupation group as well as employee attributes, perceptions, patterns and situations of work. The results highlight the top-rated hazards and imply that the perceptions of hazards in the workplace are different to actual risk experience (e.g. injury patterns). There is an unacceptable level of exposure to diverse hazards in Australian nursing occupations workplaces in regard to regulatory and performance obligations. Stronger strategies to achieve more effective risk treatment, integrate with hospital accreditation and quality programs are discussed to benefit system performance and the welfare of those in nursing occupations.     

Actuarial risk assessment in child protective services: Construction methodology and performance criteria

Purpose

To prevent the recurrence of child maltreatment, actuarial risk assessment can help child protective services (CPS) workers make more accurate and consistent decisions. However, there are few published articles describing construction methodologies and performance criteria to evaluate how well actuarial risk assessments perform in CPS. This article describes methodology to construct and revise an actuarial risk assessment, reviews criteria to evaluate the performance of actuarial tools, and applies a methodology and performance criteria in one state.

Methods

The sample included 6832 families who were followed for two years to determine whether they were re-reported and re-substantiated for maltreatment.

Results

Both the adopted and the revised tools had adequate separation and good predictive accuracy for all families and for the state's three largest ethnic/racial groups (White, Latino, and African American). The adopted tool classified relatively few families in the low-risk category; the revised tool distributed families across risk categories.

Conclusions

The revised tool classified more families as low-risk, allowing CPS to allocate more resources to higher-risk families, but at the cost of more false negatives.     

Emerging strategies for risk assessment of sexually abusive youth: theory, controversy and practice

Clinicians and other professionals evaluating, managing, and treating sexually abusive youth are frequently called upon to offer judgments regarding risk for sexual reoffense. There are currently no empirically validated methods for accurately classifying risk among this population. Therefore, those faced with this task have an obligation to consider the research on the assessment of risk and recidivism. Five methods of risk assessment are reviewed, and four scales are discussed, with directions on how to obtain them. These include the Juvenile Sex Offender Assessment Protocol (JSOAP), the Protective Factors Scale (PFS), and Estimate of Risk of Adolescent Sex Offender Recidivism (ERASOR).     

Behavioral health correlates of exposure to community violence among African-American adolescents in Chicago

AimsThough public health researchers are more aware of behavioral health concerns among African American youth, few studies have explored how exposure to community violence may be related to adverse youth concerns. This study examines the relationship between exposure to community violence and mental health problems, substance use, school engagement, juvenile justice involvement, and STI risk behaviors.MethodsA total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on exposure to community violence, mental health, school engagement proxies, substance use, delinquency markers and sexual risk behaviors.ResultsAdolescents who reported higher rates of exposure to community violence were significantly more likely to report poorer mental health, delinquent behaviors, a history of juvenile justice involvement, lower school bonding and student-teacher connectedness. These youth were also significantly more likely to use alcohol, cigarettes, and illicit substances, and engage in sexual risk behaviors.ConclusionsFindings suggest that there is a critical need for culturally relevant prevention and intervention efforts for African American adolescents who are frequently exposed to community violence.     

Climate Hazards and Risk Status: Explaining Climate Risk Assessment,Behavior, and Policy Support

Based on a national survey conducted two years after Hurricanes Katrina and Rita hit the U.S. Gulf Coast, we investigate the ways in which major “risk conditions,” which may subject individuals to climate-related hazards, translate to varying responses to risk: including risk assessment, behavioral modification, and policy support. We present a model that an individual's risk status can be determined by their embeddedness in risk conditions, which include both exposure to risk sources and access to risk information. Our findings suggest that an individual's access to information on climate risks significantly influences their proactive responses to climate hazards, as in, those who have objective knowledge of climate risks and social ties with concerned others are more likely to be proactive toward climate risks. It is also observed that an individual's political views tend to predispose their assessment of climate risks, which further affect their behavioral and policy responses.     

Emerging Strategies for Risk Assessment of Sexually Abusive Youth: Theory,Controversy, and Practice

SUMMARY

Clinicians and other professionals evaluating, managing, and treating sexually abusive youth are frequently called upon to offer judgments regarding risk for sexual reoffense. There are currently no empirically validated methods for accurately classifying risk among this population. Therefore, those faced with this task have an obligation to consider the research on the assessment of risk and recidivism. Five methods of risk assessment are reviewed, and four scales are discussed, with directions on how to obtain them. These include the Juvenile Sex Offender Assessment Protocol (JSOAP), the Protective Factors Scale (PFS), and Estimate of Risk of Adolescent Sex Offender Recidivism (ERASOR).     

Comparison of ergonomic risk assessment outputs from Rapid Upper Limb Assessment and the Strain Index for tasks in automotive assembly plants

This paper compares the ergonomic risk assessment of a task for the upper extremities as determined by Rapid Upper Extremity Assessment (RULA) and the Strain Index (SI). The ergonomic risk to the upper extremities of 244 automotive assembly plant tasks were evaluated using RULA and SI. The outcomes of each tool were compared for each task. Results from this study provide practical insight into the methods used in each tool. This study compared only the ergonomic risk outputs from each tool; it does not pursue the question of which tool best predicts injury. The kappa score was 0.11, indicating little agreement between the outputs of the two tools. This is supported by the lack of monotonicity with a gamma score of 0.1. These results indicate that the risk assessment outcome of these two ergonomic assessment tools for the upper extremities do not agree.     

Influences of mechanical exposure biographies on physical capabilities of workers from automotive industry - a study on possible dose-response relationships and consequences for short and long term job rotation

This paper describes a field study in production areas of a vehicle manufacturing plant, where 106 male workers (aged from 20 to 63 years) were examined and interviewed by the authors. Aim of study was to identify relationships between specific physical worker capabilities and doses of mechanical exposures using self-developed standardized questionnaires as well as a battery of work-specific tests. The dependent variables are different "physical capabilities", classified using a five-point rating scale with regard to the grade of limitation of the respective capability. Independent variables are "age" and specific "mechanical exposures". Several exposures were combined and multiplied with their respective durations in order to determine doses on three different body regions - back, shoulder-neck and upper limbs. There are significant positive correlations between "age" and "dose of mechanical exposure on back/shoulder-neck/upper limbs region". The analysis of the relationship between dose of exposure and different capabilities to lift or reposition loads (with variable weight) shows weak significant correlations for all three body regions. Data analysis shows no significant correlations between any dose of mechanical exposure and capabilities to work in awkward body postures.These results should be considered in age management programs when scheduling future employee assignments to workplaces, especially for production systems where manual handling tasks are dominant.     

Development of a framework for classifying threat and neglect in childhood: A qualitative study

Quantification of childhood adversity has typically involved a cumulative risk approach in which total number of discrete adversities serves as an index of overall risk. However, this approach fails to account for the growing evidence of differential outcomes following exposure to childhood adversities. An alternative approach adopts a dimensional perspective, with growing evidence for distinct developmental impacts associated with exposure to threat (violence/abuse) and deprivation (neglect). This study developed a framework for the classification of these dimensions through a thematic analysis of health practitioners' views and accounts of different forms of childhood adversity. Ten health practitioners experienced in working with children with challenging behaviours and neurodevelopmental disorders participated in semi-structured interviews regarding definitions and examples of six categories of adversity: physical/emotional/sexual abuse, physical/emotional neglect, and domestic and family violence. The qualitative analysis identified 23 themes across the six categories of adversity, along with two overarching themes regarding ambiguity of classifying exposures and non-specific outcomes of exposures. Themes were integrated to provide a framework and checklist for classifying indicators of exposure to threat and deprivation. The findings offer a framework and checklist for the assessment of threat and deprivation that will allow for further testing of the dimensional risk model.     

A simple tool for preliminary hazard identification and quick assessment in craftwork and small/medium enterprises (SME)

During the last Congress of the International Ergonomics Association (IEA), Beijing, August 2009, an international group was founded aimed at developing a "toolkit for MSD prevention" within IEA and in collaboration with World Health Organization (WHO). Possible users of toolkits are: members of health and safety committees, health and safety representatives, line supervisors; labor inspectors; health workers implementing basic occupational health services; occupational health and safety specialists.According to ISO standard 11228 series and the new Draft CD ISO 12259-2009: Application document guides for the potential user, a computer software ( in Excel?) was create dealing with hazard "mapping" in handicraft The proposed methodology, using specific key enters and quick assessment criteria, allows a simple ergonomics hazard identification and risk estimation. Thus it makes possible to decide for which professional hazards a more exhaustive risk assessment will be necessary and which professional consultant should be involved (occupational physician, safety engineer, industrial hygienist, etc.).     

The relative validity of actuarial- and consensus-based risk assessment systems

In an effort to improve decision-making in child protective services (CPS), most states have, over the last two decades, implemented risk assessment systems to guide staff faced with making critical decisions in limited time frames. Generally, these systems are characterized as consensus-based or actuarial models. This study is the first to directly compare the relative validity of these two approaches. Three risk assessment instruments, two consensus-based and one actuarial, were completed on cohorts of cases from four different jurisdictions and outcome information was collected over an 18-month follow-up period. Rates of subsequent investigations, substantiations, and placements were computed for cases classified at low, moderate, and high risk levels in each model. Results clearly demonstrate that the actuarial approach more accurately classifies cases to different risk levels. These actuarial models, therefore, have the greatest potential to improve CPS decision making and better protect America's at risk children.     

Depression in school-aged children: assessment & early intervention

A careful assessment of all of these factors will help nurse therapists who are also primary care providers develop a more holistic approach to treatment and, thus, increase treatment effectiveness. The three-pronged assessment approach discussed above is cost effective, safe, and indicated as a frontline measure to assess the risk for depression in children and their parents (particularly mothers), which can begin the process of "true" early intervention. I say "true" early intervention because in my role as an early intervention specialist, my first meeting with families usually occurs after a crucial incident requiring hospitalization of the child or the parent, or school failure, or both. My programs of intervention are hardly "early," although treatment is started relatively early in the life of the child. In the past few years, I have noticed that psychiatric-mental health advanced practice nurses, including myself, are increasingly working in some capacity in primary health centers, such as school-based clinics, churches, collaborative practices, and community health centers. It would be wonderful if we used these settings to identify risk for depression in children and begin preventive treatment (starting with teaching good sleep hygiene, a treatment in itself) to truly make early intervention a reality.     

MultipLa--a tool for the combined overall estimation of various types of manual handling tasks

In the 1990ies the German Federal Institute for Occupational Safety and Health (FIOSH) published "Key Indicator Methods" (KIM) for the evaluation of manual material handling tasks. These methods served as a national German implementation of the EU Manual Handling Directive (90/269/EEC). These methods allow the evaluation of individual handling tasks like lifting or pushing. KIM tools do not allow evaluating complex handling tasks like a combined lifting and pushing task. With respect to the needs at shop floor level (e.g. logistics), MultipLa tries to bridge that gap by means of an EXCEL based worksheet using the KIM philosophy. In the past several algorithms for a risk assessment had been developed. At the moment MultipLa is in a test phase at several automotive OEMs.     

Training care managers in risk assessment: Outcomes of an in-service training programme

Despite a recognition that social service workers require training in risk assessment, it would appear that there currently exists minimal information regarding appropriate models for risk assessment to underpin care managers' practice and, as a result, minimal discussion to inform considerations regarding appropriate training in this area. To date, not one study has appeared in the literature specifically examining whether in-service training provided to care managers actually results in changes to their work practices. This study provides results from an evaluation of an in-service training programme in risk assessment and demonstrates that the training had minimal impact on trainee behaviours. A number of reasons are offered as to why the training failed to transfer to practice; chief amongst these being insufficient time to learn the content of the training and factors associated with the specific work environment. Importantly, the particular model of risk assessment taught on the training programme was considered by care managers as far too time consuming and complicated to use, given the demands on their time and heavy workloads. It is suggested that if this particular risk assessment model is to be adopted by care managers, social services departments must ensure that such training is of appropriate duration to enable skills to be learnt, and that workplace contingencies are addressed to facilitate rather than hinder the use of training. These findings are considered to have practical significance for the design of similar short duration training programmes within social services.