Biomedical subjects

Renée Bourbonnais

Publications and source records attributed to Renée Bourbonnais.

9 recordsLinked to original sources

PubMed2006

Determinants of "return to work in good health" among workers with back pain who consult in primary care settings: a 2-year prospective study.

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.

Adaptation, Psychological↗

PubMed2005

A clinical return-to-work rule for patients with back pain.

BACKGROUND: Tools for early identification of workers with back pain who are at high risk of adverse occupational outcome would help concentrate clinical attention on the patients who need it most, while helping reduce unnecessary interventions (and costs) among the others. This study was conducted to develop and validate clinical rules to predict the 2-year work disability status of people consulting for nonspecific back pain in primary care settings. METHODS: This was a 2-year prospective cohort study conducted in 7 primary care settings in the Quebec City area. The study enrolled 1007 workers (participation, 68.4% of potential participants expected to be eligible) aged 18-64 years who consulted for nonspecific back pain associated with at least 1 day's absence from work. The majority (86%) completed 5 telephone interviews documenting a large array of variables. Clinical information was abstracted from the medical files. The outcome measure was "return to work in good health" at 2 years, a variable that combined patients' occupational status, functional limitations and recurrences of work absence. Predictive models of 2-year outcome were developed with a recursive partitioning approach on a 40% random sample of our study subjects, then validated on the rest. RESULTS: The best predictive model included 7 baseline variables (patient's recovery expectations, radiating pain, previous back surgery, pain intensity, frequent change of position because of back pain, irritability and bad temper, and difficulty sleeping) and was particularly efficient at identifying patients with no adverse occupational outcome (negative predictive value 78%- 94%). INTERPRETATION: A clinical prediction rule accurately identified a large proportion of workers with back pain consulting in a primary care setting who were at a low risk of an adverse occupational outcome.

Adolescent↗

PubMed2005

Prevalence of musculoskeletal pain and associated factors in the Quebec working population.

BACKGROUND: While the determinants of musculoskeletal pain are numerous, few studies conducted among workers have taken into account, altogether, physical factors, psychosocial factors (personal and work-related) and individual characteristics. OBJECTIVES: To estimate the 1-year prevalence of musculoskeletal pain in the Quebec working population by gender and anatomical site, and to determine which factors are associated with these prevalence figures. METHODS: Data came from the 1998 Quebec Health Survey and included 9,496 individuals. One-year period prevalences for neck pain, back pain and pain in the upper and lower extremities were calculated for men and women. Logistic regression analyses were conducted to estimate the associations between individual, physical and psychosocial work factors, on one hand, and musculoskeletal pain in the four body regions, on the other hand. RESULTS: For both genders back pain was the most frequent musculoskeletal symptom that had disturbed their activities during the past year. The largest difference between genders was observed for neck pain (women: 18%; men: 11%). Multivariate analyses indicated that physical and psychosocial work factors, as well as psychological variables, were associated with musculoskeletal pain in different body regions. Body mass index was associated only with pain in lower extremities for both genders. CONCLUSIONS: The results of this study suggest that interventions aimed at reducing musculoskeletal pain should take into account personal and work-related psychosocial variables, in addition to physical workload.

Adult↗

PubMed2005

Health care restructuring, work environment, and health of nurses.

BACKGROUND: In the last 15 years, the health care system has undergone significant restructuring. The study's objective was to examine the psychosocial work environment and the health of nurses after major restructuring in comparison with two reference populations. METHODS: This cross-sectional study involved 2,006 nurses from 16 health centers. A questionnaire measured current work characteristics: psychological demands, decision latitude, and social support at work from Karasek's Job Content Questionnaire, organizational changes, and health effects. Prevalence ratios and binomial regression were used to examine the associations between current work characteristics, changes and psychological distress (PSI). RESULTS: There was a considerable increase in the prevalence of PSI and of adverse psychosocial work factors in comparison to the prevalence reported by a comparable group of nurses in 1994. These adverse factors were also more prevalent among nurses than among Québec working women and they were independently associated with psychological distress. CONCLUSION: Workplace interventions should be based on elements identified by many nurses as being problematic.

Adolescent↗

PubMed2005

Improving the psychosocial work environment.

AIM: This paper reports a pilot project to evaluate the effectiveness of a participatory organizational intervention to improve the psychosocial work environment in one long-term care unit. BACKGROUND: Since the early 1990s, health care institutions in Quebec have been constantly changing in order to improve the efficiency of the health care system. These changes have affected the work environment and have contributed to higher rates of burnout and absenteeism among nurses and other health care workers. METHOD: The study participants were health care workers in a long-term care unit (n = 60). The participatory organizational intervention was based on a contract and carried out by a work team. Work constraints were identified, and an action plan implemented, The effectiveness of the intervention was evaluated by pre- and postintervention questionnaires: the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire and Psychiatric Symptom Index. RESULTS: There was a significant increase in reward (P < or = 0.01) and a significant decrease in Effort-Reward Imbalance (P < or = 0.01) following the intervention. Absenteeism rates decreased from 8.26% to 1.86% over the study period, but in the rest of the institution remained the same. However, there was a significant decrease in social support from supervisors (P < 0.05) at post-test. CONCLUSION: Participation by health care workers and action plans targeting problematic aspects of the psychosocial work environment are key elements in interventions to improve their health. However, such interventions present challenges, such as the involvement of managers, involvement of all relevant participants, and re-establishment of trust within work teams. Recognition and respect must be re-established, and supervisors must engage with health care workers and give support at all stages of the intervention.

Absenteeism↗

PubMed2005

Prevalence of musculoskeletal activity limitation and associated factors among adults in the general population in the 1998 Quebec Health Survey.

OBJECTIVE: To estimate the prevalence of short term and longterm musculoskeletal activity limitation among the general adult population of the province of Quebec, and to identify which factors are associated with these limitations. METHODS: We analyzed cross-sectional data from the 1998 Quebec Health Survey. Logarithmic binomial regression models were used to estimate prevalence ratios of (1) short term activity limitation related to musculoskeletal disorders (MSD); and (2) longterm activity limitation related to MSD in relation to demographic and behavioral variables and comorbidity factors. RESULTS: About one-fifth of participants reporting short term activity limitation and one-third of participants reporting longterm activity limitation mentioned MSD as a cause. Multivariate analyses showed that higher age, lower income, being overweight, ill defined nervousness, and the number of traumatic events that occurred before age 18 years were significantly associated with short term and longterm activity limitation related to MSD, whereas being in the minority ethnic group was protective for both outcomes. Female sex, physical inactivity, being a former alcohol drinker, and mental disorders were also associated with longterm activity limitation. CONCLUSION: MSD are a major cause of activity limitation among adults from Quebec. With the aging population and the increasing prevalence of obesity, increasing prevalence of activity limitation related to MSD is to be expected.

Activities of Daily Living↗

PubMed2004

Workplace prevention and promotion strategies.

Psychosocial factors refer to all organizational factors and interpersonal relationships in the workplace that may affect the health of the workers. Currently, two psychosocial risk models are universally recognized for producing solid scientific knowledge regarding the vital link between social or psychological phenomena at work and the development of several diseases, such as cardiovascular diseases or depression. The first is the "job demand-contro-support" model, which was defined by Karasek and to which the concept of social support has been added; the second is the "effort/reward imbalance" model defined by Siegrist. The public health perspective calls for theoretical models based on certain psychosocial attributes of the work environment for which there is empirical evidence of their pathogenic potential for exposed workers. Not only do these models reduce the complexity of the psychosocial reality of the work to components that are significant in terms of health risks, but they also facilitate the development and implementation of workplace interventions. Psychosocial risk intervention strategies currently implemented by companies are predominantly individual-oriented and aim chiefly at reducing the effects of stressful work situations by improving individual ability to adapt to the situation and manage stress. Like personal protection equipment for exposure to physical or chemical risks, these secondary prevention measures are commendable but insufficient, because they aim to reduce only the symptoms and not the cause of problems. Any intervention program for these risks should necessarily include a primary prevention component with a view to eliminating, or at least reducing, the psychosocial pathogenic agents in the workplace. Several authors have suggested that well-structured organizational approaches are most effective and should generate more important, longer-lasting effects than individual approaches. However, the evidence should be strengthened by more systematic studies to assess the models, their implementation and the outcomes for employers and employees alike. The research agenda on mental health and the workplace should have the following goals; to foster the development and evaluation of well-adapted models of interventions designed to reduce adverse psychosocial factors and their mental health effects to give a better understanding of the prevalence of work organization risk factors in Canada, how they may be changing and how they affect mental health in the long term to acquire an understanding of the effects on mental health of prominent trends in organizational practices, such as restructuring, lean production and flexible staffing (all of which result in precarious employment), that may pose special risks for women, immigrants or aging workers in Canada to collect data on the considerable direct and indirect costs to business, workers and society of work-related stress in Canada.

Employment↗

PubMed2004

Psychosocial job factors and the one-year evolution of back-related functional limitations.

OBJECTIVES: This 1-year prospective study aimed at assessing the association between some psychosocial job characteristics and back-related functional limitations. METHODS: The participants were 849 workers who sought medical consultation for nonspecific back pain in primary care settings of the Quebec City area. Information on job decision latitude, psychological demands, and social support at work was collected during a telephone interview conducted after the medical consultation. Back-related functional limitations were measured at baseline and 1 year later with the Roland-Morris Disability Questionnaire. The analyses were stratified by gender. Social support at work and the type of back pain were considered potential effect modifiers. Several potential confounders were also considered in the multiple regression analyses that were conducted to isolate the effect of the job psychological demands and decision latitude on the 1-year level of back-related functional limitations. RESULTS: A modest difference in the 1-year Roland-Morris average scores was found only among the women and only for the association between job decision latitude with back-related functional limitations, according to the level of social support at work. This difference was of limited clinical significance. Analyses by type of back pain showed, however, a clinically significant association between the combination of high psychological demands and low decision latitude and back-related functional limitations only for subjects with persistent pain. CONCLUSIONS: Job psychological demands and decision latitude have little influence on the 1-year evolution of back-related functional limitations for one-time and recurrent back-pain problems. However, our results suggest that this association could be important for workers with persistent pain.

Adult↗

PubMedDate not supplied

Psychologic distress in postmyocardial infarction patients who have returned to work.

OBJECTIVE: To assess the prevalence of psychologic distress in women and men returning to work after a myocardial infarction (MI) and to compare this prevalence with the prevalence observed among men and women of the general working population. METHODS: The study population was composed of 990 post-MI patients (106 women and 884 men) recruited in 30 hospitals who had returned to work after their first MI. Psychologic distress was measured with the French version of the Psychiatric Symptom Index (PSI). Adjusted mean PSI score and prevalence of psychologic distress were compared with those observed in 8829 other workers (3823 women and 5006 men), representative of the general working population. RESULTS: Mean PSI score was higher in post-MI women (30.3) than in post-MI men (20.3). This score was also higher in the post-MI population than in the general working population, both for women (30.3 compared with 17.0) and men (20.3 compared with 14.1). Psychologic distress was more prevalent in post-MI women than in post-MI men (prevalence ratio [PR], 1.62; confidence interval [CI], 1.27-2.07). This score was also higher in post-MI women and post-MI men than in the general working population (PR, 2.18; CI, 1.75-2.71 and 1.76; CI, 1.48-2.08, respectively). CONCLUSIONS: Among the presumably fittest post-MI patients, namely those who had returned to work, psychologic distress was significantly more prevalent than in the general working population, particularly among women. Further research is needed to shed light on prognosis in post-MI workers experiencing psychologic distress and on adequate intervention before and after their return to work.

Activities of Daily Living↗