WORK: A Journal of Prevention,Assessment & Rehabilitation

Objective: To determine the demographic and work characteristics of healthcare workers who were more likely to take sickness absences from work in British Columbia, Canada.

Methods: Payroll data were analyzed for three health regions. Sickness absence rates were determined per person-year and then compared across demographic and work characteristics using multivariate Poisson regression models. The direct costs to the employer due to sickness absences were also estimated.

Results: Female, older, full-time workers, long-term care workers and those with a lower hourly wage were more likely to take sickness absences and had similar trends with respect to the costs due to sickness absence. For occupations, licensed practical nurses, care aides and facility support workers had higher rates of sickness absence. Registered nurses, and those workers paid high hourly wages were associated with highest sickness related costs.

Conclusion: It is important to understand the demographic and work characteristics of those workers who are more likely to take sickness absences in order to make sure that they are not experiencing additional hazards at work or facing detrimental workplace conditions. Policy makers need to establish healthy, safe and in turn more productive workplaces. Further research is needed on how interventions can reduce sickness absence.

Purpose: The aims were to describe and analyze how people with experience of long term sick leave perceive that factors in their work environment support or interfere with work performance, satisfaction, and well-being.

Method: The 53 participants were interviewed with the Work Environment Impact Scale (WEIS). The WEIS ratings and belonging notes were analyzed by descriptive statistics and qualitative analysis respectively. Differences in WEIS ratings between; women and men; participants with somatic and mental diseases; and participants working and on full-time sick leave were tested.

Results: The most supportive factors concerned social interactions at work, and the value and meaning of work. The factors perceived as most interfering concerned work demands and rewards. The social relations at work were perceived as more supportive by the working group than by those on full-time sick leave. The participants with somatic diseases perceived physical work factors as more interfering than did participants with mental diseases, who in turn perceived the value and meaning of work as more interfering.

Conclusion: Knowledge about the interaction between the worker and the work environment could reveal useful information about the complex phenomenon of reducing sick leave. The WEIS seems useful in providing information about how alterations and accommodations in the work environment could support individual workers.

Objective: Many physicians find sick-listing tasks problematic. The aim of this study was to identify categories of dilemmas experienced by physicians in their sick-listing practice.

Design and subjects: Data was collected at courses that were aimed at improving physicians' sick-listing skills, arranged in different parts of Sweden. Before the course the participants, general practitioners (GP) sent in a written report of a sick-listing case they found problematic. The material consisted of group discussions of some 100 case reports from GPs. The process of categorisation of the dilemmas was a one-step, straightforward qualitative analysis.

Results: Eight different categories of sick-listing dilemmas experienced by the physicians were identified. Examples of them are "Not the doctors' pigeon" (when the patients' problem was perceived as not being medical in nature), "Diagnosis as disguise" (when there is a discrepancy between how the patient describes the problems and what the physician apprehends), and "Harmed by sick listing – reversible" (when the physician perceives that the main problem is the iatrogenic adverse effects of sick listing per se).

Implications: The contribution of the study is to provide understanding of and labels to the specific difficulties experienced by physicians in their sick-listing practice face to face with patients.

In Sweden, the activities initiated to promote return to work (RTW) are performed in parallel by four different public organisations: the health services, the social services, the employment and the social insurance authorities. The aim was to gain deeper understanding on the experiences of professionals involved in cooperative projects aimed at promoting RTW among unemployed sickness benefit recipients. Qualitative analyses were performed of transcribed data from interviews of professionals participating in cooperative projects. First, the analysis identified that the daily collaboration on the same cases enabled development of good relationships and cooperative competence, which improved the contact with clients. Second, the cooperative projects made it possible to include only clients perceived motivated for RTW measures. Third, the closer and more frequent interaction with clients proved to be constructive in that it facilitated recognition and mobilisation of strengths and abilities. Fourth, the differences in rules and regulations between the social insurance and the unemployment insurance standards were often perceived to induce problems, for example, on how to assess the work capacity of clients. The assessments of work capacity represent important and complex tasks that professionals must perform without having access to either scientific knowledge or consensus agreement on which to base their decisions.

Instruments related to work are commonly illuminated from an ill-health perspective. The need for a concise and useable instrument in workplace health promotion governed the aim of this paper which is to present the development process and quality assessment of the Work Experience Measurement Scale (WEMS). A survey, using a questionnaire based on established theories regarding work and health, and a focus group study were performed in hospital settings in 2005 and 2006 respectively. A Principal Component Analysis (PCA) was used to statistically develop a model, and focus group interviews were made to compare quantitative and qualitative results for convergence and corroboration. The PCA resulted in a six factor model of dimensions containing items regarding management, reorganization, internal work experience, pressure of time, autonomy and supportive working conditions. In the analysis of the focus group study three themes appeared and their underlying content was compared to, and matched, with the dimensions of the PCA. The reliability, shown by weighted kappa values, ranged from 0.36 to 0.71, and adequate Cronbach's Alpha values of the dimensions were all above 0.7. The study validity, indicated by discriminant validity, with correlation values that ranged from 0.10 to 0.39, in relation to the content validity appeared to be good when the theoretical content of the WEMS was compared to the content of similar instruments. The WEMS presents a multidimensional picture of work experience. Its theoretical base and the psychometric properties give support for applicability and offer a possibility to measure trends in the work experience over time in health care settings. One intention of the WEMS is to stimulate the ability of organizations and the employees themselves to take action on improving their work experience. The conciseness of the instrument is intended to increase its usability.

Worker Role Interview (WRI) is an assessment tool designed to identify psychosocial and environmental factors which influence a person's ability to return to work. The purpose of this study was to investigate if the Worker Role Interview (WRI) can predict return to work over a period of two years. Fifty three long-term sick-listed people were interviewed and rated with the WRI. Differences in ratings and the ability of WRI to correctly predict whether these people would fall into the working or non-working groups at 6, 12 and 24 month follow-ups were tested by Mann--Whitney test and logistic regression respectively. Eight of 17 items in WRI were rated differently between the groups at one or more of the follow-ups. The regression models based on the WRI ratings had an overall correct prediction rate ranging from 81% to 96%. 'Expectation of job success' which concerns the person's belief in abilities in relation to return to work emerged as an important predictive factor for return to work in all statistical analyses. The WRI assessment contains items that could predict return to work. This implies that the WRI could be a useful tool in vocational rehabilitation for identifying individual rehabilitation needs.

Contact centres are vehicles for a rapidly growing group of knowledge workers, or eWorkers. Using computers and high-speed telecommunications connections as work tools, these employees spend long hours performing mentally demanding work while maintaining static, physically stressful, seated positions. The complex interplay between job demands, work environment, and individual differences combine to produce high levels of physical discomfort among eWorkers. This paper discusses a new view that has emerged, one that focuses on the management rather than the elimination of work related upper limb disorders (WRULD) and computer vision syndrome (CVS) issues that are prevalent among eWorkers. It also reviews a cultural shift among practitioners and business that moves towards a consultative process and the sharing of knowledge among all stakeholders. The controlled work conditions and large single location workforce found within contact centres provide the opportunity to understand the personal and industry cost of eWork injuries and the ability to develop and review new multifaceted interventions. Advances in training and workplace design aimed at decreasing discomfort and injury and reducing the associated economic burden may then be adapted for all eWorkforce groups.

Background: Smoking cessation is one of the primary targets for risk reduction of atherosclerotic cardiovascular disease. It also leads to the prevention of workers' illness or disability. Validation of a 100-point scale to evaluate perceived tobacco dependence was conducted using a 10-item questionnaire (the Tobacco Dependence Screener; TDS), a 6-item questionnaire (Fagerstrom Test for Nicotine Dependence; FTND), and determining the salivary levels of cotinine at Japanese workplaces.

Methods: A total of 1023 male smokers completed the TDS and FTND and scored themselves on the 100-point scale for tobacco dependence (Study 1). Of the subjects participating in Study 1, 282 male smokers from one workplace presented saliva samples, and the salivary nicotine and cotinine levels were determined by high-performance liquid chromatography (Study 2). After conducting principal axis factor analysis, multiple regression analysis was employed to clarify the association between the score on the 100-point scale for perceived tobacco dependence and several factors such as age, the TDS score, the FTND score, and the salivary cotinine level.

Results: The mean age for the subjects was 40.3 years. The mean salivary cotinine level was 235.4 ng/ml, and it increased significantly with increase in the number of cigarettes smoked per day. Cronbach's alpha coefficients for the TDS and FTND were 0.77 and 0.64, respectively. A ROC analysis indicated a cutoff point for the score on the 100-point scale of 61, which yielded a positive result on the TDS (⩾ 5) with 65.7% sensitivity and 70.0% specificity. When FTND ⩾ 4 was adopted as the gold standard, the sensitivity and specificity became 68.7% and 73.2%, respectively. Three factors were extracted by principal axis factor analysis, explaining 42% of the total variation. Multiple regression analysis revealed that the score on the 100-point scale for evaluating tobacco dependence was positively associated with the TDS and FTND scores, and negatively associated with the age. The adjusted multiple correlation coefficient was 0.262.

Conclusions: The 100-point scale, which is a simple and easy tool to evaluate tobacco dependence, must be used in combination with other tobacco dependence questionnaires such as TDS and FTND and also the salivary cotinine level as a biological marker of tobacco exposure to conduct multi-dimensional education to promote smoking cessation.

Hospital workers are known to be at risk of physical assault. The objective of this study is to characterize injuries resulting from physical assault among hospital nursing staff and to identify associated risk factors. Workers' compensation reports linked to human resources data were used to identify a cohort of aides and nurses employed in acute care units at a major healthcare system from 1997 to 2004 and their reported physical assault events. Poisson regression methods were used to estimate rates and rate ratios (RR) by occupation, gender, race, age, tenure, and hospital unit. During the study period 220 assaults were reported; the overall incidence rate was 1.65 (95% CI: 1.45–1.89) per 100 full-time-equivalent employees (FTEs). Assault risk was higher among those with shorter tenure (< 5 years vs. 15 or more) (RR=1.35, 95% CI: 0.83–2.19) and younger workers (under age 30 vs. 50 or older) (RR=1.30, 95% CI: 0.78–2.19), and lower among Black workers (vs. non-Blacks) (RR=0.63, 95% CI: 0.45–0.90). Incidence rates were highest in Psychiatry (12.65, 95% CI: 8.90–17.99), Neurology (4.43, 95% CI: 3.17–6.20) and Rehabilitation (3.63, 95% CI: 1.51–8.71) units. Interventions targeting Psychiatry, Neurology, and Rehabilitation units, and younger and newly hired staff are warranted. More detailed data are needed to develop targeted interventions.

The aim of this study is to establish whether the Assessment of Motor and Process Skills (AMPS) is an appropriate tool to evaluate the quality of work performance by comparing clients' results on the AMPS with the quality of the skills that they demonstrate on the shop floor. A convenience sample of chronically unemployed (vocationally disabled) participants (N=139) with no formal training who were seeking unskilled work through Jobcentrum West-Vlaanderen (West Flanders Job Centre, Belgium) was used. Results demonstrated that in 75.2% of cases the prediction of employment outcome was correct; it is suggested that an AMPS motor score < 2.5 and a process score < 1.2 is insufficient for regular employment, while a motor score > 3.1 and process score > 1.5 indicates that regular employment is a realistic goal. The quality of the motor skills measured by the AMPS and measured on the shop floor are comparable, but little similarity was found in the measurement of process skills.

Previous studies have found illness representations to be associated with the degree to which patients adopt health behaviours. Surprisingly, pain representations, especially those in a work rehabilitation context, have rarely been explored.

Objective: To conduct a thorough investigation of the pain representations held by workers who were on sick leave due to persistent musculoskeletal pain during the process of an intensive work rehabilitation program.

Methods: Qualitative semi-structured interviews were conducted with 16 participants (male, female), three times during the program and one month after discharge. Data analysis was based on a narrative approach.

Results: Throughout the process, pain representation was an indicator of the type of action the participants were ready to take to control the immediate or possible consequences of their pain. Using the context of a work rehabilitation trajectory we identified the differential impact of reconstruction or status quo in pain representations that eventually led to a return to work, or not.

Discussion: This study highlights the importance of identifying and acknowledging workers' pain representations in facilitating their return to work.

The objective of this review is to explore the work injury management models in literatures and the essential components in different models. The resulting information could be used to develop an integrated holistic model that could be applied in the work injury management system in Hong Kong. A keyword search of MEDLINE and CINAHL databases was conducted. A total of 68 studies related to the management of an injury were found within the above mentioned electronic database. Together with the citation tracking, there were 13 studies left for selection after the exclusion screening. Only 7 out of those 13 studies met the inclusion criteria for review. It is noticeable that the most important component in the injury management model in the reviewed literatures is early intervention. Because of limitations in Employees' Compensation Ordinance in Hong Kong, there is an impetus to have a model and practice guideline for work injury management in Hong Kong to ensure the quality of injury management services. At the end of this paper, the authors propose a work injury management model based on the employees' compensation system in Hong Kong. This model can be used as a reference for those countries adopting similar legislation as in Hong Kong.

With the current state of the global economy, demand for various products plummeting. To sustain in the market, companies have to reduce cost and improve quality. Today, companies have started implementing new philosophies like TQM, TPM, six sigma and lean manufacturing techniques to remain competitive in the market. Lean manufacturing is an emerging philosophy which continuously strives to reduce waste. The main objective of analyzing the assembly line with a lean perspective is to identify the areas related to human interface with other systems that could lead to the generation of waste. Improper workplace design leads to unreasonable mental or physical burden and results in waste generation like slow work (delay and inventory), and defects, which is named as muri waste. An attempt has been made in this paper to locate muri waste and create a "Lean assembly line". The proposed method, based on the use of Rapid Upper Limp Assessment (RULA) with CATIA V5 platform, has allowed the measurement of a large set of operator posture parameters and assessment of ergonomic stresses. Based on the results, the process stations in the assembly line were redesigned to prevent the generation of waste.