Biomedical subjects

Niklas Krause

Publications and source records attributed to Niklas Krause.

14 recordsLinked to original sources

PubMed2006

The prevalence of and risk factors for back pain among home care nursing personnel in Hong Kong.

BACKGROUND: There is a large gap in research with regard to back pain (BP) among home care nursing personnel (HCNP); only seven studies have been conducted worldwide. There is a need to identify the magnitude of and risk factors for BP that are unique to Hong Kong (HK) HCNP. METHODS: A total population sampling technique was employed in this cross-sectional questionnaire-based study. Hierarchical multiple logistic regression analyses were used to control for potentially confounding variables. RESULTS: The 12-month prevalence of upper and lower BP was 71.2% (n=265). Three predictors were identified: physical risk factors in the office (OR=3.57, 95% CI=1.55-8.24), static postures (OR=1.41, 95% CI=1.04-1.90), and psychological job demands (OR=1.11, 95% CI=1.01-1.22). CONCLUSION: HCNP in HK have a high prevalence of BP. BP in HK HCNP is independently attributable to physical work factors in the office, static postures, and psychological job demands, and is not primarily associated with patient lifting and transferring which are traditionally identified as risk factors for BP in hospital nursing personnel. Am. J. Ind. Med. 49:14-22, 2006. (c) 2005 Wiley-Liss, Inc.

Adult↗

PubMed2006

Duration of work disability: a comparison of self-report and administrative data.

BACKGROUND: Studies have used insurer-reported compensable days absent as an outcome measure when studying work-related injury or illness. Compared to self-reported days absent, insurer data are less expensive to collect. Previous work has identified that insurer-claims data consistently underestimate the duration of days absent when compared to self-report. The objective of this study was to examine the agreement between the number of self-reported days absent from work following a compensable work-related injury and the number of insurer-reported compensation days paid, and to examine factors associated with the magnitude of the discrepancy between the number of self-reported days absent and the number of insurer-reported compensated days paid. METHODS: One hundred sixty six respondents who experienced a work-related injury were interviewed approximately 200 days post-injury to assess the number of days absent from work. The number of days compensated by the insurer was compared to self-report using descriptive statistics and linear regression. RESULTS: Respondents who had yet to experience a return-to-work (RTW) had the largest median discrepancy followed by respondents with an unsustained RTW and finally sustained RTW. Respondents with upper extremity injuries, lower education, and lower RTW self-efficacy showed greater discrepancy between self-reported and compensated days absent. Among respondents who self-reported fewer days absent than insurer-compensated days absent an inverse relationship between firm size and discrepancy was noted. CONCLUSIONS: Researchers should be aware of the discrepancies between self-reported and compensated days absent. Future studies planning to incorporate days absent as an outcome variable should carefully consider what measure would be more appropriate and potentially collect both self-report and administrative data to assess the discrepancy.

Absenteeism↗

PubMed2006

Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury.

PROBLEM: One of the key players in the return-to-work (RTW) and work accommodation process is the healthcare provider (HCP). This study examines the association between RTW approximately one month post injury and early, proactive HCP communication with the patient and workplace. METHODS: In this cross-sectional study 187 Ontario workers completed a telephone survey 17-43 days post injury. All had accepted or pending lost-time claims for back, neck or upper extremity occupational musculoskeletal injuries. Logistic regression was used to analyze the effects of three self-reported items "your HCP told you the date you could RTW," "your HCP advised you on how to prevent re-injury or recurrence," "your HCP made contact with your workplace" on self-reported RTW. Fourteen potential confounders were also tested in the model including sex, age, income, education, occupational classification, worksite size, co-morbidity, psycho-physical work demands, pain, job satisfaction, depression, and time from injury to interview. RESULTS: The HCP giving a patient a RTW date (adjusted OR=3.33, 95% CI=1.62-6.87) and giving a patient guidance on how to prevent recurrence and re-injury (adjusted OR=2.71, 95% CI=1.24-5.95) were positively associated with an early RTW. Contact by the HCP with the workplace was associated with RTW, however, this association became weaker upon adjusting for confounding variables (crude OR=2.11, 95% C1=1.09-4.09; adjusted OR=1.72, 95% CI=0.83-3.58). INTERPRETATION: Our study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient.

Adolescent↗

PubMed2006

Observational stress factors and musculoskeletal disorders in urban transit operators.

Associations and pathways between observed (rather than self-reported) job stressors and musculoskeletal disorders in 66 transit operators were investigated to determine specific stressors and vulnerable body regions affected, while adjusting for physical workload. Job stressors, defined as barriers to progress with work, comprised 7 categories and the sum of stressors. Outcomes included back and neck pain, low back pain, neck pain, pain of the upper extremities and the lower extremities, and any combination of these. Stressors were significantly associated with the combined musculoskeletal disorders category (odds ratio [OR] = 1.55), back and neck pain (OR = 1.41), low back pain (OR = 1.46), and pain in the lower extremities (OR = 1.44) after controlling for confounders. Five barrier categories had at least 1 significant association with outcomes. Results provide specific intervention targets by avoiding common method variance bias.

Adult↗

PubMed2005

Job strain, iso-strain, and the incidence of low back and neck injuries. A 7.5-year prospective study of San Francisco transit operators.

Work-related musculoskeletal disorders account for the largest single category of lost-time occupational injury or disease episodes in industrialized countries. In this study we analyzed the impact of the psychosocial work environment, conceptualized by the demand-control-support model, on the incidence of low back and neck injury in a cohort of 1221 public transit operators followed for 7 years and 6 months. The two main exposure variables were "job strain" (mismatch of high psychological demands and low decision latitude) and "iso-strain" (job strain plus exposure to low social support at work). Analyses controlled for demographic factors, physical workload, and pain at baseline. For low back injuries, increased hazard rates were found for job strain and iso-strain based on tertiles, with hazard ratios (HR) of 1.30 (95% CI=0.96-1.75) and 1.41 (95% CI=0.98-2.01), respectively. Job strain and iso-strain based on median split or analyzed as continuous variables were not associated with low back injuries. For neck injuries, job strain and iso-strain based on median split showed HRs of 1.27 (95% CI=0.99-1.63) and 1.33 (95% CI=1.01-1.77), respectively. Job strain and iso-strain based on tertiles had HRs of 1.52 (95% CI=1.13-2.05) and 1.73 (95% CI=1.21-2.45), respectively. When analyzed as continuous variables, a one-point increase on the job strain and iso-strain scales led to an 8% (95% CI=0.98-1.19) and 14% (95% CI=1.02-1.27) increased hazard of neck injuries, respectively. This study shows the importance of the psychosocial work environment in the etiology of musculoskeletal injuries among transit operators. Since reviews have shown that psychosocial workplace conditions in this occupational group can be changed, these findings indicate a potential for prevention at the workplace.

Adult↗

PubMed2005

Physical workload, work intensification, and prevalence of pain in low wage workers: results from a participatory research project with hotel room cleaners in Las Vegas.

BACKGROUND: Occupational injury rates among hotel workers exceed the national service sector average. This study assesses the prevalence of back and neck pain, and its associations with physical workload, ergonomic problems, and increasing work demands. METHODS: Nine hundred forty-one unionized hotel room cleaners completed a survey about health and working conditions. Associations between job demands and pain were determined by logistic regression models adjusting for individual characteristics, cumulative work demands, care-taking responsibilities at home, and psychosocial job factors. RESULTS: The 1-month prevalence of severe bodily pain was 47% in general, 43% for neck, 59% for upper back, and 63% for low back pain. Workers in the highest exposure quartiles for physical workload and ergonomic problems were between 3.24 and 5.42 times more likely to report severe pain than workers in the lowest quartile. Adjusted odds ratios for work intensification ranged from 1.74 (upper back) to 2.33 (neck). CONCLUSIONS: Most room cleaners experience severe back or neck pain. Severe pain showed strong associations with physical workload, work intensification, and ergonomic problems.

Adult↗

PubMed2005

Are difficulties perceiving and expressing emotions associated with low-back pain? The relationship between lack of emotional awareness (alexithymia) and 12-month prevalence of low-back pain in 1180 urban public transit operators.

OBJECTIVE: To assess the association of alexithymia (deficit in emotional awareness) with 12-month prevalence of low back pain (LBP) cross-sectionally in a cohort study of 1180 San Francisco transit operators. METHODS: Alexithymia was measured by the Toronto Alexithymia Scale (TAS-20). LBP was assessed in medical histories during drivers relicensing exams. Multivariate logistic regression analyses controlled for demographic, behavioral (smoking, alcohol, coping style), and physical and psychosocial job factors measured by questionnaire and interview. RESULTS: Of all the drivers, 31.4% suffered from LBP. Scoring in the upper quartile of alexithymia summary scores was associated with twofold higher odds of LBP (adjusted odds ratio=2.00, 95% confidence interval: 1.31-3.00). The association was stronger in women (adj. OR=4.35) than in men (adj. OR=1.83). The factor "difficulty identifying feelings" showed the strongest association with LBP (adj. OR=2.23). CONCLUSION: The results support an association between alexithymia and LBP.

Adaptation, Psychological↗

PubMed2005

Work-related pain and injury and barriers to workers' compensation among Las Vegas hotel room cleaners.

OBJECTIVES: We examined the prevalence of work-related pain and injury and explored barriers to and experiences of reporting among workers. METHODS: We surveyed 941 unionized hotel room cleaners about work-related pain, injury, disability, and reporting. RESULTS: During the past 12 months, 75% of workers in our study experienced work-related pain, and 31% reported it to management; 20% filed claims for workers' compensation as a result of work-related injury, and 35% of their claims were denied. Barriers to reporting injury included "It would be too much trouble" (43%), "I was afraid" (26%), and "I didn't know how" (18%). An estimated 69% of medical costs were shifted from employers to workers. CONCLUSIONS: The reasons for underreporting and the extent of claim denial warrant further investigation. Implications for worker health and the precise quantification of shifting costs to workers also should be addressed.

Accidents, Occupational↗

PubMed2004

Physical workload, ergonomic problems, and incidence of low back injury: a 7.5-year prospective study of San Francisco transit operators.

BACKGROUND: The etiologic role of biomechanical factors for low back injury (LBI) needs to be confirmed in prospective studies that control for psychosocial factors. METHODS: Complete baseline information on 1,233 vehicle operators was gathered during medical examinations and by questionnaire. First LBI during 7.5 years of follow-up was ascertained from insurance records. Hazard ratios and etiologic fractions were analyzed with Cox regression models stratified by injury severity and controlling for age, sex, height, weight, ethnicity, and biomechanical and psychosocial job factors. Severe LBI was defined as medically diagnosed postlaminectomy syndrome, spinal stenosis, herniated lumbar disc, sciatica, or spinal instability. RESULTS: An exponential dose-response relationship was found between weekly driving hours and incidence of first LBI. Indicators of physical workload were more strongly associated with more severe low back injuries compared to less severe injuries. Rates of severe LBI increased 39% for every 10-hr increase in weekly driving (hazard ratio 1.39, 95% confidence interval 1.15-1.68). Higher risks of severe LBI were also found among operators performing heavy physical labor on cable cars (hazard ratio 2.76, 95% confidence intervals 1.24-6.14) or reporting more ergonomic problems at baseline (HR for upper quartile 1.65 (95% confidence interval 1.08-2.50). Estimates of etiologic fractions suggest that reduction of ergonomic problems to the low level currently experienced by 25% of drivers would result in a 19% reduction of severe LBI among all drivers. A change from full- (more than 30 hr) to part-time driving (20-30 hr) could reduce the number of severe LBI by 59%, although this gain would be reduced to 28% at the company level if injuries expected among additional employees, hired to maintain full service are included. CONCLUSIONS: Duration of professional driving and ergonomic problems are independent and preventable risk factors for LBI even after adjustment for psychosocial factors.

Adult↗

PubMed2004

Occupational stressors and hypertension: a multi-method study using observer-based job analysis and self-reports in urban transit operators.

This multi-method study aimed to disentangle objective and subjective components of job stressors and determine the role of each for hypertension risk. Because research on job stressors and hypertension has been exclusively based on self-reports of stressors, the tendency of some individuals to use denial and repressive coping might be responsible for the inconclusive results in previous studies. Stressor measures with different degrees of objectivity were contrasted, including (1) an observer-based measure of stressors (job barriers, time pressure) obtained from experts, (2) self-reported frequency and appraised intensity of job problems and time pressures averaged per workplace (group level), (3) self-reported frequency of job problems and time pressures at the individual level, and (4) self-reported appraised intensity of job problems and time pressures at the individual level. The sample consisted of 274 transit operators working on 27 different transit lines and four different vehicle types. Objective stressors (job barriers and time pressure) were each significantly associated with hypertension (casual blood pressure readings and/or currently taking anti-hypertensive medication) after adjustment for age, gender and seniority. Self-reported stressors at the individual level were positively but not significantly associated with hypertension. At the group level, only appraisal of job problems significantly predicted hypertension. In a composite regression model, both observer-based job barriers and self-reported intensity of job problems were independently and significantly associated with hypertension. Associations between self-reported job problems (individual level) and hypertension were dependent on the level of objective stressors. When observer-based stressor level was low, the association between self-reported frequency of stressors and hypertension was high. When the observer-based stressor level was high the association was inverse; this might be indicative of denial of stress or alexithymia. We feel that multi-method studies are useful for disentangling the relations between objective and subjective stress and hypertension.

Adult↗

PubMed2003

Risk factors predicting hip pain in a 5-year prospective cohort study.

OBJECTIVES: The aim of the study was to identify and quantify risk factors for hip pain. METHODS: A representative sample of 5001 Danish men and women aged 18-65 years in 1990 were interviewed about occupational exposures (response rate 90%); 5 years later they were reinterviewed about hip pain (response rate 86%). Logistic regression with forced entry of all the independent variables was used to estimate the odds ratios for the possible risk factors. The impact of the various predictors was assessed through the calculation of population etiologic fractions. RESULTS: A double risk of hip pain was found for the women as compared with the men [odds ratio (OR) 2.28, 95% confidence interval (95% CI) 1.68-3.09]. The risk increased with body mass index. Whole-body vibration (OR 1.86, 95% CI 1.09-2.71) and physically demanding work (OR 1.83, 95% CI 1.23-2.71) were strong predictors of hip pain, while a squatting work posture was protective (OR 0.64, 95% CI 0.42-0.98). The impact of the statistically significant predictors (the etiologic fractions) was as follows: 0.49 for body mass index, 0.05 for whole body vibration, 0.10 for physically demanding work, and 0.32 for squatting (preventive). CONCLUSIONS: Female gender, age, high body mass index, whole-body vibration, and physically demanding work are significant risk factors for hip pain.

Adolescent↗

PubMed2002

Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors.

Return to work after injury or illness is a behavior influenced by physical, psychological, and social factors. Disability research lacks a conceptual framework for combining these factors in the study of the return-to-work process. Two extant theoretical models within the social context are considered as they apply to the behavior of returning to work: 1) the Readiness for Change Model originating from the field of health promotion and addressing the issue of motivation for behavior change, and 2) the Phase Model of Disability developed for the epidemiological study of occupational disability addressing the developmental and temporal aspects of disability. A new Readiness for Return-to-Work Model is proposed focusing on the interpersonal context of the work-disabled employee. Employee interactions with the workplace, the health care, and insurance systems are considered as they impact the three defining dimensions of change--decisional balance, self-efficacy and change processes. The evidence for their impact on return-to-work is examined within the framework of the Phase Model of Disability, which puts forth the phase-specificity of symptoms, risks, and interventions for disability. The Readiness for Return-to-Work Model has the potential to account for individual variation in optimal stage-specific timing of interventions based on an individual's readiness for return-to-work. The model therefore complements the Phase Model of Disability by allowing for an individual-level staging of the disability and recovery process within the broader group-level-derived framework of occupational disability phases. This link between the two models needs to be empirically tested in future research.

Accidents, Occupational↗

PubMed2002

Alcohol consumption and incidence of workers' compensation claims: a 5-year prospective study of urban transit operators.

BACKGROUND: Numerous studies have linked alcohol impairment on the job to occupational injury. Few studies have looked at the association of nonwork drinking and occupational injury. METHODS: This study examines first workers' compensation claims after a baseline assessment of alcohol consumption and other occupational variables in 1836 transit operators participating in a medical examination for driver's license renewal. A proportional hazard model was used for the analysis. RESULTS: Individuals with higher alcohol consumption were more likely to be male, have more years of driving, and have a higher job-stress score. When these variables were controlled for, individuals with higher alcohol consumption were more likely to have a workers' compensation claim over the follow-up period. Individuals reporting a consumption of 10 to 14 drinks per week had a hazard of 1.30 (p = 0.03), and those reporting 15 or more drinks per week had a hazard of 1.27 (p = 0.05) compared with individuals reporting no drinks consumed per week. CONCLUSIONS: This study indicates that drinking off the job is associated with workers' compensation injury claims. Because it is presumed that most drinking was done outside work, due to high public scrutiny of city transit operators, these results suggest that experience in life outside of work may influence work outcomes. Research should be conducted to identify the mechanisms (e.g., drinking before work, hangover, fatigue) of such effects.

Adult↗

PubMed2002

The impact of a worker health study on working conditions.

A research partnership of representatives from labor, academia, and public health enabled unionized San Francisco hotel workers to achieve important policy changes in workplace health and safety. Known as the "Housekeeping Study," the project took sixteen months to complete. A unique aspect of the project was that it utilized participatory action research methods, involving workers themselves as full participants in the study. A core group of 25 hotel room cleaners was involved in each phase of the project. The study developed health data which enabled room cleaners and their union to formulate and justify a contract proposal calling for a significant reduction in housekeeping workloads. The employer association agreed to a contract which reduced the maximum required room assignment from 15 rooms to 14 rooms per day in 14 San Francisco hotels. By lowering the maximum work assignment, these workers set a new standard which can potentially protect the health of room cleaners across the country. The project can serve as a model for worker and union participation in academic research, as well as for the application of research to improving working conditions, particularly for low-wage immigrant workers.

Data Collection↗