Daily self-reports resulted in information bias when assessing exposure duration to computer use

Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors

BACKGROUND

The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal.

METHODS

All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables.

RESULTS

A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients.

CONCLUSIONS

Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.

Correctness of Self-Reported Task Durations: A Systematic Review

Objectives

Duration of tasks in a job is an essential interest in occupational epidemiology. Such duration is frequently measured using self-reports, which may, however, be associated with both bias and random errors. The present systematic literature review examines the correctness of self-reported durations of tasks, i.e. the extent to which they differ from more valid reference data due to either systematic or random errors, and factors influencing this correctness, with particular emphasis on the assessment of exposures of relevance to musculoskeletal disorders.

Methods

The search for relevant studies included the databases ISI Web of Science, MEDLINE, EBSCO HOST, Proquest, and Psycnet.

Results

Thirty-two articles were identified; of which, 23 examined occupational tasks and 9 examined non-occupational tasks. Agreement between self-reports and a more correct reference was reported for, in total, 182 tasks. Average proportional errors were, for most tasks, between -50% (i.e. underestimations) and +100%, with a dominance of overestimations; 22% of all results considered overestimations of 100% or more. For 15% of the 182 reported tasks, the mean difference between the self-reported and the reference duration value was <5%, and 20% of the 182 mean differences were between 5 and 20%. In general, respondents were able to correctly distinguish tasks of a longer duration from shorter tasks, even though the actual durations were not correct. A number of factors associated with the task per se appeared to influence agreement between self-reports and reference data, including type of task, true task duration, task pattern across time (continuous versus discontinuous), and whether the addressed task is composed of subtasks. The musculoskeletal health status of the respondent did not have a clear effect on the ability to correctly report task durations. Studies differed in key design characteristics and detail of information reported, which hampers a formal aggregation of results.

Conclusions

The correctness of self-reported task durations is, at the best, moderate at the individual level, and this may present a significant problem when using self-reports in task-based assessment of individual job exposures. However, average self-reports at the group level appear reasonably correct and may thus be a viable method in studies addressing, for instance, the relative occurrence of tasks in a production system. Due to the disparity of studies, definite conclusions on the quantitative effect on agreement of different modifiers are not justified, and we encourage future studies specifically devoted to understanding and controlling sources of bias in self-reported task durations. We also encourage studies developing decision support for when to apply or avoid self-reports to measure task durations, depending on study purpose and occupational setting.

The relationship among computer work, environmental design, and musculoskeletal and visual discomfort: examining the moderating role of supervisory relations and co-worker support

PURPOSE

The prevalence of work-related upper extremity musculoskeletal disorders and visual symptoms reported in the USA has increased dramatically during the past two decades. This study examined the factors of computer use, workspace design, psychosocial factors, and organizational ergonomics resources on musculoskeletal and visual discomfort and their impact on the safety and health of computer work employees.

METHODS

A large-scale, cross-sectional survey was administered to a US manufacturing company to investigate these relationships (n = 1259). Associations between these study variables were tested along with moderating effects framed within a conceptual model.

RESULTS

Significant relationships were found between computer use and psychosocial factors of co-worker support and supervisory relations with visual and musculoskeletal discomfort. Co-worker support was found to be significantly related to reports of eyestrain, headaches, and musculoskeletal discomfort. Supervisor relations partially moderated the relationship between workspace design satisfaction and visual and musculoskeletal discomfort.

CONCLUSION

This study provides guidance for developing systematic, preventive measures and recommendations in designing office ergonomics interventions with the goal of reducing musculoskeletal and visual discomfort while enhancing office and computer workers' performance and safety.

A comparison of two methods to assess the usage of mobile hand-held communication devices

The purposes of this study were to: 1) examine agreement between self-reported measures of mobile device use and direct measures of use, and 2) understand how respondents thought about their device use when they provided self-reports. Self-reports of six categories of device use were obtained using a previously developed questionnaire, and direct measures of use were collected using a custom logging application (n = 47). Bland-Altman analyses were used to examine agreement between the two measurement approaches. Interviews targeted participants' experiences completing the device use section of the questionnaire. Self-reports of use on a typical day last week overestimated logged use. Overestimates tended to be low at low average usage times, and became more variable as usage time increased. Self-reports of use yesterday also exceeded logged use, however the degree of overestimation was less than for a typical day last week. Six themes were identified from interviews, including the thought process used by participants to arrive at usage and the ease of reporting usage. It is challenging for respondents of this questionnaire to provide accurate self-reports of use. The source of this challenge may be attributed to the intrinsic difficulty of estimating use, partly due to the multiple functions of the devices as well as the variability of use both within a day and a week. Research investigating the relationship between device use and health outcomes should include a logging application to examine exposure simultaneously with self-reports to better understand the sources of hazardous exposures.

Musculoskeletal disorders among clerical workers in Los Angeles: a labor management approach

BACKGROUND

Musculoskeletal disorders (MSDs) persist among clerical workers despite ergonomic advances.

METHODS

A cross-sectional survey among 2,310 clerical workers investigated MSD cases, defined as musculoskeletal discomfort and seeking treatment for that discomfort in the past 12 months. A modified Poisson regression model was adopted to assess the association between work and individual factors and the risk of MSDs.

RESULTS

Over half of respondents reported musculoskeletal discomfort. The prevalence of MSD cases was: 37.2% neck/shoulders, 21.7% upper extremities, 18% lower extremities, and 34.3% back region. Elevated risk of MSDs was associated with less workstation adjustability; work schedule, gender, age, and BMI were also significant. Positive trends were observed between computer use and MSDs for the neck/shoulder region and the effect was amplified among those reporting insufficient workstation adjustability and lacking computer ergonomics training.

CONCLUSIONS

Results demonstrate the need to limit continuous computer use and to improve the human-machine interface through adjustable workstations and worker training to enhance use of adjustable features.

Diversity of tasks and information technologies used by office workers at and away from work

BACKGROUND

Computer use is associated with musculoskeletal complaints among office workers. Insufficient exposure diversity between tasks is a proposed etiological factor, but little information exists on diversity of tasks and information and communication technologies (ICT) among office workers.

METHOD

Direct observation and self-report data were collected on tasks performed and ICT used among 24 office workers, over 12 h in work and non-work environments. Self-reports were repeated on four additional days.

RESULTS

Observations were for a mean [SD] 642[40] min. Productive tasks comprised 63% of observations, instrumental 17%, self-care 12% and leisure 8%. Non-ICT tasks comprised 44% of observations; New electronic-based ICT 36%; Old paper-based ICT 15%, and Combined ICT tasks 4%. Proportions of tasks and ICT use differed between environments and days.

CONCLUSION

Information about diversity in tasks and ICT provides the basis for future investigations into exposure variation in ICT-intensive environments and possible musculoskeletal health risks. STATEMENT OF RELEVANCE: Information and communication technologies (ICT) provide office workers access to perform work-related tasks after work hours and in away-from-work locations. Musculoskeletal disorder risk assessment for office workers should account for actual tasks performed over a work day, including away from work exposures. This study provides rich, detailed data on occurrence of tasks performed and ICT used by office workers throughout the day.