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The aim of the study was to analyse the effectiveness of occupational health and safety (OHS) training methods on safety behaviour of farmers and agricultural workers based on literature results. The scoping review intends to find out the main gaps in teaching methodology influencing safety performance of employers and employees in agriculture. A systematic search of literature with help of predefined search strings (agriculture, education, effectiveness, farmer, farm worker, intervention, safety, training) in two literature databases (Scopus, EBSCO) was carried out. It was analysed, how effectively different training methods improved safety awareness and performance of farmers, students and employees. The strength of the evidence on training's effectiveness was assessed for existence of control or comparison group, pre- and post-testing, follow-up testing, statistical significance testing, clear methodology description and thorough study overview were presented. In the primary literature research, 276 articles were identified. A total of 224 articles were left after the exclusion of redundant publications. After the abstracts' screening 52 publications met the eligibility criteria. After the full text screening by two independent researchers additionally 33 studies were excluded, and in total 19 studies entered into the data charting process. The articles were assessed as medium (n = 8) and high (n = 8) in terms of strength of evidence. According to the review results, the training methods used in the agricultural sector have shown as effective due to the safety awareness and risk behavior among the trainees improved, but new OHS knowledge after training need to be engaged and regularly updated. [ABSTRACT FROM AUTHOR]

Digitization is actively spreading and widely implemented in the occupational health and safety (OHS) systems. Progressive technologies make it possible to effectively implement digitalised systems in all the elements of management cycle - from planning to monitoring, evaluation and solutions in the different economy sectors. Aim. The purpose of the article is to give a review on the current state of digital transformation in OHS policy of European countries and Ukraine and identify the positive and negative aspects of digitization in OHS management systems. Method. The review is based on full research articles, reports and conference proceedings in Scopus, Web of Science and Google Scholar database, where the keywords 'digitization', 'occupational health', 'safety', 'robots' and 'management systems' for literature search have used. Results. In total 51 sources were under analysis, including 23 full research articles and 28 publications from EU-OSHA, ILO and OECD. The database formation and use of big data systems and control tools for monitoring and assessing work environment, digital guidelines, legislation and e-teaching platforms are the main digital instruments in OHS management systems. Use of workplace navigator programs helps to collect necessary information and make right regulations by the law. Use of new digital technologies allows more effectively perform OHS inspection, service and risk prevention functions, and diminish work related injuries and illnesses. Conclusions. A new ideology of public policy in developing digitalised OHS management systems (DOHSS) will make the evidence-based solutions effective and achieve high safety standards and stimulate business growth of specific industries on the national and EU level. The best European experiences of digital transformation into OHS management systems can be implemented also in Ukraine. [ABSTRACT FROM AUTHOR]

Agriculture is known as a hazardous industry worldwide, although there are great challenges in enumerating the size of the workforce and numbers of accidents at work. The aim of the study was to characterize variation in agricultural accident statistics in European countries and opportunities to improve collection and reporting of accident data in agriculture on the national and European levels. This study explored the incidence of fatal (FA) and non-fatal work accidents (NFA) in agriculture (excluding forestry and fishing) in selected European countries, using Eurostat and national sources in 2013. Eurostat reported highest NFA rates (per 100,000 workers) in Finland (5331) and lowest in Greece (5). The highest FA rate was reported in Malta (51), while zero fatalities were reported in Estonia, Greece, Luxembourg, Slovenia, Sweden and Iceland. Eurostat and national statistics differed in many cases. Some variations were observed in European and national statistics. Germany reported 89 fatalities (rate 2.3/100,000) in Eurostat and 160 (rate 16.3/100,000) in national sources. Poland, with a similar land area and five times more farms and workers as Germany, reported only 4 fatalities in agriculture in Eurostat. The Estonian Labour Inspectorate (2013) registered 785 NFAs per 100,000 agricultural workers, while the rate in Eurostat was more than twice as high (1914/100,000). Finland and Sweden with similar agricultural structures had a ten-fold difference in NFA rates in Eurostat; Finland 5,331 and Sweden 554 per 100,000 workers. These examples illustrate the large variation in agricultural accident statistics due to: a) farm structure, b) use of reference populations, c) under-reporting, d) different inclusion/exclusion criteria and e) interpretation by users. Some inconsistencies are structural due to lacking social insurance schemes for farmers, family labour and undocumented workers. Some inconsistencies could be addressed by better implementation of ESAW harmonizing rules. Alternative methods, such as standardized surveys, could be considered to augment Eurostat statistics. [ABSTRACT FROM AUTHOR]

The risk of dying in a work-related accident is greatest for those employed in agricultural sector. The aim of this study is to analyse the dynamics of work accidents (WA) incidence by severity, gender and lost workdays in Estonian agriculture in 2008-2017. Method: The database of accidents in agriculture (2008-2017) was obtained from the Estonian Labour Inspectorate (ELI). Work accidents statistics is based on official reports of employers. Results: In total 1,683 non-fatal work accidents (NFA) was registered in the past decade, from which 1,235 (79.3%) were minor and 448 (20.7%) severe. In total 13 fatal work accidents (FA) have occurred, which accounts 0.8% of all the WAs (n = 1,696). Although the trends of minor and severe WA cases showed steady increase, the number of FA has remained low. A major part WAs (74%) was registered in farming and horticulture, with prevalence of minor accidents. A severe WA is likely to occur in forestry or very likely in fishery. The proportion of injured male and female was 51.8% and 48.2%, accordingly. In the farming and horticulture sector there were more accidents among women - of all the minor accidents (n = 1,235) 52.1% occurred to women. Of all the severe WAs (n = 448) 61.2% and all the fatal work accidents happened to male workers. About 2/3 of severe WAs caused sick leave 31-90 days and more. Conclusion: The number of WAs in Estonian agricultural sector show steady increase in the past decade. A major part of accidents is minor and mostly occurred in farming and horticulture, and more often with females. Severe and FAs more often occurred in forestry and fishery. Mostly the severe WAs cause long sick leave - a month or more. When to increase work accidents severity level by one step (from minor to severe), the sick leave is increasing significantly. [ABSTRACT FROM AUTHOR]

Background: Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally.Methods: Baseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline ('pain propensity index'). After a mean interval of 14 months, 9055 participants (77.3%) provided follow-up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow-up were assessed by random intercept Poisson regression.Results: After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95% CI: 2.2-3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within-country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58).Conclusions: Within our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine.Significance: Our findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working age. [ABSTRACT FROM AUTHOR]

Current efforts to minimize energy losses and maximize energy savings for heating of all houses are most often gained by insulating facades and replacing windows. However, these measures can have a significant negative impact on human health and these problems can occur in buildings with a high concentration of people, such as school buildings. The aim of this paper is to analyse the results of measurements of air temperature, relative air humidity and carbon dioxide in winter period in the classrooms of two universities, Estonian University of Life Sciences (EULS) in Tartu and Czech University of Life Sciences (CULS) in Prague. The measurements have carried out in 2017-2018 in eight classrooms of the EULS and two classrooms of the CULS. The external and internal temperature, relative humidity and concentration of carbon dioxide have measured in the classrooms during a few days in the winter period. In the lecture rooms of CULS, when the air conditioning was off, the levels of CO2 exceeded the recommended levels about two times. The average internal temperature and CO2 concentrations in the classrooms of EULS follows the norms and refers on good ventilation. The extremely low relative humidity in the classrooms of EULS at 17.1 ± 2.6% refers to a high risk of allostatic load and respiratory symptoms among students. It is important to pay attention on regular ventilation and relative air humidity control in the teaching rooms, especially with high number of students to prevent seasonal sickness of upper respiratory tract. [ABSTRACT FROM AUTHOR]

Unlimited number of hazards can be found in almost every workplace increasingly causing work-related diseases (WRDs) and injuries among workers. In work environment there are various risk factors: physiological, physical or psychological. An awkward and static postures, repetitive movements, high work pace, non-ergonomic tools and poorly organized workstations are most likely causing musculoskeletal disorders. As well inconvenient room temperature, noise, vibration and poor lighting conditions can conduce to additional work discomfort, mental stress, fatigue, injury, or trauma among employees. Ergonomic interventions are coming more popular. Many organizations are trying to find best solutions to avoid musculoskeletal disorders (MSD). The aim of this paper is to describe different ergonomic interventions focused on diminishing of musculoskeletal discomfort and MSDs among workers. This paper gives overview about the most common and effective ergonomic interventions which really have worked in practice. For this research were used three different databases EBSCO, Science Direct and Mendeley. The selection of publications passed three phases of systematic search of literature: the first elimination consist of keywords 'ergonomics, intervention' and year of publication. In the second phase was added a keyword 'work' and in the third phase were eliminated repeated and literature review publications and as well publications which had little sample size or the exploration was not covered with real interventions. The publications (n = 209) of ergonomic interventions carried out in the past five years 2010-2015 were analyzed. Wide spectrum of different ergonomic interventions was found in several economic sectors, whereas the most effective ones were related to well-known ergonomics methods, workstation adjustment, training and exercises. [ABSTRACT FROM AUTHOR]

Musculoskeletal disorders (MSD) are a common and most often disabling problem among sewing machine operators and associated to work related factors. The aim of study was to determine work related and individual risk factors and the prevalence of MSDs among sewing machine operators and describe relationships between risk factors and MSDs. The data were collected in random sample method, using parts of a standardized CUPID (Cultural and Psychosocial Influences on Disability) questionnaire. The questions were focused on occurrence of MSDs in different body regions, in the past year and past month. The respondents assessed pain in the neck, lower back, and both on the right and left side of shoulders, elbows, wrists/hands and knees. The questions about individual, physiological and psychological risk factors and health behaviour were included. The response rate was 43.9%, from 130 sewing machine operators fifty seven of them responded to the questionnaire. They all were women, in mean age 44.4 ± 8.6 years and with average body mass index (BMI) 26.8 ± 6.6 kg m-2. The majority had work experience more than 5 years. Sewing work is monotonous, in steady sitting position, with repetitive movements in elbow, wrist and fingers during a whole workday. The most of respondents (93%) have reported poor autonomy to decide over the working schedule and 75.4% had low decision latitude over what and how to do work. The majority of sewing machine operators get support from the colleagues and management. Musculoskeletal pain at least in one body site was measured in 91.2% of cases in the past 12 months and among 82.5% of respondents in the past month. More than half of participants reported pain in three or more body sites. The most often pain regions were lower back (66.7%), neck (61.4%), wrist/hand (50.9%) and shoulders (42.1%) in the past year, and neck (45.6%) in the past month. Pearson correlation analysis showed positive relationships between lower back pain and poor autonomy (p = 0.02) and BMI (p = 0.05) and repetitive elbow bending was related to neck and wrist/hand pain (p = 0.05, in both). Regular smoking was related to wrist/hand pain (p = 0.003). In conclusion, high prevalence of MSDs among the sewing machine operators has observed, whereas lower back, neck, wrist and shoulders were the most often reported pain regions. Lower back pain correlated positively with BMI and autonomy, smoking with wrist/hand pain and repeated upper limb movements with neck and elbow pain. [ABSTRACT FROM AUTHOR]

Objectives: Work-related stress is highly prevalent. Recent systematic reviews concluded on a significant association between common work-related stress measures and depression. Our scoping review aims to explore whether work-related psychosocial stress is generally associated with depression or depressiveness, the extent and methodology of the primary research undertaken on this topic and to elucidate inconsistencies or gaps in knowledge., Methods: We searched for literature in Pubmed, PsycInfo and Web of Science including full reports in seven languages published between 1999 and 2022 and applied the PRISMA statement for scoping reviews criteria., Results: Of 463 primarily identified articles, 125 were retained after abstract and full-text screening. The majority report significant associations between work-related stress and depression. Cross-sectional studies are most prevalent. Sufficient evidence exists only for job strain and effort-reward imbalance. Most studies are from Asia, North America and Europe. The health sector is the most studied. Several research gaps such as the lack of interventional studies were identified., Conclusion: The consistency of most studies on the significant association between work-related stress and depression is remarkable. More studies are needed to improve evidence and to close research gaps., Competing Interests: DM is employed by Research Group, Institute of Occupational Medicine. The remaining authors declare that they do not have any conflicts of interest., (Copyright © 2024 du Prel, Koscec Bjelajac, Franić, Henftling, Brborović, Schernhammer, McElvenny, Merisalu, Pranjic, Guseva Canu and Godderis.)

Objectives: This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe., Methods: A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022., Results: The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries., Conclusions: COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Multisite musculoskeletal pain is common and disabling. This study aimed to prospectively investigate the distribution of musculoskeletal pain anatomically, and explore risk factors for increases/reductions in the number of painful sites., Methods: Using data from participants working in 45 occupational groups in 18 countries, we explored changes in reporting pain at 10 anatomical sites on two occasions 14 months apart. We used descriptive statistics to explore consistency over time in the number of painful sites, and their anatomical distribution. Baseline risk factors for increases/reductions by ≥3 painful sites were explored by random intercept logistic regression that adjusted for baseline number of painful sites., Results: Among 8927 workers, only 20% reported no pain at either time point, and 16% reported ≥3 painful sites both times. After 14 months, the anatomical distribution of pain often changed but there was only an average increase of 0.17 painful sites. Some 14% workers reported a change in painful sites by ≥3. Risk factors for an increase of ≥3 painful sites included female sex, lower educational attainment, having a physically demanding job and adverse beliefs about the work-relatedness of musculoskeletal pain. Also predictives were as follows: older age, somatizing tendency and poorer mental health (each of which was also associated with lower odds of reductions of ≥3 painful sites)., Conclusions: Longitudinally, the number of reported painful sites was relatively stable but the anatomical distribution varied considerably. These findings suggest an important role for central pain sensitization mechanisms, rather than localized risk factors, among working adults., Significance: Our findings indicate that within individuals, the number of painful sites is fairly constant over time, but the anatomical distribution varies, supporting the theory that among people at work, musculoskeletal pain is driven more by factors that predispose to experiencing or reporting pain rather than by localized stressors specific to only one or two anatomical sites., (© 2022 European Pain Federation - EFIC®.)

Objective A consensual definition of occupational burnout is currently lacking. We aimed to harmonize the definition of occupational burnout as a health outcome in medical research and reach a consensus on this definition within the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET). Methods First, we performed a systematic review in MEDLINE, PsycINFO and Embase (January 1990 to August 2018) and a semantic analysis of the available definitions. We used the definitions of burnout and burnout-related concepts from the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to formulate a consistent harmonized definition of the concept. Second, we sought to obtain the Delphi consensus on the proposed definition. Results We identified 88 unique definitions of burnout and assigned each of them to 1 of the 11 original definitions. The semantic analysis yielded a first proposal, further reformulated according to SNOMED-CT and the panelists` comments as follows: "In a worker, occupational burnout or occupational physical AND emotional exhaustion state is an exhaustion due to prolonged exposure to work-related problems". A panel of 50 experts (researchers and healthcare professionals with an interest for occupational burnout) reached consensus on this proposal at the second round of the Delphi, with 82% of experts agreeing on it. Conclusion This study resulted in a harmonized definition of occupational burnout approved by experts from 29 countries within OMEGA-NET. Future research should address the reproducibility of the Delphi consensus in a larger panel of experts, representing more countries, and examine the practicability of the definition.

Introduction: The Defence Forces' members are exposed to high-level noise that increases their risk of hearing loss (HL). Besides military noise, the other risk factors include age and gender, ototoxic chemicals, vibration, and chronic stress. The current study was designed to study the effects of personal, work conditions-related risk factors, and other health-related traits on the presence of hearing problems., Materials and Methods: A cross-sectional study among active military service members was carried out. Altogether, 807 respondents completed a questionnaire about their health and personal and work-related risk factors in indoor and outdoor environments. The statistical analysis was performed using statistical package of social sciences (descriptive statistics) and R (correlation and regression analysis) software., Results: Almost half of the active service members reported HL during their service period. The most important risk factors predicting HL in the military appeared to be age, gender, and service duration. Also, working in a noisy environment with exposure to technological, vehicle, and impulse noise shows a statistically significant effect on hearing health. Moreover, we could identify the effect of stress on tinnitus and HL during the service period. Most importantly, active service members not using hearing protectors, tend to have more tinnitus than those who use it., Conclusions: The members of the Defence Forces experience noise from various sources, most of it resulting from outdoor activities. Personal and work conditions-related risk factors as well as stress increase the risk of hearing problems., (© Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Context: Hearing loss (HL) is a major health concern among military personnel due to noise from shooting, blasts, military vehicles, and noisy training environments. Nevertheless, one's exposure can be partially reduced by using personal protective equipment (PPE). The aim of this study is to estimate the prevalence of HL among military personnel, to analyse associations between HL and self-reported occupational and leisure noise exposure, and use of PPEs., Materials and Methods: A cross-sectional study was conducted among 150 military personnel during their routine medical examinations. First, all participants filled in a questionnaire about their exposure to noise and later the respondents went through an audiometric test. The diagnostic criteria for slight, moderate, and severe HL was HL of 25-40, 41-60, and >60 dB at 4 and 6 kHz, respectively. The associations between noise exposure and HL were studied with multinomial logistic regression analysis., Results: The prevalence of slight to severe HL in high frequencies (4 and 6 kHz) among study participants was 62.7%. Nevertheless, the majority of it was slight, as the prevalence of severe HL was 9.3%. The prevalence of any kind of HL was highest in the Navy and the prevalence of severe HL was highest in the Central Command Units. The relative risk ratios (RRRs) for HL were higher among those who had been working for a long time in a noisy environment, working with noise-producing equipment, driving in a PASI or a Bandvagn or had been shooting with blanks at least once per week. It also appeared that military personnel who had HL, reported tinnitus more often. Respondents' previous health problems, music-listening habits, and amount of exposure to loud noise in non-military environments were not independently associated with HL, but in several cases it increased the RRRs together with military exposure. We also found significantly more frequent HL among those never using PPEs., Conclusion: HL loss was more prevalent among personnel who are more often exposed to military noise, especially among those who never use PPEs. The effect was enhanced by leisure time noise, but it was not independently associated to HL., Competing Interests: None

Introduction: Noise-induced hearing loss is one of the most common health problems among military service personnel. Exposure to noise in military vehicles constitutes a large proportion of total noise exposure. This pilot study aimed to evaluate in-vehicle noise levels depending on the type of vehicle, riding compartment and road surface., Method: Noise levels were measured in armoured personnel carriers and heavy all-terrain trucks, in the cab and rear passenger compartment, while driving on paved or off-road surfaces. The results were compared with national LLV and allowed noise exposure times were calculated per vehicle and surface., Results: The equivalent noise levels in the cab of SISU XA-188 (p=0.001) and peak noise levels in MAN 4620 (p=0.0001) and DAF 4440 (p=0.0047) were higher on paved road, compared with off-road. The equivalent noise levels in the canvas covered rear compartment of MAN 4620 were significantly higher than in the cab on both paved (p=0.004) and off-road (p=0.0003). Peak noise levels in the cab of DAF 4440 exceeded the parameters measured in the canvas covered rear compartment on both paved (p=0.002) and off-road (p=0.0002). In most cases, peak noise levels were below the LLV (p=0.02-0.0001). The maximum noise exposure to passengers in the canvas covered rear compartment of MAN 4620 despite road surface was calculated 0.6 hours per working day., Conclusion: A high risk of noise-induced hearing loss among military personnel occurs during long distance transportation with vehicles showing noise levels higher than allowed LLV., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To explore the association of sickness absence ascribed to pain at specific anatomical sites with wider propensity to musculoskeletal pain., Methods: As part of the CUPID (Cultural and Psychosocial Influences on Disability) study, potential risk factors for sickness absence from musculoskeletal pain were determined for 11 922 participants from 45 occupational groups in 18 countries. After approximately 14 months, 9119 (78%) provided follow-up information about sickness in the past month because of musculoskeletal pain, including 8610 who were still in the same job. Associations with absence for pain at specific anatomical sites were assessed by logistic regression and summarised by ORs with 95% CIs., Results: 861 participants (10%) reported absence from work because of musculoskeletal pain during the month before follow-up. After allowance for potential confounders, risk of absence ascribed entirely to low back pain (n=235) increased with the number of anatomical sites other than low back that had been reported as painful in the year before baseline (ORs 1.6 to 1.7 for ≥4 vs 0 painful sites). Similarly, associations with wider propensity to pain were observed for absence attributed entirely to pain in the neck (ORs up to 2.0) and shoulders (ORs up to 3.4)., Conclusions: Sickness absence for pain at specific anatomical sites is importantly associated with wider propensity to pain, the determinants of which extend beyond established risk factors such as somatising tendency and low mood. Better understanding of why some individuals are generally more prone to musculoskeletal pain might point to useful opportunities for prevention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: Previous research has indicated that wide international variation in the prevalence of disabling low back pain among working populations is largely driven by factors predisposing to musculoskeletal pain more generally. This paper explores whether the same applies to disabling wrist/hand pain (WHP)., Methods: Using data from the Cultural and Psychosocial Influences on Disability (CUPID) study, we focused on workers from 45 occupational groups (office workers, nurses and other workers) in 18 countries. Among 11,740 participants who completed a baseline questionnaire about musculoskeletal pain and potential risk factors, 9082 (77%) answered a further questionnaire after a mean interval of 14 months, including 1373 (15%) who reported disabling WHP in the month before follow-up. Poisson regression was used to assess associations of this outcome with baseline risk factors, including the number of anatomical sites other than wrist/hand that had been painful in the 12 months before baseline (taken as an index of general propensity to pain)., Results: After allowance for other risk factors, the strongest associations were with general pain propensity (prevalence rate ratio for an index ≥6 vs. 0: 3.6, 95% confidence interval 2.9-4.4), and risk rose progressively as the index increased. The population attributable fraction for a pain propensity index > 0 was 49.4%. The prevalence of disabling WHP by occupational group ranged from 0.3 to 36.2%, and correlated strongly with mean pain propensity index (correlation coefficient 0.86)., Conclusion: Strategies to prevent disability from WHP among working populations should explore ways of reducing general propensity to pain, as well as improving the ergonomics of occupational tasks.

Study Design: A cross-sectional survey with a longitudinal follow-up., Objectives: The aim of this study was to test the hypothesis that pain, which is localized to the low back, differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain., Methods: We analyzed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability, and potential risk factors, in 47 occupational groups (office workers, nurses, and others) from 18 countries., Results: Among 12,197 subjects at baseline, 609 (4.9%) reported localized LBP in the past month, and 3820 (31.3%) nonlocalized LBP. Nonlocalized LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, nonlocalized LBP was differentially associated with risk factors, particularly female sex, older age, and somatizing tendency. There were also marked differences in the relative prevalence of localized and nonlocalized LBP by occupational group., Conclusion: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP that occurs in association with pain at other anatomical locations., Level of Evidence: 2.

To inform case definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association, and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability, and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The 1-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs 1.3) and poor mental health (PRR 1.3 vs 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs 61.7%). Our findings highlight important epidemiological distinctions between subcategories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain that is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.

Background . Musculoskeletal pain is the most common cause of incapacity among nurses. This study aimed to report the prevalence of musculoskeletal pain among hospital nurses and to explore the associations of work-related psychosocial factors and mental health problems with musculoskeletal pain. Methods . A cross-sectional survey was carried out among registered nurses at Tartu University Hospital during April and May 2011. Binary logistic regression was used to assess the associations between dependent and independent variables. Results . Analysis was based on 404 nurses (45% of the hospital's nursing population). The overall prevalence of MSP was 70% in the past year and 64% in the past month. Lower back (57%) and neck (56%) were the body areas most commonly painful in the past year. Higher quantitative and emotional demands, work pace, low justice and respect in the workplace, influence on work organisation, and role conflicts were significantly associated with musculoskeletal pain among nurses ( p < 0.05). All mental health problems and most strongly somatic stress symptoms were associated with musculoskeletal pain. Conclusions . Work-related psychosocial risk factors and mental health problems, especially somatic stress symptoms, have an important impact on the occurrence of musculoskeletal pain among university hospital nurses., Competing Interests: The authors declare they have no competing interests.

Background: Cervical and lumbar range of motion limitations are usually associated with musculoskeletal pain in the neck and lower back, and are a major health problem among nurses. Physical exercise has been evaluated as an effective intervention method for improving cervical and lumbar range of motion, and for preventing and reducing musculoskeletal pain. The purpose of this study was to investigate the effects of a home-exercise therapy programme on cervical and lumbar range of motion among intensive care unit nurses who had experienced mild to moderate musculoskeletal pain in the neck and or lower back during the previous six months., Methods: A quasi-experimental study was conducted among intensive care unit nurses at Tartu University Hospital (Estonia) between May and July 2011. Thirteen nurses who had suffered musculoskeletal pain episodes in the neck and or lower back during the previous six months underwent an 8-week home-exercise therapy programme. Eleven nurses without musculoskeletal pain formed a control group. Questions from the Nordic Musculoskeletal Questionnaire and the 11-point Visual Analogue Scale were used to select potential participants for the experimental group via an assessment of the prevalence and intensity of musculoskeletal pain. Cervical range of motion and lumbar range of motion in flexion, extension, lateral flexion and (cervical range of motion only) rotation were measured with a digital goniometer. A paired t-test was used to compare the measured parameters before and after the home-exercise therapy programme. A Student's t-test was used to analyse any differences between the experimental and control groups., Results: After the home-exercise therapy, there was a significant increase (p < 0.05) in cervical range of motion in flexion, extension, lateral flexion and rotation, and in lumbar range of motion in lateral flexion. Cervical range of motion in flexion was significantly higher (p < 0.01) in the experimental group compared to the control group after therapy., Conclusions: Our results suggest an 8-week intensive home-exercise therapy programme may improve cervical and lumbar range of motion among intensive care nurses. Further studies are needed to develop this simple but effective home-exercise therapy programme to help motivate nurses to perform such exercises regularly., Trial Registration: Current Controlled Trials ISRCTN19278735. Registered 27 November 2015.

Aim: Rapid changes in the Estonian health care system have placed extra pressure on the nursing profession, but the potential impacts of psychosocial changes have not been investigated. We aimed to explore the work-related psychosocial risk factors and their relationships with mental health problems (MHPs) amongst nurses at the university hospital in Estonia., Methods: A cross-sectional survey was undertaken amongst registered nurses at Tartu University Hospital (TUH). Psychosocial work factors and MHPs (stress, somatic symptoms, depressive symptoms and burnout) were measured using version two of the Copenhagen Psychosocial Questionnaire (COPSOQ II). Descriptive statistics and Pearson's r correlation with sequential Bonferroni correction were used to analyse the data., Results: The analysis was based on 404 nurses (45% of the full-time working population of nurses). The highest mean scores recorded for the positive work-related psychosocial factors studied were meaning of work, role clarity, social relationships and mutual trust between employees. The highest scores for the negative factors studied were the demands for hiding emotions, work pace, cognitive and emotional demands. Stress and burnout showed the highest mean scores amongst the MHPs. Quantitative and emotional demands were positively related to all of the studied MHPs, while work pace and role conflicts had a positive correlation with stress and burnout. All of the studied negative psychosocial factors were significantly correlated with burnout., Conclusions: work-related psychosocial risk factors such as quantitative demands work load, emotional demands, work pace and role conflicts, had significant positive relationships with MHPS in nurses in Estonia, and may contribute to high levels of stress as well as burnout amongst nurses: ., (© 2015 the Nordic Societies of Public Health.)

Background: Occupational use of computers has increased rapidly over recent decades, and has been linked with various musculoskeletal disorders, which are now the most commonly diagnosed occupational diseases in Estonia. The aim of this study was to assess the prevalence of musculoskeletal pain (MSP) by anatomical region during the past 12 months and to investigate its association with personal characteristics and work-related risk factors among Estonian office workers using computers., Methods: In a cross-sectional survey, the questionnaires were sent to the 415 computer users. Data were collected by self-administered questionnaire from 202 computer users at two universities in Estonia. The questionnaire asked about MSP at different anatomical sites, and potential individual and work related risk factors. Associations with risk factors were assessed by logistic regression., Results: Most respondents (77%) reported MSP in at least one anatomical region during the past 12 months. Most prevalent was pain in the neck (51%), followed by low back pain (42%), wrist/hand pain (35%) and shoulder pain (30%). Older age, right-handedness, not currently smoking, emotional exhaustion, belief that musculoskeletal problems are commonly caused by work, and low job security were the statistically significant risk factors for MSP in different anatomical sites., Conclusions: A high prevalence of MSP in the neck, low back, wrist/arm and shoulder was observed among Estonian computer users. Psychosocial risk factors were broadly consistent with those reported from elsewhere. While computer users should be aware of ergonomic techniques that can make their work easier and more comfortable, presenting computer use as a serious health hazard may modify health beliefs in a way that is unhelpful.

Objective: The aim of the study was to explore the role of managerial style, work environment factors and burnout in determining job satisfaction during the implementation of quality improvement activities in a dental clinic., Method: Quantitative research was carried out using a prestructured anonymous questionnaire to survey 302 respondents in Kaarli Dental Clinic, Estonia. Dental clinic staff assessed job satisfaction, managerial style, work stress and burnout levels through the implementation period of ISO 9000 quality management system in 2003 and annually during 2006-2009. Binary logistic regression was used to explain the impact of satisfaction with management and work organisation, knowledge about managerial activities, work environment and psychosocial stress and burnout on job satisfaction., Results: The response rate limits were between 60% and 89.6%. Job satisfaction increased significantly from 2003 to 2006 and the percentage of very satisfied staff increased from 17 to 38 (p<0.01) over this period. In 2007, the proportion of very satisfied people dropped to 21% before increasing again in 2008-2009 (from 24% to 35%). Binary logistic regression analysis resulted in a model that included five groups of factors: managerial support, information about results achieved and progress to goals, work organisation and working environment, as well as factors related to career, security and planning. The average scores of emotional exhaustion showed significant decrease, correlating negatively with job satisfaction (p<0.05)., Conclusion: The implementation of quality improvement activities in the Kaarli Dental Clinic has improved the work environment by decreasing burnout symptoms and increased job satisfaction in staff.

Background: Routine statistics indicate a high frequency of work-related musculoskeletal disorders in Estonia. We aimed to describe the prevalence of musculoskeletal pain (MSP) amongst Estonian nurses, and to explore associations with personal characteristics and occupational risk factors., Methods: As a part of an international investigation (the Cultural and Psychosocial Influences on Disability (CUPID) study), a cross-sectional survey was carried out amongst registered nurses at Tartu University Hospital, focusing on pain at six anatomical sites (low back, neck, shoulder, elbow, wrist/hand and knee) lasting for more than a day during the past year and past month. Associations with regional and multi-site (≥2 anatomical sites) pain were analysed by logistic regression., Results: Analysis was based on 221 female nurses (response rate 57%). The overall prevalence of MSP was 84% in the past year and 69% in the past month. The prevalence of multi-site pain was 60% in the past year and 40% in the past month. Low back, neck and knee were the sites most commonly painful. Pain in the past year tended to be more frequent at older ages, and with higher emotional exhaustion, and at most sites, with poor self-rated health, and reported distress from somatic symptoms. Multi-site pain was also significantly associated with older age and tendency to somatise., Conclusions: The prevalence of MSP among Estonian nurses is high. Psychological risk factors such as somatising tendency have an important impact. However, none of the risk factors examined seems likely to explain the high frequency of work-related musculoskeletal disorders in Estonia.

To explore definitions for multisite pain, and compare associations with risk factors for different patterns of musculoskeletal pain, we analysed cross-sectional data from the Cultural and Psychosocial Influences on Disability (CUPID) study. The study sample comprised 12,410 adults aged 20-59 years from 47 occupational groups in 18 countries. A standardised questionnaire was used to collect information about pain in the past month at each of 10 anatomical sites, and about potential risk factors. Associations with pain outcomes were assessed by Poisson regression, and characterised by prevalence rate ratios (PRRs). Extensive pain, affecting 6-10 anatomical sites, was reported much more frequently than would be expected if the occurrence of pain at each site were independent (674 participants vs 41.9 expected). In comparison with pain involving only 1-3 sites, it showed much stronger associations (relative to no pain) with risk factors such as female sex (PRR 1.6 vs 1.1), older age (PRR 2.6 vs 1.1), somatising tendency (PRR 4.6 vs 1.3), and exposure to multiple physically stressing occupational activities (PRR 5.0 vs 1.4). After adjustment for number of sites with pain, these risk factors showed no additional association with a distribution of pain that was widespread according to the frequently used American College of Rheumatology criteria. Our analysis supports the classification of pain at multiple anatomical sites simply by the number of sites affected, and suggests that extensive pain differs importantly in its associations with risk factors from pain that is limited to only a small number of anatomical sites., (Copyright © 2013 International Association for the Study of Pain. All rights reserved.)

To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross-sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1-month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up-to 8-fold difference in prevalence remained. Systems of compensation for work-related illness and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed., (Copyright © 2013 International Association for the Study of Pain. All rights reserved.)

Background: The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample., Methods/principal Findings: A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as "repetitive strain injury" (RSI)., Conclusions/significance: The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.

Background: Health impact assessments (HIA) use information on exposure, baseline mortality/morbidity and exposure-response functions from epidemiological studies in order to quantify the health impacts of existing situations and/or alternative scenarios. The aim of this study was to improve HIA methods for air pollution studies in situations where exposures can be estimated using GIS with high spatial resolution and dispersion modeling approaches., Methods: Tallinn was divided into 84 sections according to neighborhoods, with a total population of approx. 390,000 persons. Actual baseline rates for total mortality and hospitalization with cardiovascular and respiratory diagnosis were identified. The exposure to fine particles (PM2.5) from local emissions was defined as the modeled annual levels. The model validation and morbidity assessment were based on 2006 PM10 or PM2.5 levels at 3 monitoring stations. The exposure-response coefficients used were for total mortality 6.2% (95% CI 1.6-11%) per 10 microg/m3 increase of annual mean PM2.5 concentration and for the assessment of respiratory and cardiovascular hospitalizations 1.14% (95% CI 0.62-1.67%) and 0.73% (95% CI 0.47-0.93%) per 10 microg/m3 increase of PM10. The direct costs related to morbidity were calculated according to hospital treatment expenses in 2005 and the cost of premature deaths using the concept of Value of Life Year (VOLY)., Results: The annual population-weighted-modeled exposure to locally emitted PM2.5 in Tallinn was 11.6 microg/m3. Our analysis showed that it corresponds to 296 (95% CI 76528) premature deaths resulting in 3859 (95% CI 10236636) Years of Life Lost (YLL) per year. The average decrease in life-expectancy at birth per resident of Tallinn was estimated to be 0.64 (95% CI 0.17-1.10) years. While in the polluted city centre this may reach 1.17 years, in the least polluted neighborhoods it remains between 0.1 and 0.3 years. When dividing the YLL by the number of premature deaths, the decrease in life expectancy among the actual cases is around 13 years. As for the morbidity, the short-term effects of air pollution were estimated to result in an additional 71 (95% CI 43-104) respiratory and 204 (95% CI 131-260) cardiovascular hospitalizations per year. The biggest external costs are related to the long-term effects on mortality: this is on average euro 150 (95% CI 40-260) million annually. In comparison, the costs of short-term air-pollution driven hospitalizations are small euro 0.3 (95% CI 0.2-0.4) million., Conclusion: Sectioning the city for analysis and using GIS systems can help to improve the accuracy of air pollution health impact estimations, especially in study areas with poor air pollution monitoring data but available dispersion models.

The effects of developmental lead exposure on the emotional reactivity, contextual fear conditioning and neurogenesis in the dentate gyrus of 60-80 days-old rats were studied. Wistar rat pups were exposed to 0.2% lead acetate via their dams' drinking water from postnatal day (PND) 1 to PND 21 and directly via drinking water from weaning until PND 30. At PND 60 and 80 the level of anxiety and contextual fear conditioning were studied, respectively. At PND 80 all animals received injections of BrdU to determine the effects of Pb on the generation of new cells in the dentate gyrus of hippocampus and on their survival and differentiation patterns. The results of the present study demonstrate that developmental lead exposure induces persistent increase in the level of anxiety and inhibition of contextual fear conditioning. Developmental lead exposure reduced generation of new cells in the dentate gyrus and altered the pattern of differentiation of BrdU-positive cells into mature neurons. A lower proportion of BrdU-positive cells co-expressed with the marker for mature neurons, calbindin. In contrast, the proportions of young not fully differentiated neurons and proportions of astroglial cells, generated from newly born cells, were increased in lead-exposed animals. Our results demonstrate that developmental lead exposure induces persistent inhibition of neurogenesis and alters the pattern of differentiation of newly born cells in the dentate gyrus of rat hippocampus, which could, at least partly, contribute to behavioral and cognitive impairments observed in adulthood.

A total of 43 males with craniocerebral injury of varying severity were studied for the venous blood plasma levels of adrenaline, noradrenaline, adrenocorticotrophic hormone, and hydrocortisone in dynamics. Their computed tomograms were quantitatively analysed to identify the site of contusion foci in the cerebral hemispheres, especially the lesion signs of mesodiencephalic and truncal regions of the brain. The results of the studies and non-linear regression analysis have shown that brain injury leads to a substantial activation of the body's sympathoadrenal system, extremely severe injury causes its partial reduced performance. In severe and critical cerebrocranial injury, the central link of the hypothalamus-pituitary-adrenocortical system is exhausted and hydrocortisone release occurs without its control. The above changes depend on the size of hepatoma and edema of the cerebral hemispheres and on secondary lesion of the brain mesodiencephalic and truncal regions. The activity of the sympathoadrenal and hypothalamus-pituitary-adrenocortical system, which was observed over a week, tended to its gradual decrease.