Risk factors for musculoskeletal disorders among farm owners and farm workers: a systematic review

Occupational Risk Factors for Musculoskeletal Disorders among Workers in Dairy Diversification

BACKGROUND

In a changing European agricultural context, diversification of dairy farms is gaining attention. This study seeks to (1) assess musculoskeletal pain prevalence associated with tasks such as butter, yogurt, and cheese production; and (2) analyze associated risks.

METHODS

Observing 31, mostly female, workers, we utilized the ERGOROM questionnaire, a methodology adapted from the Institut National de Recherche et de Sécurité, and Key Indicator Method forms.

RESULTS

Findings revealed that tasks like load carrying (42% of workers), manual work (17%), and awkward postures (14%) resulted in musculoskeletal pain, predominantly in the lower back (65%), neck (39%), and dominant upper limb areas (shoulder: 61%, elbow: 26%, and wrist: 65%). While psychosocial risks remained low, concerns arose from workload, hygiene standards, and resource unpredictability.

CONCLUSIONS

As dairy farming evolves from artisanal to semi-industrial, our study emphasizes the importance of ergonomic adaptations to protect farmers' health and prevent musculoskeletal disorders during diversification.

Occupational health surveillance and detection of emerging occupational diseases among Taiwan farmers, through analysis of national-based farmers' and medico-administrative databases

OBJECTIVES

The purpose of this study was to identify occupational injuries and diseases associated with agriculture in Asia, to provide a reference for prevention and hypotheses for future research.

METHODS

We matched data on agricultural workers (n = 963,124) enrolled in Taiwan's national Farmers Health Insurance since its inception in 1989, to general population controls of the same age, gender, and township. The study population was linked to the National Health Insurance Research Database from 2001 to 2016 for inpatient cases. Logistic regression was used to assess odds ratios for outcomes.

RESULTS

Farmers had 2.76 times the risk of mycotic corneal ulcer (95% CI: 1.96-3.87) and 1.65 times the risk of typhus fever infections (95% CI: 1.47-1.85) compared to the general population. The odds ratio for poisonous animal bites was 2.22 (95% CI: 2.07-2.38), for falling into a storm drain or manhole was 2.04 (95% CI: 1.30-3.20), and for toxic effects from pesticides was 2.01 (95% CI: 1.92-2.11). The toxic effects of organophosphate and carbamate insecticides were correlated with the cultivation of rice, fruit trees, and flowers. Q fever and motorcycle accidents were associated with fruit tree cultivation.

CONCLUSIONS

The study identifies agricultural occupational injuries and diseases that may inform occupational health policy and the development of prevention priorities to prevent occupational hazards for farmers.

Mistreatment at work and musculoskeletal pain in male and female working Syrian refugee children

Since the Syrian war in 2011, Syrian refugees in Lebanon have continued to experience socioeconomic deprivation, resorting many families to child labour as a form of survival. Adopting a gender-sensitive analysis, this study explores the relationship between psychosocial adversities and musculoskeletal pain among male and female Syrian refugee children in Lebanon, using data from a cross-sectional survey of working Syrian refugee children between 8 and 18 years in informal tented settlements in the Bekaa Valley of Lebanon. The majority of working children (4090) worked in agriculture (75.8%). Of the children who experienced musculoskeletal pain, 27.4% worked despite severe pain, three-quarters of the children worked under time pressure, over a third (37.4%) were physically abused at work, and the majority (95.8%) had a good relationship with their co-workers. Logistic regression models revealed a significant association between exposure to psychosocial stressors at work and musculoskeletal pain among male and female children.Practitioner summary: This study is the first to obtain direct testimony on musculoskeletal pain and psychosocial risk factors, among Syrian refugee children in Lebanon. Using a gender-sensitive analysis, the survey results demonstrated associations between exposure to psychosocial stressors and musculoskeletal pain among male/female Syrian refugee children enduring strenuous working conditions.

Lessons Learned from an Attempted Pragmatic Randomized Controlled Trial for Improvement of Chronic Pain-Associated Disability in Green Professions: Long-Term Effectiveness of a Guided Online-Based Acceptance and Commitment Therapy  (PACT-A)

Musculoskeletal symptoms are increased in farmers, whereas the prevalence of chronified pain is unknown. Online interventions based on acceptance and commitment therapy (ACT) have shown encouraging results in the general population, representing a promising approach for reducing pain interference in green professions (i.e., farmers, foresters, gardeners). We conducted a pragmatic RCT comparing a guided ACT-based online intervention to enhanced treatment-as-usual in entrepreneurs, contributing spouses, family members and pensioners in green professions with chronic pain (CPG: ≥grade II, ≥6 months). Recruitment was terminated prematurely after 2.5 years at N = 89 (of planned N = 286). Assessments were conducted at 9 weeks (T1), 6 months (T2) and 12 months (T3) post-randomization. The primary outcome was pain interference (T1). The secondary outcomes encompassed pain-, health- and intervention-related variables. No treatment effect for reduction of pain interference was found at T1 (β = -0.16, 95%CI: -0.64-0.32, p = 0.256). Improvements in cognitive fusion, pain acceptance, anxiety, perceived stress and quality of life were found only at T3. Intervention satisfaction as well as therapeutic and technological alliances were moderate, and uptake and adherence were low. Results are restricted by low statistical power due to recruitment issues, high study attrition and low intervention adherence, standing in contrast to previous studies. Further research is warranted regarding the use of ACT-based online interventions for chronic pain in this occupational group. Trial registration: German Clinical Trial Registration: DRKS00014619. Registered: 16 April 2018.

Older Female Farmers and Modeling of Occupational Hazards, Wellbeing, and Sleep-Related Problems on Musculoskeletal Pains

Musculoskeletal pains seem to be the most prevalent among occupational diseases in older female farmers. This study analyzes the relationships between exposure to ergonomic or environmental hazards, sleep-related problems, wellbeing, and musculoskeletal pains in older female farmers. In this study, older farmer means a farmer aged ≥60, and 2005 older female farmers were selected. A structural equation model (SEM) was used to investigate the relationships. In the results of SEM, musculoskeletal pains were more affected by the level of wellbeing (standardized path coefficient = −0.149) than the level of sleep-related problems (standardized path coefficient = 0.131) or the exposure level of ergonomic hazards (standardized path coefficient = 0.086). Among the ergonomic risk factors felt by elderly female farmers, the influence level of “awkward posture” (0.735), “repetitive motion” (0.718), or “standing posture” (0.693) was greater than that of “manual material handling” (0.661). “Vibration” (0.786) and “noise” (0.683) were influential variables of environmental hazards. In addition, “upper limb pain” (0.796) and “lower limb pain” (0.751) variables were more influential variables of musculoskeletal pains than the “backache” (0.472) variable. This study shows that strategies to improve wellbeing or sleep problems are important to alleviate or prevent musculoskeletal pains among older female farmers.

Prevalence and risk factors for MSDs in vegetable greenhouse farmers: a cross-sectional survey from Shandong rural area, China

Purpose:

The aim of the research is a cross sectional survey on the prevalence of symptoms related to MSDs in vegetable greenhouse farmers from Shandong rural area and on the risk factors that may influence it.

Methods:

This cross-sectional survey was selected 249 farmers working in vegetable greenhouse from different districts of Shandong Province, China. The Questionnaire and the Rapid Upper Limb Assessment (RULA) technique were used to identify ergonomic risks. χ² analysis was used to find the relationship between MSDs and various factors. Also, logistic regression methodology was applied to get the most influencing factor for MSDs.

Results:

The prevalence of MSDs in farmers working in vegetable greenhouse is 87.5%, and the top 3 prevalent areas of MSDs in various parts of the body are: lower back (47.4%), neck (33.3%), and shoulder (31.7%). The results of Logistic regression analysis showed that age, years working in vegetable greenhouses, keeping their backs in the same position for a long time, and working hours greater than 10 hours per day were the risk factors for MSDs in the farmers. The outcome of the RULA grand score had been found to be higher than 5 in the overwhelming majority of the farmers.

Conclusions:

All findings infer that each task of greenhouse vegetable growing inflicts different levels of disorder in a farmers’ musculoskeletal structure. Interventions should be increased and reduce the bad ergonomic load level as soon as possible, provided to reduce the impact of such disorders.

Effects of human variation on foot and ankle pain in rural Madagascar

OBJECTIVES

Foot and ankle dysfunction in barefoot/minimally shod populations remains understudied. Although factors affecting musculoskeletal pain in Western populations are well-studied, little is known about how types of work, gender, and body shape influence bone and joint health in non-Western and minimally shod communities. This study examines the effect of human variation on locomotor disability in an agrarian community in Madagascar.

MATERIALS AND METHODS

Foot measurements were collected along with height, weight, age, and self-report data on daily activity and foot and ankle pain from 41 male and 48 female adults. A short form revised foot function index (FFI-R), that measures functional disability related to foot pain, was calculated. Raw and normalized foot measurements were compared by gender and used in a multiple linear regression model to determine predictors of FFI-R.

RESULTS

Compared to men, women reported higher FFI-R scores (p = 0.014), spent more time on their feet (p = 0.019), and had higher BMIs (p = 0.0001). For their weight, women had significantly smaller and narrower feet than men. Bimalleolar breadth (p = 0.0005) and foot length (p = 0.0223) standardized by height, time spent on feet (p = 0.0102), ankle circumference standardized by weight (p = 0.0316), and age (p = 0.0090) were significant predictors of FFI-R score.

DISCUSSION

Our findings suggest that human variation in anatomical and behavioral patterns serve as significant explanations for increased foot and ankle pain in women in this non-Western rural population. Foot and ankle pain were prevalent at similar levels to those in industrialized populations, indicating that research should continue to examine its effect on similar barefoot/minimally shod communities.

Socio-Demography, Working Conditions, and Musculoskeletal Ailments among Pineapple Farmers in Northeast India

This study was conducted to examine the socio-demography, working conditions, and consequential musculoskeletal ailments of pineapple farmers in northeast India. A total of 152 pineapple farmers (92 males and 60 females) participated in the study. Data were collected using a pre-tested structured schedule and a standard Nordic questionnaire through personal interviews followed by direct observation. Chi-square (χ²) analysis and multiple logistic regression were conducted using SPSS software 16.0 to explore the association of various independent factors and their influences on the musculoskeletal symptoms (MSS) scores. The study revealed that a majority (>85%) of the pineapple farmers in northeast India had low to medium annual income, with more than 95% of the farmers belonging to small and marginal categories. Moreover, MSS were highly prevalent among the farmers (79.61%), and the low-back (76.32%) was the most affected body part. The results of the Chi-square (χ²) analysis highlighted that age, education level, and farming experience were significantly associated (p < 0.05) with the prevalence of overall MSS among the pineapple farmers. Among the factors, only age and gender significantly influenced the risk of complaints for the farmers' neck (OR = 6.62, 95% CI: 1.29-34.02, p ≤ 0.05) and low back (OR = 2.54, 95% CI: 1.00-6.47, p ≤ 0.05). This study's findings demonstrated the need for the urgent exploration of sustainable and innovative interventions to reduce the occurrence of MSS and improve the working conditions of the pineapple farmers in northeast India.

Frequency of examination and perceived contribution of factors relating to work-related musculoskeletal disorders of physiotherapists

Objective. Literature confirms that many physiotherapists suffer from work-related musculoskeletal disorders (WMSDs), but studies mention different, complementary and contradictory findings regarding risk factors. This scoping review aimed at revealing the most frequently examined and contributory WMSD factors mentioned in recent studies about physiotherapists. Methods. Based on specific inclusion/exclusion and appraisal criteria, 11 studies published between 2012 and 2018 were included in the analysis. The factors recorded per publication were grouped into 18 categories, the frequency of their appearance across the sources was counted and the median ranks of their relative reported contribution were calculated. Results. Excessive workload was found to be the most contributory factor, followed by the application of manual orthopaedic techniques. However, demanding and repetitive manual tasks were the most common factors investigated in the publications reviewed. A medium-strength correlation was found between the frequency of examination and reported contribution of factors but with a noticeable range of the confidence interval possibly due to the diversity of the approaches in the studies reviewed. Conclusions. The findings indicate a relative discordance between the level of contribution of each factor to the development of WMSDs and the types of factors most frequently addressed by studies.

Carpal Tunnel Syndrome Among Male French Farmers and Agricultural Workers: Is It Only Associated With Physical Exposure?

Background

Exploratory study to investigate whether co-exposure to physical wrist stressors and chemicals is associated with carpal tunnel syndrome (CTS) in French male farmers and agricultural workers.

Methods

Cross-sectional study of 711 men aged 30–65 years and working as either farmers or agricultural workers in 2009–2010 within a cohort covered by the French Agricultural Workers' and Farmers' Mutual Benefit Fund. CTS and exposure to physical wrist stressors and chemicals were assessed using a self-administered questionnaire. Associations between CTS and personal/medical factors, exposure to physical wrist stressors, exposure to chemicals, and co-exposure to physical wrist stressors and chemicals were studied using multivariate logistic regression models.

Results

Forty-four men {5.6% [95% confidence interval (CI) 4.0–7.7]} reported that they had suffered from unilateral/bilateral CTS during the last 12 months. CTS was associated with age, current smoking [odds ratio (OR) = 2.1 (1.0–4.5)], and exposure to physical wrist stressors [OR = 2.6 (1.1–5.9)]. An association was found between CTS and co-exposure to physical wrist stressors and chemicals [OR = 3.3 (0.8–14.3), p = 0.044] in comparison with the no-exposure group.

Conclusions

This exploratory study shows an association of CTS with exposure to biomechanical wrist stressors in male farmers and agricultural workers and suggests an association of CTS with co-exposure to physical wrist stressors and chemicals. Owing to the limitations of the study, this result must be confirmed by a prospective study with objective assessments of the outcome and exposure before drawing conclusions on the possible synergistic effects of mechanical stressors and chemicals on the impairment of the median nerve.

Biomechanical factors during common agricultural activities: Results of on-farm exposure assessments using direct measurement methods

Agricultural work is associated with increased risk of adverse musculoskeletal health outcomes. The purpose of this study was to quantify exposure to biomechanical factors among a sample (n = 55) of farmers in the Midwest region of the U.S. while they performed a variety of routine agricultural activities, and to compare exposure levels between these activities. Surface electromyography was used to estimate activity levels of the erector spinae, upper trapezius, forearm flexor, and forearm extensor muscle groups. Simultaneously, inertial sensors were used to measure kinematics of the trunk, upper arm, and wrist. In general, lower muscle activity levels, less extreme postures, and slower movement speeds were observed during activities that involved primarily the use of agricultural machinery in comparison to manual activities, suggesting a potential advantage of mechanization relative to musculoskeletal health. Median wrist movement speeds exceeding recently proposed exposure thresholds were also observed during many manual activities, such as milking animals and repairing equipment. Upper arm postures and movement speeds did not appear to confer excessive risk for shoulder-related outcomes (on the whole), but interpretation of the results is limited by a sampling approach that may not have captured the full extent of exposure variation. Not surprisingly, substantial variation in exposure levels were observed within each agricultural activity, which is related to substantial variation in the equipment, tools, and work practices used by participants. Ultimately, the results of this study contribute to an emerging literature in which the physical demands of routine agricultural work have been described on the basis of sensor-based measurements rather than more common self-report or observation-based approaches.

Whole-Body Vibration and Trunk Posture During Operation of Agricultural Machinery

Exposure to whole-body vibration (WBV) is common among agricultural workers and is associated with musculoskeletal health outcomes such as low back pain. Little is known, however, about the characteristics of exposure experienced during actual production practices. We measured WBV levels during agricultural machinery use among a sample of farmers (n = 55) performing routine agricultural activities and explored machinery attributes that may explain WBV summary measures. We also measured trunk posture to provide additional information about physical exposures during machinery operation. Measurements were made on-farm and during actual work conditions of a sample of agricultural machines (n = 112), including tractors, combines, heavy utility vehicles, and all-terrain vehicles (ATVs). Results indicated the presence of high levels of vibration (median frequency-weighted root-mean-square acceleration of approximately 0.8 m s-2) with time signatures that include high-amplitude mechanical shocks (median crest factor of nearly 23). Compared to other machinery types, combines exhibited the lowest WBV levels and among the most favorable trunk postures. Substantial variability was observed in both the WBV and trunk posture summary measures, suggesting for future studies that alternative sampling strategies are needed to fully capture temporal patterns of machinery use.

Trunk Posture Exposure Patterns among Prairie Ranch and Grain Farmers

Objectives: Low back disorders (LBD) are the most common musculoskeletal disorder among farmers, and awkward trunk postures such as repetitive bending are often cited as a contributor. However, it is not clear whether trends of increasing mechanization in agriculture may be impacting the requirement for trunk-intensive tasks. This study compared the patterns of working trunk posture among prairie farmers during both machine-intensive and non-intensive work days.Methods: Forty-nine adult farm workers from 22 farms participated in this study. Individual and farm characteristics were documented via questionnaire. Trunk angles and velocities were measured with an I2M inertial sensor placed on the chest. Participants completed electronic posture assessments during up to three regular work days throughout the growing season for a total of 91 electronic posture measurements. Forward and lateral trunk bending patterns were expressed in three domains: magnitude, duration, and frequency.Results: Working tasks were categorized into driving, manual, and mixed. Driving was the most commonly measured task (52% of work days), and mixed tasks the least (12%). Both 90th percentile trunk flexion-extension angles and velocities were significantly higher for manual as compared to driving tasks. Participants spent 38% of their working time in trunk forward flexion ≥ 20°, which, according to previous epidemiological studies, may increase their risk for LBD.Conclusion: The directly-measured trunk posture exposure patterns in this study suggest that machinery-intensive workdays result in less awkward trunk posture and lower velocities. Increasing mechanization invites more research on the exposures associated with machinery operation and increasing automation.

How do we assess musicians' musculoskeletal symptoms?: a review of outcomes and tools used

Recent reviews of musicians' musculoskeletal symptoms (MSS) have reported heterogeneity in the outcomes reported and data collection tools used, making it difficult to compare and synthesise findings. The purpose of this present review was to improve the consistency of future research, by documenting the outcomes reported in recent studies of musicians' MSS and the data collection tools used. All English language, peer-reviewed studies, published 2007-2016 that reported musicians' self-reported MSS outcomes were identified. Details of the types of outcomes reported and the tools used were extracted, and synthesised descriptively. A range of MSS outcomes were reported, including MSS with a temporal relationship to activities performed, and the consequences of symptoms. Only 24% of studies used standardised questionnaires, with the Nordic Musculoskeletal Questionnaire (NMQ) being the most commonly used. To improve the homogeneity of outcomes and data collection tools when investigating musicians' MSS, we recommend using the NMQ, where appropriate. Recall periods of 12-months and 7-d are the most appropriate for prevalence, and 7-d recall periods for ratings. Importantly, outcomes and the tools used to collect data should be reported in sufficient detail to ensure that the study can be replicated, critiqued, and accurately interpreted.

Work-Related Musculoskeletal Symptoms among Loggers in the Ark-La-Tex Region

BACKGROUND

The U.S. logging sector is among the most dangerous industrial sectors, with high fatality and non-fatal injury rates. Limited research has addressed work-related musculoskeletal disorders among logging machine operators (LMOs). The purpose of this study was to estimate the 12-month prevalence of musculoskeletal symptoms and the associated work-related risk factors among LMOs in the Arkansas, Louisiana, and Texas (Ark-La-Tex) logging region.

METHODS

A self-administered 93-item questionnaire with six different sections: (1) demographics, (2) lifestyle and medical background, (3) work experience, (4) job training, (5) occupational heat-related stress, and (6) occupational injuries and MSS was administered to LMOs (n = 88) using Qualtrics Mobile Survey Software®. Poisson regression models were used to estimate crude prevalence ratios (PR), adjusted PR [aPR], and corresponding 95% confidence intervals (95% CI).

RESULTS

Regarding organizational, ergonomic, and handling equipment occupational factors and 12-month MSS prevalence, the adjusted model controlled for age, BMI, smoking status, and drinking status. For organizational, the most problematic factors for the lower back were performing a task over and over (63.2%) and working very fast, for short periods (60.0%). For ergonomics, the most problematic factor for the lower extremities was awkward or cramped conditions (58.1%) and for the lower back was bending/twisting back awkward (55.9%). Last, for handling equipment, the most problematic for both the lower back and lower extremities was handling or grasping small objects (57.1%).

CONCLUSION

Our findings revealed associations between work-related MSS and specific job factors (e.g., organizational, ergonomic, handling equipment, etc.), extreme environmental conditions or environmental, and personal risk factors. In particular, study findings suggest lower back and lower extremities MSS are associated with the a majority of job-related risk factors, lower extremities with extreme environmental conditions, and neck and upper back with personal risk factors.

Knee musculoskeletal impairments and associated pain factors among rice farmers

BACKGROUND

Rice farming is done using manual methods and involves strenuous labour, which can lead to musculoskeletal disorders.

OBJECTIVE

To identify the factors associated with knee musculoskeletal impairments and related pain among rice farmers complaining of knee pain.

METHODS

The study employed a community-based, cross-sectional design. Full-time rice farmers (n= 201) were surveyed. A questionnaire was used to record demographics and details of farm work; followed by a physical examination of knee structures impairments.

RESULTS

The prevalence of knee impairment was highest among farmers with joint dysfunction (79.6%), followed by those with dysfunctional hamstring muscles (52.74%), quadriceps muscles (44.28%), neural tissue (38.81%), and ligaments (1.99%). It was lowest among farmers with meniscus dysfunction (1.49%). Stooping with twisting was strongly associated with knee joint and quadricep muscle impairment. Stooping with twisting and carrying loads were associated with hamstring muscle impairment. Stooping while twisting and being overweight was associated with neural tissue impairment. Being overweight was significantly associated with ligament impairment. There were no factors significantly associated with meniscus dysfunction.

CONCLUSIONS

Knee musculoskeletal impairments is common among Thai rice farmers. Joint dysfunction was common. The factors associated with knee musculoskeletal impairments included being overweight, stooping while twisting and carrying heavy weight.

Multiple Exposures and Coexposures to Occupational Hazards Among Agricultural Workers: A Systematic Review of Observational Studies

BACKGROUND

Workers may be exposed to various types of occupational hazards at the same time, potentially increasing the risk of adverse health outcomes. The aim of this review was to analyze the effects of multiple occupational exposures and coexposures to chemical, biomechanical, and physical hazards on adverse health outcomes among agricultural workers.

METHODS

Articles published in English between 1990 and 2015 were identified using five popular databases and two complementary sources. The quality of the included publications was assessed using the methodology developed by the Effective Public Health Practice Project assessment tool for quantitative studies.

RESULTS

Fifteen articles were included in the review. Multiple chemical exposures were significantly associated with an increased risk of respiratory diseases, cancer, and DNA and cytogenetic damage. Multiple physical exposures seemed to increase the risk of hearing loss, whereas coexposures to physical and biomechanical hazards were associated with an increased risk of musculoskeletal disorders among agricultural workers.

CONCLUSION

Few studies have explored the impact of multiple occupational exposures on the health of agricultural workers. A very limited number of studies have investigated the effect of coexposures among biomechanical, physical, and chemical hazards on occupational health, which indicates a need for further research in this area.

Risk factors for musculoskeletal disorders in manual harvesting farmers of Rajasthan

Manual harvesting is a physically demanding occupation with several work-related issues in which musculoskeletal disorders (MSDs) happen most commonly. The risk factors for MSDs among manual harvesting farmers are not investigated properly in low and low-middle-income nations. Therefore, a study among 140 farmers of Rajasthan, India was carried out through the usage of Nordic Musculoskeletal Questionnaire and the Rapid Upper Limb Assessment (RULA) technique to identify ergonomic risks. χ² analysis was used to find the relationship between the MSDs and various factors. Also, logistic regression methodology was applied to get the most influencing factor for MSDs in different body regions. The lower-back, fingers, shoulders and wrists/hands were the body parts in which more than 50% workers reported MSDs. MSDs in one or more body regions were found to be associated with age, daily working in farms, farming experience, gender, hand dominance and perceived work fatigue. The age was majorly associated with MSDs in all body regions except the shoulder and neck as per the outcome of logistic regression. The outcome of RULA grand score had been found higher than or equal to 5 in 92% of the farmers which give directions for further research and changes.

The Effect of Inhalant Organic Dust on Bone Health

PURPOSE OF REVIEW

Agriculture remains a major economic sector globally, and workers experience high rates of chronic inflammatory lung and musculoskeletal diseases. Whereas obstructive pulmonary diseases are known risk factors for bone loss, the underlying relationship between lung inflammation and bone health is not well known.

RECENT FINDINGS

An agriculture organic dust extract inhalation animal model has recently linked lung injury-induced inflammation to systemic bone loss. This process is dependent upon lipopolysaccharide and the toll-like receptor 4 (TLR4) signaling pathway. Downstream systemic interleukin-6 is a key mediator that subsequently activates osteoclastogenesis. Age is a host factor that impacted bone disease with younger mice demonstrating increased susceptibility to bone loss following inhalant exposures as compared to older mice. Supplemental dietary vitamin D was shown to prevent organic dust-induced bone loss, but not lung disease, in animals. Recent animal studies provide new mechanistic insight into the lung-bone inflammatory axis. Host factors, diet, and lipopolysaccharide/TLR4 signaling pathways play a significant role in explaining how inhalant organic dust exposures impact bone health. These investigations might lead to specific targeted therapeutic approaches.

Identification of influential demographic and work-related risk factors associated to lower extremity pain perception among rice farmers

BACKGROUND

A high prevalence of musculoskeletal disorders and abnormal alignments of the lower extremities (LE) was found for rice farmers. It is important to investigate demographic and work-related risk factors associated with LE pain prior to developing intervention strategies addressing the problematic factors of the highest-risk task.

OBJECTIVE

To identify factors associated with LE pain in rice farmers for every stage of the cultivation process.

METHODS

Thirty experienced farmers (age of 45.9±6.21 (mean±SD)) rated LE pain experienced before and after each cultivation stage using the Standardized Nordic Questionnaire. Risk factors of pain were characterized based on expert risk assessment of tasks due to force, posture and motion, in addition to a conventional survey of demographic and other work-related information.

RESULTS

Ergonomic risk factors were found to be the strongest predictors of knee and foot pain perception, which induced a substantial increase of pain perception (up to 4.6 times) with varying extent for individual cultivation stages. The highest risk and pain perception was found during the planting performance. Age exhibited significantly positive association with foot pain during planting and harvesting. However, more experienced farmers perceived less foot pain, presumably by developing effective movement strategies.

CONCLUSIONS

The findings suggest that the planting process should be subject of further intervention development, especially for older farmers, with focus on reducing force, awkward posture and repetitive movement to minimize risk of LE pain.

Investigating the Association Between Lower Extremity and Low Back Symptoms Among Saskatchewan Farmers Using the Standardized Nordic Questionnaire

STUDY DESIGN

Cross-sectional survey.

OBJECTIVE

The aim of this study was to investigate the association between self-reported low back symptoms and symptoms in the hip, knee, and ankle in a high-risk occupational group.

SUMMARY OF BACKGROUND DATA

Low back pain, with or without lower extremity referral, poses a major challenge to occupational productivity, especially in farming. Although low back symptoms can occur independent of lower extremity symptoms, anatomical positioning of nerves supplying the lower limbs means structural and physiological changes in the spine can lead to referred pain in the lower limbs, but the magnitude of the association between low back and lower extremity symptoms is unclear.

METHODS

Baseline postal questionnaire data from the Saskatchewan Farm Injury Cohort Study yielded surveys from 2653 adults from 1020 farms, who responded to Standardized Nordic Questionnaire (SNQ) items on "ache, pain, discomfort" in nine body parts during the last 12 months. Bivariate and multivariate regression modeling was performed with low back symptoms as the outcome and lower extremity symptoms as the independent variable.

RESULTS

After adjustment for age, sex, depression, and heavy lifting, low back symptom was significantly related with hip pain (odds ratio [OR] = 3.84, 95% confidence interval [CI] 3.04-4.84), knee pain (OR = 1.84, 95% CI 1.49-2.28), and ankle pain (OR = 1.79, 95% CI 1.40-2.29). Results showed a significant but decreasing relationship to low back symptoms as sites became more distal.

CONCLUSION

Hip and low back symptoms are highly associated, suggesting a common mechanism may be at work. Although there appears be increased risk of knee and ankle region symptoms among those with back pain, the SNQ is not designed to differentiate types of referred symptoms (i.e., numbness, tingling, shooting pain) and/or clinical diagnoses. Other tools, possibly corroborated with clinical examination findings, are likely necessary for a more thorough investigation of referred pain patterns in this high-risk occupational group.

LEVEL OF EVIDENCE

3.

Assessing the effects of biomechanical overload on dairy parlor workers' wrist: Definition of a study approach and preliminary results

BACKGROUND

Dairy milking is a demanding work task that has been associated with hand and wrist musculoskeletal disorders. Clinical approaches to identify the early effects of musculoskeletal disorders among dairy parlor workers' wrist have not been well defined.

OBJECTIVES

The purpose of this pilot study was to develop a study protocol that would assist in the identification and quantification of hand and wrist disorders among dairy workers that perform tasks in the dairy parlor. Additionally, such a study protocol was needed to perform relatively rapid assessments of the wrist/hand on large samples of dairy workers.

METHODS

Fourteen dairy parlor workers were assessed for i) upper limb symptoms and work history through questionnaire, ii) a physical examination of the upper limb and in particular wrists and iii) wrist ultrasonography. An additional 21 unexposed paired participants (the control group) also participated in the data collection.

RESULTS

The study results identified two ultrasound acoustic windows characterized by the highest predictive value for alteration of the wrist's structure. Study results indicated an impairment of the distal median nerve in structure and mobility and impairment of the distal tendon of the muscle extensor carpi ulnaris that included dislocation and frank damage.

CONCLUSIONS

This study identified at least two acoustic windows that should be assessed with ultrasound studies on larger groups and in prospective periodical health surveillance of dairy workers. The study confirmed the wrist was at risk for biomechanical stress among workers conducting milking tasks in the dairy parlors.

Non-chemical Risk Assessment for Lifting and Low Back Pain Based on Bayesian Threshold Models

Background

Self-reported low back pain (LBP) has been evaluated in relation to material handling lifting tasks, but little research has focused on relating quantifiable stressors to LBP at the individual level. The National Institute for Occupational Safety and Health (NIOSH) Composite Lifting Index (CLI) has been used to quantify stressors for lifting tasks. A chemical exposure can be readily used as an exposure metric or stressor for chemical risk assessment (RA). Defining and quantifying lifting nonchemical stressors and related adverse responses is more difficult. Stressor–response models appropriate for CLI and LBP associations do not easily fit in common chemical RA modeling techniques (e.g., Benchmark Dose methods), so different approaches were tried.

Methods

This work used prospective data from 138 manufacturing workers to consider the linkage of the occupational stressor of material lifting to LBP. The final model used a Bayesian random threshold approach to estimate the probability of an increase in LBP as a threshold step function.

Results

Using maximal and mean CLI values, a significant increase in the probability of LBP for values above 1.5 was found.

Conclusion

A risk of LBP associated with CLI values > 1.5 existed in this worker population. The relevance for other populations requires further study.

Prevalence of Musculoskeletal Disorders Among Saskatchewan Farmers

The extent of the musculoskeletal disorder (MSD) problem is not well understood among Canadian farmers, and little too is known about their epidemiology. The purpose of this study was therefore to (1) determine the prevalence of MSDs among farmers in one Canadian province; and (2) describe the types and severities of these disorders and patterns in their occurrence. This cross-sectional analysis was conducted using baseline survey data from the Saskatchewan Farm Injury Cohort Study. Reports of MSDs, demographic and health-related variables, reports of farm-related injuries, and economic conditions of individual farms were available for 2595 adult participants from 1212 farms in Saskatchewan, Canada. Relationships between MSDs and time spent doing farm work were investigated using tests of association. The participation rate was 48.8%. Most (85.6%) of participants reported having musculoskeletal pain in at least one body part over the past year. The lower back was most frequently affected (57.7%), followed by shoulders (44.0%), and neck (39.6%). More serious pain prevented 27.9% of respondents from performing regular work activities. MSD prevalence did not vary by sex, commodity type, or by total hours of farm work completed; prevalence was significantly (P < .05) related to time spent performing biomechanically demanding tasks such as heavy lifting and working with arms overhead. The most common MSD site in farmers was the low back, followed by the upper and then lower extremities. Although this study aimed to identify high-risk groups, lack of differences between demographic groups suggests that the majority of farmers are at risk for MSDs.

The prevalence of low back pain and its associated factors in Thai rubber farmers

Objectives:

Low back pain (LBP) is one of the most prevalent musculoskeletal disorders in the general population, especially among manual laborers. Moreover, it often brings about lost wages and additional medical expenses. However, the potential risk factors for LBP are unknown. This study aimed to estimate the prevalence of LBP and to determine the individual, occupational, and psychosocial factors associated with LBP among rubber farmers.

Methods:

A cross-sectional survey was conducted among 450 Thai rubber farmers using cluster random sampling. Data were collected using face-to-face interviews and objective examination and were analyzed using multivariate logistic regression.

Results:

Of the 433 rubber farmers, the point and 12-month prevalence of LBP in rubber farmers was 33% and 55.7%, respectively. BMI, primary school education, exposure to pesticides, and tapping below knee level were statistically associated with LBP after controlling for other variables.

Conclusions:

Low back pain is common among rubber farmers. Only four factors were identified as being associated with the high prevalence of LBP. However, these factors might be altered if more variables are taken into account. Further research investigating the causal relation between these factors and LBP should be conducted.

Toll-Like Receptor 4 Signaling Pathway Mediates Inhalant Organic Dust-Induced Bone Loss

Agriculture workers have increased rates of airway and skeletal disease. Inhalant exposure to agricultural organic dust extract (ODE) induces bone deterioration in mice; yet, mechanisms underlying lung-bone crosstalk remain unclear. Because Toll-like receptor 2 (TLR2) and TLR4 are important in mediating the airway consequences of ODE, this study investigated their role in regulating bone responses. First, swine facility ODE stimulated wild-type (WT) bone marrow macrophages to form osteoclasts, and this finding was inhibited in TLR4 knock-out (KO), but not TLR2 KO cells. Next, using an established intranasal inhalation exposure model, WT, TLR2 KO and TLR4 KO mice were treated daily with ODE or saline for 3 weeks. ODE-induced airway neutrophil influx and cytokine/chemokine release were similarly reduced in TLR2 and TLR4 KO animals as compared to WT mice. Utilizing micro-computed tomography (CT), analysis of tibia showed loss of bone mineral density, volume and deterioration of bone micro-architecture and mechanical strength induced by ODE in WT mice were significantly reduced in TLR4 but not TLR2 KO animals. Bone marrow osteoclast precursor cell populations were analyzed by flow cytometry from exposed animals. In WT animals, exposure to inhalant ODE increased osteoclast precursor cell populations as compared to saline, an effect that was reduced in TLR4 but not TLR2 KO mice. These results show that TLR2 and TLR4 pathways mediate ODE-induced airway inflammation, but bone deterioration consequences following inhalant ODE treatment is strongly dependent upon TLR4. Thus, the TLR4 signaling pathway appears critical in regulating the lung-bone inflammatory axis to microbial component-enriched organic dust exposures.

Prevalence of musculoskeletal disorders among immigrant Latino farmworkers and non-farmworkers in North Carolina

This paper evaluates the variability in the prevalence of epicondylitis, rotator cuff syndrome, low back pain, and lower extremity pathology among immigrant Latino farmworkers and non-farmworkers. Data were collected from a study among 272 farmworkers and non-farmworkers. Participants were recruited in eastern and central North Carolina. A physical examination was conducted by trained physicians. Prevalence of musculoskeletal disorders (MSDs) among Latino manual workers is high compared with other workers in similar occupations. Non-farmworkers (49%) had a higher prevalence of MSDs than farmworkers (35%). Epicondylitis (20.2%) and rotator cuff syndrome (19.1%) were most prevalent. Age was found to be significant among those who had epicondylitis (adjusted odds ratio [AOR] = 1.04) and lower extremity pathology (AOR = 1.07). Latino immigrant manual workers have high prevalence of MSDs. Further studies are needed to identify possible factors that make these populations more vulnerable to MSDs.

How to Assess the Biomechanical Risk Levels in Beekeeping

Beekeepers are at particular risk of developing work-related musculoskeletal disorders, but many of the studies lack detailed exposure assessment. To evaluate the biomechanical overload exposure in a specific farming activity, a multitasking model has been developed through the characterization of 37 basic operational tasks typical of the beekeeping activity. The Occupational Repetitive Actions (OCRA) Checklist and the National Institute for Occupational Safety and Health (NIOSH) Lifting Index methodologies have been applied to these elementary tasks to evaluate the exposure, and the resulting risk indices have been time-weighted averaged. Finally, an easy access, computer-assisted toolkit has been developed to help the beekeepers in the biomechanical risk assessment process. The risk of biomechanical overload for the upper limbs ranges from acceptable (maintenance and recovery of woody material and honey packaging with dosing machine tasks) to high (distribution of the top supers) risk level. The risk for back injury is always borderline in women and increases with exposure time, whereas it ranges from acceptable to borderline in men. The definition of the biomechanical risk levels allows for planning of corrective actions aimed at preventing and reducing the risk of musculoskeletal disorders through engineering, administrative, and behavioral interventions. The methodology can be used for risk assessment in other mainly manual agricultural activities.

Age Impacts Pulmonary Inflammation and Systemic Bone Response to Inhaled Organic Dust Exposure

Agricultural workers have high rates of airway and skeletal health disease. Studies recently demonstrated that inhaled agricultural organic dust extract (ODE)-induced airway injury is associated with bone deterioration in an animal model. However, the effect of age in governing these responses to organic dusts is unclear, but might be important in future approaches. Young (7-9 wk) and older (12-14,o) male C57BL/6 mice received intranasal (i.n.) inhalation exposure to ODE from swine confinement facilities once or daily for 3 wk. Acute ODE-induced neutrophil influx and cytokine and chemokine (tumor necrosis factor [TNF]-α, interleukin [IL]-6, keratinocyte chemoattractant [CXCL1], macrophage inflammatory protein-2 [CXCL2]) airway production were reduced in older compared to young mice. Repetitive ODE treatment, however, increased lymphocyte recruitment and alveolar compartment histopathologic inflammatory changes in older mice. Whole lung cell infiltrate analysis revealed that young, but not older, mice repetitively treated with ODE demonstrated an elevated CD4:CD8 lymphocyte response. Acute inhalant ODE exposure resulted in a 4-fold and 1.5-fold rise in blood neutrophils in young and older mice, respectively. Serum IL-6 and CXCL1 levels were elevated in young and older mice i.n. exposed once to ODE, with increased CXCL1 levels in younger compared to older mice. Although older mice displayed reduced bone measurements compared to younger mice, younger rodents demonstrated ODE-induced decrease in bone mineral density, bone volume, and bone microarchitecture quality as determined by computed tomography (CT) analysis. Collectively, age impacts the airway injury and systemic inflammatory and bone loss response to inhalant ODE, suggesting an altered and enhanced immunologic response in younger as compared to older counterparts.

Prevalence and risk factor analysis of lower extremity abnormal alignment characteristics among rice farmers

BACKGROUND

Rice farming activities involve prolonged manual work and human-machine interaction. Prolonged farming risk-exposure may result in lower limb malalignment. This malalignment may increase the risk of lower extremity injury and physical disabilities. However, the prevalence and factors associated with lower extremity malalignment have not yet been reported. This study aimed to investigate the prevalence and risk factors of lower extremity malalignment among rice farmers.

METHODS

A cross-sectional survey was conducted with 249 rice farmers. Lower extremity alignment assessment included: pelvic tilt angle, limb length equality, femoral torsion, quadriceps (Q) angle, tibiofemoral angle, genu recurvatum, rearfoot angle, and medial longitudinal arch angle. Descriptive statistics were used to analyze participant characteristics and prevalence of lower extremity malalignment. Logistic regression analysis was used to identify risk factors.

RESULTS

The highest prevalence of lower extremity malalignment was foot pronation (36.14%), followed by the abnormal Q angle (34.94%), tibiofemoral angle (31.73%), pelvic tilt angle (30.52%), femoral antetorsion (28.11%), limb length inequality (22.49%), tibial torsion (21.29%), and genu recurvatum (11.24%). In females, the risk factors were abnormal Q angle, tibiofemoral angle, and genu recurvatum. Being overweight was a risk factor for abnormal pelvic tilt angle, Q angle, and tibiofemoral angle. Age was a risk factor for limb length inequality. Years of farming were a major risk factor for abnormal Q angle, tibiofemoral angle, and foot malalignment.

CONCLUSION

Prevalence of lower extremity malalignment was reported in this study. Female sex, being overweight, and years of farming were major risk factors for lower extremity malalignment. Lower extremity screening should assist in the identification of foot and knee malalignment in rice farmers. This may then lead to early prevention of musculoskeletal disorders arising from such malalignment.

Low-back pain

Low-back pain is one of the most common painful conditions experienced by humans throughout their life. Some occupational risk factors (namely, heavy manual material handling) may also contribute to the development of low-back pain: due to the high prevalence of both low-back pain and manual material handling in the adult working population, it has been estimated that low-back pain is probably the most common occupational disorder worldwide. Lifetime prevalence of low-back pain has been reported to be as high as 84%, depending on the case definition used, and no age group is spared, even children. Although low-back pain is not a lethal condition, it was estimated at the third rank among all diseases by disability-adjusted life-years in 2010 in the USA, after ischemic heart disease and chronic obstructive pulmonary disease, and at the first rank by years lived with disability. It also ranked high (13th) globally for the same year, in disability-adjusted life-years. Low-back pain is currently classified as nonspecific/specific as to putative cause and as acute (lasting less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks) according to duration of symptoms. The distinction between nonspecific/specific and acute/subacute/chronic low-back pain is useful not only for epidemiologic studies, but also (mainly) for choosing the appropriate strategy for the diagnosis and treatment of the disorder. Workplace risk factors for low-back pain include manual lifting and whole-body vibration exposure. This chapter will provide an overview of modern concepts of low-back pain (in general) and will then outline some distinctive features of work-related low-back pain.

Work-related musculoskeletal disorders in senior farmers: safety and health considerations

Aging farmers are at high risk musculoskeletal disorders due to occupational exposures. The development of musculoskeletal conditions can increase older farmers' risk for additional injuries because many older farmers continue to work past typical retirement age. Occupational health nurses with agricultural expertise can assist farmers by evaluating their health and safety needs. Possible interventions include ergonomic improvements in farm equipment, safety improvements in farm environment, and referrals to programs that assist older farmers in modifying their farms to improve safety.

International perspectives on psychosocial working conditions, mental health, and stress of dairy farm operators

Dairy farm operators-farmers, workers, and family members-are faced with many demands and stressors in their daily work and these appear to be shared across countries and cultures. Dairy operators experience high psychosocial demands with respect to a hard work and production ethos, economic influences, and social and environmental responsibility. Furthermore, both traditional and industrial farms are highly dependent on external conditions, such as weather, fluctuating markets, and regulations from government authorities. Possible external stressors include disease outbreaks, taxes related to dairy production, and recent negative societal attitudes to farming in general. Dairy farm operators may have very few or no opportunities to influence and control these external conditions, demands, and expectations. High work demands and expectations coupled with low control and lack of social support can lead to a poor psychosocial work environment, with increased stress levels, ill mental health, depression, and, in the worst cases, suicide. Internationally, farmers with ill mental health have different health service options depending on their location. Regardless of location, it is initially the responsibility of the individual farmer and farm family to handle mental health and stress, which can be of short- or long-term duration. This paper reviews the literature on the topics of psychosocial working conditions, mental health, stress, depression, and suicide among dairy farm operators, farm workers, and farm family members in an international perspective.

Limitação no trabalho por dor lombar em fumicultores do sul do Brasil

Introdução:o trabalho agrícola exige esforço físico e posturas inadequadas que são de risco para dor lombar e limitação no trabalho. A dor lombar, em especial a crônica, é responsável por grande número de afastamentos do trabalho.Objetivo:avaliou-se a prevalência de limitação no trabalho por dor lombar crônica (DLC), dor lombar no último mês (DLM) e dor lombar aguda (DLAguda), bem como as tarefas que os fumicultores deixaram de fazer devido a essas patologias.Métodos:estudo transversal realizado no ano de 2011 com uma amostra aleatória de 2469 fumicultores de São Lourenço do Sul/RS. A investigação de fatores associados à limitação por DLM foi realizada através da regressão de Poisson.Resultados:as prevalências de limitação no trabalho por DLC, DLM e DLAguda foram respectivamente, de 37,6%, 14,4,% e 7,8%. Carregar folhas, empilhar lenha e colher baixeiro foram as tarefas que os fumicultores mais deixaram de fazer. Na análise ajustada, foram associadas à limitação por DLM: idade, gastos com imposto sobre a propriedade de veículos automotores (IPVA), dificuldades para pagar dívidas e problemas psiquiátricos menores. Indivíduos com DLAguda deixam de fazer as mesmas tarefas daqueles com DLC, mas estes têm muito mais limitação no trabalho.

Organic dust, lipopolysaccharide, and peptidoglycan inhalant exposures result in bone loss/disease

Skeletal health consequences associated with chronic inflammatory respiratory disease, and particularly chronic obstructive pulmonary disease (COPD), contribute to overall disease morbidity. Agricultural environmental exposures induce significant airway diseases, including COPD. However, animal models to understand inhalant exposure-induced lung injury and bone disease have not been described. Using micro-computed tomography (micro-CT) imaging technology and histology, bone quantity and quality measurements were investigated in mice after repetitive intranasal inhalation exposures to complex organic dust extracts (ODEs) from swine confinement facilities. Comparison experiments with LPS and peptidoglycan (PGN) alone were also performed. After 3 weeks of repetitive ODE inhalation exposure, significant loss of bone mineral density and trabecular bone volume fraction was evident, with altered morphological microarchitecture changes in the trabecular bone, compared with saline-treated control animals. Torsional resistance was also significantly reduced. Compared with saline treatment, ODE-treated mice demonstrated decreased collagen and proteoglycan content in their articular cartilage, according to histopathology. Significant bone deterioration was also evident after repetitive intranasal inhalant treatment with LPS and PGN. These findings were not secondary to animal distress, and not entirely dependent on the degree of induced lung parenchymal inflammation. Repetitive LPS treatment demonstrated the most pronounced changes in bone parameters, and PGN treatment resulted in the greatest lung parenchymal inflammatory changes. Collectively, repetitive inhalation exposures to noninfectious inflammatory agents such as complex organic dust, LPS, and PGN resulted in bone loss. This animal model may contribute to efforts toward understanding the mechanisms and evaluating the therapeutics associated with adverse skeletal health consequences after subchronic airway injury.

Work-related musculoskeletal disorders among Irish farm operators

BACKGROUND

To establish prevalence, risk factors, and impact of work-related musculoskeletal disorders (WMSDs) among farmers in Ireland.

METHODS

In summer 2009, a questionnaire was appended to the Teagasc (Irish Agricultural and Food Development Authority) National Farm Survey (n = 1,110) to obtain data on the prevalence, risk factors and impact of WMSDs amongst farm operators in Ireland. Data were collected by trained recorders and analyzed using chi-square tests, t-tests, Mann-Whitney's U-tests and logistic regression models.

RESULTS

The prevalence of WMSDs in the previous year was 9.4% (n = 103), with the most commonly affected body region being the low back 31% (n = 32). Nearly 60% (n = 57) of farmers reported missing at least a full day's work as a consequence of their WMSD. Personal factors evaluated using binary regression analysis, were found not to influence whether or not a farmer experienced a WMSD. However, work-related factors such as larger European Size Units (ESUs, OR: 1.007, CI: 1.002-1.012), greater number of hectares farmed (OR: 2.501, CI: 1.208-4.920), higher income (OR: 1.859, CI: 1.088-3.177), dairy enterprise (OR: 1.734, CI: 1.081-2.781), and working on a full-time farm (OR: 2.156, CI: 1.399-3.321) increased the likelihood of experiencing a WMSD. Working on a full-time farm was the only factor found to independently predict WMSDs in the multiple regression analyses.

CONCLUSIONS

This study suggests that the prevalence of WMSDs can be reduced by the application of improved farm management practices. A more detailed examination of the risk factors associated with WMSDs is required to establish causality and develop effective interventions.

Sustained employability of workers in a production environment: design of a stepped wedge trial to evaluate effectiveness and cost-benefit of the POSE program

Background

Sustained employability and health are generating awareness of employers in an aging and more complex work force. To meet these needs, employers may offer their employees health surveillance programs, to increase opportunities to work on health and sustained employability. However, evidence for these health surveillance programs is lacking. The FLESH study (Functional Labour Evaluation for Sustained Health and employment) was developed to evaluate a comprehensive workers’ health promotion program on its effectiveness, cost-benefit, and process of the intervention.

Methods

The study is designed as a cluster randomised stepped wedge trial with randomisation at company plant level and is carried out in a large meat processing company. Every contracted employee is offered the opportunity to participate in the POSE program (Promotion Of Sustained Employability). The main goals of the POSE program are 1) providing employee’s insight into their current employability and health status, 2) offering opportunities to improve employability and decrease health risks and 3) improving employability and health sustainably in order to keep them healthy at work. The program consists of a broad assessment followed by a counselling session and, if needed, a tailored intervention. Measurements will be performed at baseline and will be followed up at 20, 40, 60, 80, 106 and 132 weeks. The primary outcome measures are work ability, productivity and absenteeism. Secondary outcomes include health status, vitality, and psychosocial workload. A cost-benefit study will be conducted from the employers’ perspective. A process evaluation will be conducted and the satisfaction of employer and employees with the program will be assessed.

Discussion

This study provides information on the effectiveness of the POSE program on sustained employment. When the program proves to be effective, employees benefit by improved work ability, and health. Employers benefit from healthier employees, reduced sick leave (costs) and higher productivity. The study can expose key elements for a successful implementation and execution of the POSE program and may serve as an example to other companies inside and outside the industry.

Trial registration

The trial is registered at the Dutch Trial Register (http://www.trialregister.nl): NTR3445

An evaluation of low back pain among farmers in Ireland

BACKGROUND

Low back pain (LBP) is the most commonly reported musculoskeletal disorder among farmers. There is limited research regarding LBP among farmers in Ireland.

AIMS

To explore attributed causes of LBP, investigate the relationship between LBP and personal and work-related factors and measure the impact of LBP.

METHODS

A questionnaire survey of Irish farmers was conducted on farmers from each of the main farm enterprise systems in Ireland. Data were analysed using chi-square tests, t-tests, Mann-Whitney tests and logistic regression models.

RESULTS

There were 600 farmers included in the survey with 100 from each of the six main farm systems. Lifting/pulling/pushing was identified as the most commonly attributed cause of LBP. In the multiple regression analysis the variables found to be associated with LBP included farm size and self-rated health. The odds ratios (OR) of LBP were greater among operators of medium and large farms [(OR = 1.52; 95% confidence interval (CI): 1.04-2.22 and OR = 1.86; 95% CI: 1.16-3.98, respectively] compared with smaller farms (P < 0.05). Those who perceived health as 'good' (OR = 1.63; 95% CI: 1.14-2.33) by comparison with a rating of 'very good' had greater odds of LBP (P < 0.01). Some farmers changed work habits, sought help and needed time off work due to LBP.

CONCLUSIONS

Lifting was identified as the main attributed cause for LBP. LBP leads to work disability that necessitated farmers changing work habits, getting help and needing time off work. In order to reduce LBP-related disability among farmers in the future, work practices involving lifting need to be further investigated.