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ABSTRACT: Objective: The aim of this study was to examine the relationship between age and the lost-time workers' compensation claims in British Columbia, Canada, over three time periods (1997-98, 2001-02 and 2005-06). We examined if the relationship between age and risk of lost-time claims is consistent over time and for different nature of injury categories. Methods: Secondary analyses of lost-time workers' compensation claims combined with estimates of person-years of exposure generated from the Canadian Labour Force Survey were performed. Analyses examined the relationship between age and claim risk using sex-stratified regression models, adjusting for time period, occupational characteristics and whether the claimant was employed in the goods or service industry. Multiplicative interaction terms were used to examine if the relationship between age and lost-time claim risk changed over time. Seven separate regression models were generated to explore the variation in the effect of age across nature of injury groups. Results: We observed important differences in the relationship between age and risk of injury depending on the nature of injury examined. A negative relationship was observed between age and lost-time claims for open wounds, while a positive relationship was observed for traumatic injuries to bones, nerves and the spinal cord. We found no evidence that the relationship between age and risk of lost-time claims changed over time periods. Conclusions: The association between age and risk of lost-time claims depends on the nature of injury under investigation. We found no evidence that the relationship between age and overall lost-time claim risk has changed over time in British Columbia.
Journal of Occupational Health 02/2013; · 1.55 Impact Factor
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ABSTRACT: Objective To examine the role of pain experiences in relation to work absence, within the context of other worker health factors and workplace factors among Canadian nurses with work-related musculoskeletal (MSK) injury. Methods Structural equation modeling was used on a sample of 941 employed, female, direct care nurses with at least one day of work absence due to a work-related MSK injury, from the cross-sectional 2005 National Survey of the Work and Health of Nurses. Results The final model suggests that pain severity and pain-related work interference mediate the impact of the following worker health and workplace factors on work absence duration: depression, back problems, age, unionization, workplace physical demands and low job control. The model accounted for 14 % of the variance in work absence duration and 46.6 % of the variance in pain-related work interference. Conclusions Our findings support a key role for pain severity and pain-related work interference in mediating the effects of workplace factors and worker health factors on work absence duration. Future interventions should explore reducing pain-related work interference through addressing workplace issues, such as providing modified work, reducing physical demands, and increasing job control.
Journal of Occupational Rehabilitation 01/2013; · 2.80 Impact Factor
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ABSTRACT: Longitudinal studies using multi-level models to examine health inequalities in lower and middle income countries (LMICs) are rare. We explored socio-economic gradients in health among small farm members participating in a pesticide-related health and agriculture program in highland Ecuador.
We profiled 24 communities through key informant interviews, secondary data (percent of population with unsatisfied basic needs), and intervention implementation indicators. Pre (2005) and post (2007) surveys of the primary household and crop managers included common questions (education, age, and the health outcome - digit span scaled 0-10)) and pesticide-related practice questions specific to each. Household assets and pesticide use variables were shared across managers. We constructed multi-level models predicting 2007 digit span for each manager type, with staged introduction of predictor variables.
376 household managers (79% of 2005 participants) and 380 crop managers (76% of 2005 participants) had complete data for analysis. The most important predictor of 2007 digit span was 2005 digit span: β (Standard Error) of 0.31(0.05) per unit for household and 0.17(0.04) for crop managers. Household asset score was next most important: 0.14(0.06) per unit for household and 0.14(0.05) for crop managers. Community percent with unsatisfied basic needs was associated with reductions in 2007 digit span: -0.04(0.01) per percent for household and -0.03(0.01) for crop managers.
The important roles of life endowments and/or persistent neurotoxicity were exemplified by limited change in the health outcome. Gradients by household assets and community deprivation were indicative of ongoing, structural inequities within this LMIC.
International Journal for Equity in Health 11/2011; 10(1):54. · 1.71 Impact Factor
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ABSTRACT: To evaluate the impact of worker and workplace factors and of their relationships on work absence duration.
Structural equation modeling of 11,762 female, Canadian nurses from the 2005 National Survey of the Work and Health of Nurses.
Worker and workplace factors were associated with prolonged work absence. Key proximal predictors were pain-related work interference, depression, pain severity, and respect and support at work. More distal predictors were multimorbidity, abuse at work, and organizational culture.
Worker health and workplace factors are important in explaining work absence duration. Self-management for pain and mood, adapted to the work context, may be useful for nurses with chronic pain or depression. Policy makers and administrators should focus on creating respect and support at work, and improving organizational culture.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 08/2011; 53(8):919-27. · 1.88 Impact Factor
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ABSTRACT: A range of determinants at multiple socio-ecological levels operate in small farm households' use and handling of hazardous pesticides, suggesting the need for integrated health and agriculture promotion approaches. The aim is to assess changes in health promotion outcomes relevant to highly hazardous pesticide use associated with a multi-component community program. A longitudinal evaluation design using mixed methods was employed in 18 agricultural communities in Ecuador. Over a 7-month period, health education and agricultural interventions focused upon: health risks associated with hazardous pesticides, more adequate use and handling of pesticides, and better crop management techniques. Data collection included field forms, focus groups, structured observations and repeat surveys. In the qualitative analysis, communities were compared by extent of leadership and involvement with the interventions. For the quantitative analysis, hypothesized paths were constructed including factors relevant to pesticide-related practices and use. Testing involved gender-role stratified (household and crop manager) multivariable regression models. Information on pesticide health impacts and the pesticide use and handling, shared in focus groups, showed substantial improvement, as a result of health promotion activities though people were still observed to engage in risky practices in the field. In path models, community leadership and intervention intensity lead to changes in the household managers' pesticide-related knowledge and practices and to reduction in farm use of hazardous pesticides (both significant, p < 0.05). Integrated, community programs can promote pesticide-related risk reduction among small farm households. Changing practices in the use and management of pesticides among crop managers appears limited by deeper structural and cultural factors.
Health Promotion International 02/2011; 26(4):432-46. · 1.94 Impact Factor
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ABSTRACT: Low back pain (LBP) is a common and in some cases disabling condition. Until recently, workers presenting with non-specific LBP have generally been regarded as a homogeneous population. If this population is not homogeneous, different interventions might be appropriate for different subgroups. We hypothesized that (1) Clusters of individuals could be identified based on risk factors, (2) These clusters would predict duration and recurrences 6 months post-injury.
The study focuses on the 442 LBP claimants in the Readiness for Return-to-Work Cohort Study. Claimants (n = 259) who had already returned to work, approximately 1 month post-injury were categorized as the low risk group. A latent class analysis was performed on 183 workers absent from work, categorized as the high risk group. Groups were classified based on: pain, disability, fear avoidance beliefs, physical demands, people-oriented culture and disability management practice at the workplace, and depressive symptoms.
Three classes were identified; (1) workers with 'workplace issues', (2) workers with a 'no workplace issues, but back pain', and (3) workers having 'multiple issues' (the most negative values on every scale, notably depressive symptoms). Classes 2 and 3 had a similar rate of return to work, both worse than the rate of class 1. Return-to-work status and recurrences at 6 months were similar in all 3 groups.
This study largely confirms that several subgroups could be identified based on previously defined risk factors as suggested by an earlier theoretical model by Shaw et al. (J Occup Rehab 16(4):591-605, 2006). Different groups of workers might be identified and might benefit from different interventions.
Journal of Occupational Rehabilitation 11/2009; 20(3):394-405. · 2.80 Impact Factor
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ABSTRACT: The relative importance of region, workplace, and individual determinants of health burden is debated.
To model the contribution of hospital characteristics to employee mental and musculoskeletal disorders.
We linked employment records of nurses and support services' staff with health records, neighbourhood census, and hospital administrative data. We conducted multi-level logistic regression analyses with three levels: year (I), employee characteristics (II), and hospital characteristics (III).
Northern region hospitals experienced lower disorder prevalences (odds ratios (OR) 0.58, 95% confidence intervals (0.40, 0.82) for mental and 0.56 (0.44, 0.73) for musculoskeletal disorders). Hospitals with yearly workloads of the highest versus lowest quintiles of inpatient days/1000 employee hours (>86.0 vs. <42.6) and surgical cases/1000 employee hours (>10.5 vs. <3.9) had greater odds of mental (1.29 (1.05, 1.57); 1.22 (1.05, 1.42)) and musculoskeletal (1.38 (1.21, 1.58); 1.21 (1.09, 1.34)) disorders.
Opportunities exist for reduction in burden with hospital workload reduction. Further exploration of regional effects is needed.
Health & Place 05/2009; 15(4):1046-57. · 2.67 Impact Factor
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ABSTRACT: Urban agriculture is an important livelihood strategy to increase access to and availability of food in urban settings.
We examined the impact of sociodemographic and farming variables on the household food security and nutritional security of an index child aged 2 to 5 years. Our hypothesis was that dietary quality (percentage of energy from animal-source foods [%ASF] and dietary diversity) would have an impact on infection (as measured by C-reactive protein [CRP]), which in turn would have an impact on biochemical indices (hemoglobin and retinol) and anthropometric indices (weight-for-age z-score [WAZ] and body mass index z-score [ZBMI]). We examined the relationships among urban agricultural activities, household food security, and child nutritional security.
We conducted a cross-sectional survey of 296 households within each randomly selected study zone in Kampala, Uganda. Correlations were calculated and bivariate and exploratory path analysis was conducted to explore relationships.
Household food security score was significantly positively correlated with the number of tropical livestock units (r = 0.142, p = .017), dietary diversity (r = 0.230, p < .001), %ASF (r = 0.185, p = .002), and WAZ (r = 0.149, p = .017). Exploratory path analysis demonstrated a significant positive relationship between household food security and %ASF, which in turn was positively associated with retinol. Consumption of animal-source food was significantly negatively associated with C-reactive protein level, which in turn was significantly negatively associated with hemoglobin level, and hemoglobin was significantly positively associated with WAZ.
Our findings are supportive of efforts to enhance access to land for urban farming and engagement in activities aimed at improving the quality of dietary intake of urban residents, in particular by increasing consumption of animal-source foods.
Food and nutrition bulletin 06/2007; 28(2 Suppl):S237-46. · 1.92 Impact Factor
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ABSTRACT: Participatory ergonomic (PE) interventions have been increasingly utilized to deal with work-related musculoskeletal disorders (WMSD).
Using a longitudinal quasi-experimental design, a PE process was launched at one depot of a large courier company, with a nearby depot serving as a control. Evaluations focused on 122 employees across the two depots who participated in both pre- and post-questionnaires. An evaluation framework assessed the process of implementation, changes in risk factors, and changes in musculoskeletal health outcomes. Partial and multiple regressions explored the relationships in the evaluation framework.
Changes in work organizational factors had a consistent impact upon changes in health outcomes. Greater participation in the process was associated with increased levels of job influence and communication (P = 0.0059 and P = 0.0940 respectively). Improvements in communication levels were associated with reduced pain intensity and improved work role function (WRF) (P = 0.0077 and P = 0.0248 respectively). Lower levels of pain post-intervention were related to greater WRF (P = 0.0493).
A PE approach can improve risk factors related to WMSD, and meaningful worker participation in the process is an important aspect for the success of such interventions.
American Journal of Industrial Medicine 11/2006; 49(10):801-10. · 1.63 Impact Factor
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ABSTRACT: To assess the impact of a workplace ergonomic program to reduce musculoskeletal burden among newspaper employees and to understand relationships among participation, risk factor changes and health status within an employee cohort.
We conducted repeat cross-sectional surveys, with 1,003 employees from all major departments in 1996 and 813 in 2001, generating a cohort of 433 participants in both surveys. Elements of the ergonomic program included employee RSI (repetitive strain injury) training, pro-active assessment of workstations and workstation modifications, and encouragement of early treatment through on-site physiotherapy. Potential risk factors included biomechanical and work organizational aspects of office work. Health status measures included pain intensity and the Work-Disability of the Arm, Shoulder, and Hand (DASH). Repeat cross-sectional analyses incorporated modifications for shared variance. For the cohort, a theory of change informed path analyses using MPLUS.
Among respondents in 2001, 69% reported participation in RSI training and 56% had workstation assessments. Among those with pain, 57% had consulted a health practitioner, including the on-site physiotherapist. In repeat cross-sectional analyses, the proportion reporting moderate pain or worse, at least once per month or for longer than 1 week, declined from 20 to 16% (p=0.01). Among the cohort, pain intensity and work disability in 1996 were the strongest predictors of 2001 health status (both p<0.001). Stable or increased supervisor awareness and concern about RSI was associated with decreased pain in 2001(p<0.01). Participation in RSI training was associated with increases in decision latitude (p<0.05), which themselves were associated with decreased work disability in 2001 (p<0.05). Increased time mousing was associated with increases in work disability (p<0.05).
Implementation of a worksite ergonomics program was associated with a reduction in frequent and severe pain in the workforce. Changes in work disability were affected by multiple factors.
International Archives of Occupational and Environmental Health 11/2006; 80(2):98-108. · 1.89 Impact Factor
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ABSTRACT: To investigate the effects of low level maternal and paternal persistent contaminant exposures on fecundability among couples from the general population.
About 41 couples having their first pregnancy completed questionnaires and provided blood samples for analysis of metals, organochlorine pesticides, and polychorinated biphenyls. Associations of personal consumption and contaminant measures for mothers, fathers, and couples overall were analyzed through fecundability odds ratios (fOR, probability of pregnancy per month in more versus less exposed) in multivariable analyses.
Couples with higher reported caffeine consumption (couple consumption > or =111 drinks/month, fOR 0.25, 95% CI, 0.10, 0.63) and higher mercury concentrations in maternal blood (>1.2 microg/L or 0.24 ppm in hair, fOR 0.22, 95% CI, 0.07, 0.72) had lower fecundability, after adjustment for intercourse frequency.
Reduced fecundability at levels below the mercury reference dose warrants further research and prudent reduction in persistent toxic substances exposure among women and men of reproductive age.
Reproductive Toxicology 07/2006; 22(1):13-9. · 3.23 Impact Factor
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ABSTRACT: Background: Literature pertaining to the relationship between workplace factors and depression has been compartmentalized: work conditions, family conditions, and work–family balance have been studied separately as predictors of depressive symptoms but not concurrently.Objective: Work conditions and work–family spillover were considered concurrently as modifiable workplace factors associated with depressive symptomatology, while controlling for confounding socio-economic factors.Methods: This cross-sectional study involved 218 female health care workers who completed a survey assessing work conditions [Effort–Reward Imbalance (ERI) scale and Job Content Questionnaire (JCQ)], work–family balance (work–family spillover scale), sociodemographic information, and depressive symptoms [Center for Epidemiological Studies Depression (CES-D) scale].Results: Path analysis supported the presence of a direct relationship between depressive symptoms and high effort–reward imbalance, high negative work–family spillover, low positive family-to-work spillover, and low education. The indirect effect of low support from work was mediated by negative work-to-family spillover and high effort–reward imbalance. The indirect effect of high effort–reward imbalance was mediated by increased negative work-to-family spillover. The indirect effect of having children 18 years or younger was mediated by decreased positive family-to-work spillover. An indirect effect of low education was mediated by high effort–reward imbalance and high negative work-to-family spillover.Conclusions: The association between work conditions and depressive symptomatology is mediated by increased negative work-to-family spillover. The impact of having young children is mediated by decreased positive family-to-work spillover. Copyright © 2006 John Wiley & Sons, Ltd.
Stress and Health 04/2006; 22(2):91 - 103. · 1.23 Impact Factor
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ABSTRACT: The present study examined the relationship between work-family spillover, job characteristics, and sleep quality in a sample of health care workers (N = 168) recruited from 3 Canadian hospitals. A multiple regression analysis revealed that positive family-to-work spillover is associated with better sleep quality, after controlling for age, physical health, depressive symptomatology, work situation, and number of children. These findings are discussed within a theoretical framework drawing on the concepts of effort and recovery.
Journal of Occupational Health Psychology 02/2006; 11(1):27-37. · 2.07 Impact Factor
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ABSTRACT: We assessed predictors of work-related repetitive strain injuries using data from 4 waves of the Canadian National Population Health Survey.
Participants were 2806 working adults who completed an abbreviated version of the Job Content Questionnaire in 1994-1995 and did not experience repetitive strain injuries prior to 2000-2001. Potential previous wave predictors of work-related repetitive strain injuries were modeled via multivariate logistic regression.
Female gender (odds ratio [OR] = 1.98; 95% confidence interval [CI]=1.24, 3.18), some college or university education (OR=1.98; 95% CI=1.06, 3.70), job insecurity (OR=1.76; 95% CI=1.07, 2.91), high physical exertion levels (OR = 2.00; 95% CI = 1.29, 3.12), and high levels of psychological demands (OR = 1.61; 95% CI = 1.02, 2.52) were all positively associated with work-related repetitive strain injuries, whereas working less than 30 hours per week exhibited a negative association with such injuries (OR=0.2; 95% CI=0.1, 0.7).
Modifiable job characteristics are important predictors of work-related repetitive strain injuries.
American Journal of Public Health 08/2005; 95(7):1233-7. · 3.93 Impact Factor
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ABSTRACT: Work stressors are increasingly recognized as potentially important determinants of mental health status. We examined such relationships using a structural equation modelling approach with data on adult, working Canadians who participated in the first wave of the National Population Health Survey (NPHS). Work stressors formed a composite construct with paths from psychological demands, decision latitude, work social support and job insecurity, each measured through a reduced version of the Job Content Questionnaire. Life stressors also formed a composite construct composed of chronic stressors and recent life events. Psychological distress was the outcome, mediated by the latent effect constructs of mastery and self-esteem. Work stressors had consistently positive total effects on distress (sum of standardized path coefficients from 0.004 to 0.153 across gender-occupation strata), with all of these effects mediated through reduced self-esteem and mastery (work stressors to these mediators: -0.188 to -0.413). Life stressors had larger positive total effects on distress (0.462 to 0.536), with the majority of these effects direct.
Chronic diseases in Canada 02/2002; 23(3):91-9. · 0.98 Impact Factor
