How to carry out participatory research that takes account of sex and gender issues: a scoping review of guidelines targeting health inequities

OBJECTIVE

Conducting participatory research (PR) aimed at improving health implies considering inequitable power relations, including those related to sex/gender (S/G). This necessitates specific skills and methods and may be challenging especially since guidelines are scarce. Our objective was to perform a scoping review to provide a typology of existing guidelines for researchers on how to take account of S/G in the context of PR in public health, with a focus on occupational and environmental health.

METHODS

All steps of the research were conducted with the collaboration of an advisory committee, following PR principles. Nineteen documents were retained from 513 references identified in nine scientific databases and grey literature between 2000 and 2020. Data on recommendations were extracted and coded qualitatively. Cluster analysis based on similarities in recommendations proposed in the documents identified four types: (1) empowerment-centered; (2) concrete action-centered; (3) macrosystem-centered; and (4) stakeholder-centered.

SYNTHESIS

Many sources gave pointers on how to include S/G during data collection and analysis or during the dissemination of findings, but there was a dearth of suggestions for building partnerships with stakeholders and producing sustainable S/G sociopolitical transformations. Occupational health PR showed less similarities with other public health subfields including environmental health PR. Power relationships with workplace stakeholders generated specific obstacles related to S/G integration that require further attention. Intersectionality and reflexive practices emerged as overarching themes.

CONCLUSION

This review provides helpful guidelines to researchers at different stages of planning PR, ranging from familiarizing themselves with S/G approaches to anticipating difficulties in their ongoing S/G-transformative PR.

How Can Quantitative Analysis Be Used to Improve Occupational Health without Reinforcing Social Inequalities? An Examination of Statistical Methods

Taking account of sex and gender in occupational health studies poses statistical challenges. Other sociodemographic variables, such as racialization, class, and age, also affect the relations between workplace exposures and health and interact with sex and gender. Our objective was to perform a critical review of conventional and emerging statistical tools, examining whether each analysis takes account of sociodemographic variables (1) in a way that contributes to identification of critical occupational determinants of health (2) while taking account of relevant population characteristics to reflect intersectional approaches to health and (3) using sample sizes and population characteristics available to researchers. A two-step search was conducted: (1) a scientific watch concerning the statistical tools most commonly used in occupational health over the past 20 years; (2) a screening of the 1980-2022 literature with a focus on emerging tools. Our examination shows that regressions with adjustment for confounders and stratification fail to reveal the sociodemographic mechanisms that interact with occupational health problems, endangering the identification of occupational risks. Multilevel (notably MAIHDA) analyses, decision tree, cluster, and latent analyses are useful methods to consider when seeking to orientate prevention. Researchers should consider methods that adequately reveal the mechanisms connecting sociodemographic variables and occupational health outcomes.

Should data on gender and ethnicity inform ergonomics interventions? Lessons from four case studies

Ergonomists intervene to improve work for all workers and adapt jobs to a range of worker characteristics. But their mandate rarely includes explicit attention to the distribution of worker demographics, to divisions among workers, or to discrimination on the basis of sex/gender or racialisation. A decades-long collaboration between ergonomists and the women's committees of three union confederations in Québec, Canada led to several instances where ergonomists had to confront situations involving sexism or racism, not foreseen during their training. This article will explore four problematic situations and suggest solutions, including paying more attention to teamwork, considering gender during ergonomics training, and developing a code of practice for ergonomics interventions.Practitioner summary: Workplace inequities related to sex/gender, racialisation and other sources of social inequity can affect job performance and workers' health. As such, do ergonomists need to consider them during an intervention? How? We analyse four situations encountered during interventions and suggest more attention to understanding workplace dynamics and promoting team function.

Integration of sex and gender in interventions by students in ergonomics

This article aims to analyse the integration of sex and gender (s/g) by ergonomics students during their internship at the master's degree level, following training sessions on s/g issues in the workplace. This exploratory research used a descriptive mixed-methods design, encompassing evaluation of students' intention to use the content from the training (n = 13 students), and a multiple case study (n = 5 ergonomics interventions). The results show that while students found the training relevant, they only minimally integrated s/g in their interventions and when they did, it was primarily from an anthropometric and physiological perspective. In addition to discussing the training format limitations, the article discusses barriers to this integration: combining learning about s/g issues with learning about activity analysis is challenging; employers' and workers' organisations may be reluctant to approach s/g issues; and it is difficult for an ergonomist to integrate these issues when the employer's request does not specify it.Practitioner summary: This article aims to analyse the integration of s/g by ergonomics students during their internships. Findings show that they only minimally considered s/g. The discussion examines s/g training, organisational obstacles to inclusion of s/g during interventions, and how ergonomists can consider s/g in their practice.

Gender and work in ergonomics: recent trends

Since the establishment of the Gender and Work Technical Committee (TC) of the International Ergonomics Association (IEA) in 2006, many researchers have addressed the role of sex and gender in ergonomics, producing a great deal of new information. This special issue aims to present new ways of viewing women's work and gender differences in work-related injury risks in an era of rapidly changing labour market configurations. It offers innovative methods for integrating sex and gender into ergonomic analysis and for designing work environments. It shares reflections on the intersection of vulnerabilities according to certain identity markers. Finally, it contributes to establishing milestones standards of practice so that the consideration of sex and gender can be more systematically modelled in ergonomics research and interventions, for example, in training ergonomists or in knowledge transfer initiatives.Practitioner summary: This editorial article provides an overview of the background and the content of the Special Issue 'Gender and Work in Ergonomics: Recent trends'.

Overview of the “Gender & Work” track at the IEA 2021 congress

BACKGROUND: The International Ergonomics Association (IEA) is an international federation of associations created in 1959, whose mission is to extend the scope of ergonomics research and intervention to all spheres of society in order to improve human well-being. OBJECTIVE: This article presents an overview of the main research papers that were presented at the 21st Triennial IEA 2021 Conference. METHOD: A total of 23 talks, from nine countries, were presented over four sessions. These papers were summarized based on reading the abstracts and taking notes at the time of the oral presentation. RESULTS: The themes of these sessions were: 1) Knowledge Transfer, Gender and Ergonomics 2) Approaching Ergonomic Interventions with a Sex/Gender Lens: Designing Training for Ergonomists 3) Ergonomic Studies of Atypical Work and Vulnerable Population through a Sex/Gender Lens: Toward Better Understanding of Context and Risks, for Better Prevention and 4) Gender and Occupational Risks (Part 1: Exposure and Risk Perception; Part 2: Strategies to Manage Risk). CONCLUSION: Ergonomists are beginning to understand that they have the qualifications and legitimacy to play a role in reducing workplace health inequities and helping to make workplaces inclusive and rich of all the workers’ diversity. The four sessions of the Gender and Ergonomics TC have moved ergonomics practice a step closer to that goal.

Considering sex and gender in ergonomics: Exploring the hows and whys

At the 2018 IEA conference, the Gender and Work Technical Committee organized three symposia with over 20 presentations. Overall, these contributions positioned ergonomics as a theoretical and pragmatic approach developing innovative methods to integrate sex/gender analysis into the construction and evaluation of interventions. This special issue of Applied Ergonomics includes diverse approaches to the consideration of sex and gender in ergonomics, including methods in accident analysis, musculoskeletal disorders, work-family interactions, work schedule analysis, prevention programs and evaluation of interventions. The contents are summarized in this introduction.

Impacts of considering sex and gender during intervention studies in occupational health: Researchers' perspectives

The aim of this article is to examine the impacts of incorporating sex and gender (s/g) analysis in integrated knowledge translation (iKT) initiatives in the field of ergonomics and occupational health. The article presents findings based on a retrospective analysis of twelve intervention-research (IR) studies, including a thematic content analysis of in-depth interviews conducted with 15 researchers involved in these IRs. The findings offer an overview of various categories of impacts, such as changes in partners' views, in workplace settings and conditions, in practices and policies, and in economic outcomes. In these types of IR, health effects measurement is not the main objective, and direct health outcomes are difficult to assess. Explicitly talking about sex/gender led more often to system-level changes but less often to workplace-level changes, compared to interventions where sex/gender was not identified as a specific object of the intervention.

Protecting Pregnant Workers while Fighting Sexism: Work-Pregnancy Balance and Pregnant Nurses' Resistance in Québec Hospitals: Protéger les travailleuses enceintes en luttant contre le sexisme: équilibre travail-grossesse et résistance d'infirmières enceintes dans des hôpitaux québécois

Women's workplaces should guarantee healthy pregnancies while supporting pregnant women as workers. In Québec (Canada), a pregnant worker exposed to a "danger" for herself or her fetus may ask her employer to be reassigned to other work appropriate to her skills. This approach differs from other regulatory contexts in North America in that protection of fetal and maternal health is embedded in the health and safety legislation. The advantage is that the pregnant worker is guaranteed access to her full salary, but some may question whether specific provisions for pregnant women single out such women and produce risks for their careers or, conversely, pregnancy should receive even more special consideration. These questions are discussed using the results of a qualitative analysis of interviews with pregnant nurses, their supervisors, and their union representatives in ten hospitals in Québec. We think that the management of pregnancy under this legislation generally protects health, but that, in the absence of true employer commitment to the health of all workers, undue burdens may be placed upon other members of the work team. Résumé Les lieux de travail des femmes devraient garantir des grossesses saines tout en soutenant les femmes enceintes en tant que travailleurs. Au Québec (Canada), une travailleuse enceinte exposée à un danger pour elle-même ou son fœtus peut demander à son employeur d'être réaffectée à d'autres tãches sans danger et adaptéches à ses compétences. Cette approche diffère des autres contextes réglementaires en Amérique du Nord en ce sens que la protection de la santé foetale et maternelle est intégrée dans la législation sur la santé et la sécurité. Certains peuvent se demander si des dispositions spécifiques pour les femmes enceintes singularisent ces travailleuses et contribuent à la précarisation de leur emploi. Ou, à l'inverse, si la grossesse devrait recevoir une considération encore plus spéciale. Ces questions sont discutées à la lumière du récit d infirmières enceintes, de gestionnaires et de représentants syndicaux responsables des dossiers de conciliation travail-grossesse dans dix hôpitaux du Québec. Nous constatons que la gestion de la grossesse en vertu de cette législation est généralement protectrice de la santé, mais qu'en l'absence d'un véritable engagement de l'employeur envers la santé de tous les travailleurs, des charges excessives peuvent être imposées aux autres membres de l'équipe de travail.

A Feminist Intervention That Hurt Women: Biological Differences, Ergonomics, and Occupational Health: Une intervention féministe qui a nui aux femmes: différences biologiques, égalité, ergonomie et santé au travail

The University of Québec in Montréal has agreements with trade unions providing access to university resources. Researchers involved in this program worked in partnership with union women's and health and safety committees for more than twenty years. Not all studies succeeded in improving women's working conditions. One joint project involved observational studies of tasks done by health-care workers, complemented by interviews and questionnaires. We found that task assignments, movements, postures, and work-related musculoskeletal disorders varied by gender/sex and made recommendations for change. However, issues of pay equity, spending on health care, and contracting-out of "ancillary work" were salient. Researchers learned that in the absence of changes in power relationships in the workplace, women may be disadvantaged by denial as well as by exaggeration of female-male differences. Men may also be at risk when their gender is invisible. We suggest some feminist approaches to workplace solutions and some pathways for research. Résumé L'Université du Québec à Montréal a signé avec des centrales syndicales des ententes leur donnant un accès à des ressources universitaires. Des chercheures ont travaillé en partenariat avec des comités syndicaux de condition des femmes et de santé-sécurité au travail pendant plus de 25 ans, mais ce ne sont pas toutes les études qui ont abouti à des améliorations. Un projet concernait des observations du travail d'employé.e.s du secteur de la santé, dont les tâches, mouvements, et postures variaient selon le genre/sexe. Nous avons recommandé des transformations, mais des enjeux d'équité salariale, de coûts et de sous-traitance y ont fait obstacle. Les chercheures ont appris qu'en l'absence de transformation des rapports de pouvoir au travail, le déni des différences hommes-femmes, autant que leur exagération, peut désavantager les travailleuses (et les travailleurs). Nous suggérons des approches féministes aux solutions pour le milieu de travail, ainsi que des pistes de recherche.

Women's Occupational Health: Resisting When We Can: Santé des femmes au travail: mobiliser quand c'est encore possible

The continuing worldwide struggle for decent working conditions is under intense economic, social, and political pressures. Women are particularly affected by these pressures because of their still-tenuous position in the service sector, in lowprestige, low-paid occupations. In addition, their occupational health issues are often overlooked or minimized. Nevertheless, women continue to struggle, as individuals and collectively. This issue describes a number of instances where women in the Québec labor movement have attempted to reconcile equality concerns with protecting their own health. There are successes, failures, and puzzles. Résumé La lutte mondiale pour des conditions de travail décentes subit d'intenses pressions économiques, sociales et politiques. Les femmes sont particulièrement touchées par ces pressions à cause de leur situation encore fragile dans le secteur des services, dans des professions de faible prestige et salaire. De plus, leurs besoins en santé au travail sont souvent minimisés ou ignorés. Toutefois, les femmes continuent à résister, individuellement et collectivement. Ce numéro décrit un certain nombre d'exemples où des travailleuses militantes ont tenté de concilier leurs revendications d'égalité et d'accès au travail avec leur besoin de protéger leur santé.

« Travailler la nuit pour voir ses enfants, ce n’est pas l’idéal ! »

Les horaires atypiques imposés compliquent la conciliation travail-famille (CTF), particulièrement lorsqu’ils sont associés à un travail impliquant un bas salaire, un faible contrôle sur le travail, ou du temps partiel involontaire. Un nombre grandissant de travailleuses et de travailleurs sont exposés à ces horaires, mais peu d’études se sont intéressées aux stratégies de CTF déployées pour faire face à ces conditions contraignantes. Les seuls accommodements possibles reposent souvent sur des ententes informelles. Ces ententes sont fragiles et individuelles et, de plus, elles sont marquées par les rapports avec un gestionnaire ou des collègues. Elles exercent aussi une pression importante sur le collectif de travail, ce qui peut venir limiter la marge de manoeuvre permettant de concilier les deux réalités, c’est-à-dire l’espace nécessaire afin d’adapter sa tâche en fonction de son contexte et de ses capacités.

Notre étude interdisciplinaire (en communication et ergonomie) porte sur les stratégies de CTF d’agentes et d’agents de nettoyage, un emploi comportant des horaires atypiques imposés et un faible niveau de prestige social. Cet article porte sur les facteurs organisationnels et les dynamiques relationnelles qui influencent la marge de manoeuvre d’agentes de nettoyage qui, pour concilier horaires atypiques et vie familiale, font le choix de travailler la nuit.

L’analyse des données provenant d’observations et d’entretiens met en évidence l’interaction entre le choix de l’horaire de travail, le soutien des collègues et les rapports liés au genre ainsi qu’à l’ancienneté. En situant les stratégies de CTF au coeur de l’activité de travail, nos résultats permettent d’illustrer les tensions collectives suscitées par l’accommodement des besoins individuels de CTF.

Améliorer les marges de manoeuvre visant à concilier vie familiale et horaires atypiques nécessite d’intervenir simultanément sur l’organisation du travail et les dynamiques relationnelles afin de favoriser l’émergence de pratiques collectives de soutien autour des enjeux de CTF. Ces dynamiques doivent être prises en compte lors de la mise en place de mesures organisationnelles, voire même de dispositifs légaux ayant pour but de faciliter la CTF.

Work activity in food service: The significance of customer relations, tipping practices and gender for preventing musculoskeletal disorders

Some evidence shows that food servers are exposed to an elevated risk of musculoskeletal disorders and injuries, and that their work activity varies by gender. Interviews of servers and observations of food service in Québec, Canada, were carried out in three restaurants and a questionnaire was administered to 64 workers from 44 other restaurants. The relationship with the customer has specific effects on work activity and transforms the physical, emotional and cognitive work. Strategies intended to speed service or otherwise related to the customer relationship can involve health risks. Women reported more direct food service (p < 0.01), a tendency to do more "housekeeping" tasks (p < 0.07) and fewer hours of work per week (p < 0.01). Women workers reported experiencing more sites of pain (p < 0.003). This exploratory study suggests that managing the server-customer relationship could be important in preventing musculoskeletal disorders in this population and that women are at particular risk.

[≪ If it's not documented, it's not done ≫: Management indicators of workload can leave women's work invisible]

Historically, eldercare was usually furnished by unpaid women at home. Now that women are in paid work, much of this care is given by personal support workers (PSWs), usually female. With the massive introduction of management indicators in public organisations, a form of organisational silence appears: work is rendered invisible. To examine the mechanism involved, we have observed the work of 37 PSWs in six Ontario residences, and performed interviews. Contrary to the way tasks are assigned, PSW work is often done collectively and documentation requirements are demanding; documenting can even conflict with direct health care. PSWs have insufficient time, so they are sometimes forced to omit data showing the challenges of their work. They thus contribute to a vicious circle where, unable to document the work they do, they lack resources and must skimp even more on documentation.

Pain and Prejudice: Does Collecting Information From the Standpoint of Exposed Workers Improve Scientific Examination of Work-Related Musculoskeletal Disorders?

The meaning, feasibility, and importance of scientific objectivity have been debated among public health scientists. The debate is particularly relevant to occupational health, because of frequent opposition between employer and worker interests. This article suggests that the concept of standpoint (J. Eakin) may be more useful than that of objectivity in framing discussion of work-related musculoskeletal disorders. Studies done from a "worker" standpoint can, for example, investigate and characterize environmental risk factors for work-related musculoskeletal disorders, while studies from an "employer" standpoint may concentrate on identifying individual workers likely to report work-related musculoskeletal disorders or those for whom consequences of work-related musculoskeletal disorders are more severe. Within "worker" standpoints, a distinction between "high-prestige worker" and "lower-prestige worker" standpoints can be identified in the current scientific debate about the health costs and benefits of prolonged standing vs prolonged sitting at work. Contact with workers, particularly lower-prestige workers, is critical to developing and sustaining a worker-based standpoint among researchers in occupational health. This contact can be facilitated by formal collaborations between universities and unions or other community groups.

Is sitting worse than static standing? How a gender analysis can move us toward understanding determinants and effects of occupational standing and walking

The Yant Award was established in 1964 to honor the contributions of William P. Yant, the first president of the American Industrial Hygiene Association. It is presented annually for outstanding contributions in industrial hygiene or allied fields to an individual residing outside the United States. The 2014 award recipient is Dr. Karen Messing, Professor emeritus, Department of Biological Sciences, Université du Québec à Montréal and Researcher, CINBIOSE Research Centre. Gender (socially determined) differences in occupations, employment, and working conditions, task assignments, and work methods that affect exposure to health risks are increasingly documented. Interactions of (biologically influenced) sex differences with workplace parameters may also influence exposure levels. During field studies, ergonomists learn a lot about gender and sex that can be important when generating and testing hypotheses about the mechanisms that link workplace exposures to health outcomes. Prolonged standing is common in North America; almost half (45%) of Québec workers spend more than three-quarters of their working time on their feet and 40% of these cannot sit at will. This posture has been linked to chronic back pain and musculoskeletal disorders (MSDs) in the lower limbs, but many health professionals suggest workers should stand rather than sit at work. We ask: (1) Given the fact that roughly the same proportion of men and women stand at work, what does a gender-sensitive analysis add to our ability to detect and thus prevent work-related MSDs?; (2) How does ergonomics research inform gender-sensitive analysis of occupational health data?; and (3) What do researchers need to know to orient interventions to improve general working postures? We have sought answers to these questions through collaborative research with specialists in epidemiology, occupational medicine, biomechanics, and physiology, carried out in partnership with public health organisations, community groups, and unions. We conclude that failure to characterize prolonged static standing and to apply gender-sensitive analysis can confuse assessment of musculoskeletal and circulatory effects of working postures. We suggest that prolonged static sitting and standing postures can and should be avoided by changes to workplace organization and environments. Research is needed to define optimal walking speeds and arrive at optimal ratios of sitting, standing, and walking in the workplace.

Underreporting work absences for nontraumatic work-related musculoskeletal disorders to workers' compensation: results of a 2007-2008 survey of the Québec working population

OBJECTIVES

We examined underestimation of nontraumatic work-related musculoskeletal disorders (WMSDs) stemming from underreporting to workers' compensation (WC).

METHODS

In data from the 2007 to 2008 Québec Survey on Working and Employment Conditions and Occupational Health and Safety we estimated, among nonmanagement salaried employees (NMSEs) (1) the prevalence of WMSDs and resulting work absence, (2) the proportion with WMSD-associated work absence who filed a WC claim, and (3) among those who did not file a claim, the proportion who received no replacement income. We modeled factors associated with not filing with multivariate logistic regression.

RESULTS

Eighteen percent of NMSEs reported a WMSD, among whom 22.3% were absent from work. More than 80% of those absent did not file a WC claim, and 31.4% had no replacement income. Factors associated with not filing were higher personal income, higher seniority, shorter work absence, and not being unionized.

CONCLUSIONS

The high level of WMSD underreporting highlights the limits of WC data for surveillance and prevention. Without WC benefits, injured workers may have reduced job protection and access to rehabilitation.

Quebec Research on Work-related Musculoskeletal Disorders

This paper aimed to demonstrate the contribution of the research performed by the musculoskeletal disorders (MSD) Research Axis group of the Quebec Occupational Health and Safety Research Network towards better understanding of work-related MSD (WMSD) development and prevention. Although the group targets its work to the Quebec population, its work has significant impact around the world, placing MSD axis members and knowledge and expertise created in Quebec on the international map. Results from the contribution of members are relevant, primarily in the demonstration of the implication of physical workload as well as organizational and psychosocial work-related factors in the development of WMSDs. Also, members have demonstrated that gender, sex, social class, age and ethno-cultural groups interact in various ways with WMSD determinants. Efforts are devoted towards improving understanding of the physiological responses linked with MSDs, which could also lead to new workplace practices in rehabilitation. The group emphasizes the integration of prevention procedures from the design stage to the workplace intervention. Members have proposed research-based tools for best practices at work and also an original conceptual model as a key, novel element of a theoretical conceptualization of WMSDs. Moreover, the group focuses on improving WMSD surveillance, using multiple sources of information, providing information on newly identified health risks and developing new methods of assessing risk in order to effectively prevent disability in the working population. Finally, results from research of the MSD axis group have implications for orienting legal processes, improving legal recognition of MSDs as occupational diseases, and contributing to the evolution of legal thinking. However, much remains to be done. To that end, the group plans and encourages new initiatives for further advancement. In conclusion, the originality of the work places the group in a favourable position to address the complexity underlying WMSDs, combining expertise that enriches fundamental, clinical and population-based research.

Strategies for managing work/life interaction among women and men with variable and unpredictable work hours in retail sales in Québec, Canada

Increasingly, work schedules in retail sales are generated by software that takes into account variations in predicted sales. The resulting variable and unpredictable schedules require employees to be available, unpaid, over extended periods. At the request of a union, we studied schedule preferences in a retail chain in Québec using observations, interviews, and questionnaires. Shift start times had varied on average by four hours over the previous week; 83 percent had worked at least one day the previous weekend. Difficulties with work/life balance were associated with schedules and, among women, with family responsibilities. Most workers wanted: more advance notice; early shifts; regular schedules; two days off in sequence; and weekends off. Choices varied, so software could be adapted to take preferences into account. Also, employers could give better advance notice and establish systems for shift exchanges. Governments could limit store hours and schedule variability while prolonging the minimum sequential duration of leave per week.

First steps for integrating sex and gender considerations into basic experimental biomedical research

In recent decades there has been an increasing recognition of the need to account for sex and gender in biology and medicine, in order to develop a more comprehensive understanding of biological phenomena and to address gaps in medical knowledge that have arisen due to a generally masculine bias in research. We have noted that as basic experimental biomedical researchers, we face unique challenges to the incorporation of sex and gender in our work, and that these have remained largely unarticulated, misunderstood, and unaddressed in the literature. Here, we describe some of the specific challenges to the incorporation of sex and gender considerations in research involving cell cultures and laboratory animals. In our view, the mainstreaming of sex and gender considerations in basic biomedical research depends on an approach that will allow scientists to address these issues in ways that do not undermine our ability to pursue our fundamental scientific interests. To that end, we suggest a number of strategies that allow basic experimental researchers to feasibly and meaningfully take sex and gender into account in their work.

Development of discomfort and vascular and muscular changes during a prolonged standing task

Background: Some proposed mechanisms for the development of back discomfort and musculoskeletal disorders relate to fatigue of trunk musculature, but these phenomena require further investigation. Hydrostatic pressure changes in vascular tissue are thought to drive development of lower limb discomfort and vascular disorders; however, specific vascular outcomes during standing work have not been investigated experimentally. Objectives: The goals of this experiment were to evaluate the effects of standing work on indicators of discomfort and on biological variables related to risk for trunk musculoskeletal andlower limb vascular disorders. Methods: Ten university-aged female volunteers, who did not work in jobs requiring prolonged standing, moved small objects between two containers for 32 minutes while standing. Electromyography from the erector spinae and rectus abdominis, lower limb blood flow data, brachial and ankle blood pressure, heart rate, and discomfort ratings were collected every 4 minutes. Results: There were no significant changes in electromyography outcomes for either muscle group. Foot and soleus blood flow (p < 0.05) and ankle blood pressure (p < 0.05) increased over time. There were strong correlations (> 0.8) between lower limb discomfort (feet and knees) and blood flow in the foot and soleus. Conclusions: Blood pooling may explain the discomfort associated with the simulated standing work evaluated here, and this vascular indicator should be tracked when attempting to alleviate lower limb symptoms in various working postures. Additional work is needed to determine which musculoskeletal indicators might explain back discomfort during standing.

Si le bruit rend sourd, rend-il nécessairement sourde ?

Au Québec, des données spécifiques concernant les conditions d’emploi, de travail et de rémunération des hommes et des femmes sont publiées régulièrement. Depuis peu, des données ventilées selon le sexe commencent à alimenter les efforts de prévention en santé au travail. Malgré ces progrès, certains défis techniques, idéologiques et politiques demeurent: allant des difficultés dans les calculs des populations à risque, à la réticence à adapter les postes de travail ou à adapter la formation à la spécificité biologique des femmes. La recherche sur la santé des femmes au travail a beaucoup progressé, mais il reste plusieurs étapes à franchir. Notons également que les spécificités associées au genre des hommes sont presqu'entièrement oubliées dans les études. Il est difficile de conserver un équilibre entre la protection de la santé et l’égalité des sexes dans la recherche et l’intervention en santé au travail. Pour assurer cet équilibre, la recherche doit se faire en collaboration avec les travailleuses et travailleurs. Ils peuvent ainsi contribuer à construire une base solide d’informations qui permettront aux gouvernements, aux organismes responsables de la prévention en santé au travail, aux employeurs et aux syndicats de tenir compte, dans leurs politiques, des besoins des deux sexes en santé au travail.

Work organisation and gender among hospital cleaners in Quebec after the merger of 'light' and 'heavy' work classifications

In Québec, Canada, cleaning tasks were once divided into 'light' or 'heavy' cleaning, assigned respectively to women and men. These categories are being merged; in principle, both genders are assigned the same tasks. Activity analysis using observations and interviews examined work activity of male and female cleaners in two hospitals. In one hospital, work activity could be compared before (time 1) and after the work reorganisation (time 2). Some gender segregation of tasks appeared to have persisted at time 2, in both hospitals. Some route assignments contained components that were difficult for all cleaners, especially women of average strength. Only about one-third of the recommendations for improvement made at time 1 had been carried out by time 2, 12 years later. In a low-status job, it may be hard to meet equality, health and efficiency goals because commitment to improving equipment and worksite design may be lacking.

PRACTITIONER SUMMARY

Current attempts to desegregate jobs should be accompanied by attention to physical job demands in order to protect employee health and access to equal employment. The study also shows the need to follow up ergonomic interventions, particularly in low-status jobs such as cleaning, where recommendations can be forgotten.

Action research for the health and safety of domestic workers in montreal: using numbers to tell stories and effect change

In 2007, a Filipina organization in Quebec (PINAY) sought the help of university researchers to document the workplace health and safety experiences of domestic workers. Together, they surveyed 150 domestic workers and produced a report that generated interest from community groups, policy-makers, and the media. In this article, we-the university researchers-offer a case study of community-university action research. We share the story of how one project contributed to academic knowledge of domestic workers' health and safety experiences and also to a related policy campaign. We describe how Quebec workers' compensation legislation excludes domestic workers, and we analyze the occupational health literature related to domestic work. Striking data related to workplace accidents and illnesses emerged from the survey, and interesting lessons were learned about how occupational health questions should be posed. We conclude with a description of the successful policy advocacy that was possible as an outcome of this project.

Are immigrants, ethnic and linguistic minorities over-represented in jobs with a high level of compensated risk? Results from a Montréal, Canada study using census and workers' compensation data

OBJECTIVES

Few Canadian data sources allow the examination of disparities by ethnicity, language, or immigrant status in occupational exposures or health outcomes. However, it is possible to document the mechanisms that can create disparities, such as the over-representation of population groups in high-risk jobs. We evaluated, in the Montréal context, the relationship between the social composition of jobs and their associated risk level.

METHODS

We used data from the 2001 Statistics Canada census and from Québec's workers' compensation board for 2000-2002 to characterize job categories defined as major industrial groups crossed with three professional categories (manual, mixed, non-manual). Immigrant, visible, and linguistic minority status variables were used to describe job composition. The frequency rate of compensated health problems and the average duration of compensation determined job risk level. The relationship between the social composition and risk level of jobs was evaluated with Kendall correlations.

RESULTS

The proportion of immigrants and minorities was positively and significantly linked to the risk level across job categories. Many relationships were significant for women only. In analyses done within manual jobs, relationships with the frequency rate reversed and were significant, except for the relationship with the proportion of individuals with knowledge of French only, which remained positive.

CONCLUSIONS

Immigrants, visible, and linguistic minorities in Montréal are more likely to work where there is an increased level of compensated risk. Reversed relationships within manual jobs may be explained by under-reporting and under-compensation in vulnerable populations compared to those with knowledge of the province's majority language.

Full-time homemakers: workers who cannot "go home and relax"

This paper examined how musculoskeletal disorders (MSDs) of female homemakers were studied in the literature. It also presented preliminary findings from field observations of housework and fulltime homemakers in urban settings. PubMed, Ergonomics Abstracts, Sociofile, and PsycINFO databases were used in the literature search. The review focused on comparing demands of housework and paid work. Also, exposure factors found in studies of various occupations were compared with the results of field observations of housework in 4 homes in Beirut, Lebanon. Few studies systematically examined associations between MSDs and risk factors in housework. Some well-known risk factors for MSDs were identified in the Beirut homes; however, other unique factors were noted. Housework activities expose homemakers to known risk factors for MSDs, which calls for further studies to identify appropriate intervention and prevention strategies.

Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day

A relationship between low back pain (LBP) and prolonged standing or prolonged sitting at work has not been clearly shown, despite its biological plausibility. Because sitting and standing postures vary as to duration and freedom to alternate postures, and standing postures vary as to mobility, associations between specific working postures and LBP were explored using multiple logistic regression. Associations between work factors and self-reported LBP during the previous 12 months that interfered with usual activities were examined among 4493 standing workers and 3237 sitting workers interviewed in the 1998 Quebec Health and Social Survey; 24.5% reported significant LBP. Since the same conditions can correspond to different physiological demands for sitting compared with standing workers, analyses were performed separately for the two groups. Standing without freedom to sit was associated with LBP. Different occupational physical and psychosocial factors were associated with LBP in sitting compared with standing populations.

Should studies of risk factors for musculoskeletal disorders be stratified by gender? Lessons from the 1998 Québec Health and Social Survey

OBJECTIVES

Several studies have reported male-female differences in the prevalence of symptoms of work-related musculoskeletal disorders (MSD), some arising from workplace exposure differences. The objective of this paper was to compare two strategies analyzing a single dataset for the relationships between risk factors and MSD in a population-based sample with a wide range of exposures.

METHODS

The 1998 Québec Health and Social Survey surveyed 11 735 respondents in paid work and reported "significant" musculoskeletal pain in 11 body regions during the previous 12 months and a range of personal, physical, and psychosocial risk factors. Five studies concerning risk factors for four musculoskeletal outcomes were carried out on these data. Each included analyses with multiple logistic regression (MLR) performed separately for women, men, and the total study population. The results from these gender-stratified and unstratified analyses were compared.

RESULTS

In the unstratified MLR models, gender was significantly associated with musculoskeletal pain in the neck and lower extremities, but not with low-back pain. The gender-stratified MLR models identified significant associations between each specific musculoskeletal outcome and a variety of personal characteristics and physical and psychosocial workplace exposures for each gender. Most of the associations, if present for one gender, were also found in the total population. But several risk factors present for only one gender could be detected only in a stratified analysis, whereas the unstratified analysis added little information.

CONCLUSIONS

Stratifying analyses by gender is necessary if a full range of associations between exposures and MSD is to be detected and understood.

Orthostatic symptoms, blood pressure and working postures of factory and service workers over an observed workday

North American workers usually stand while working, and prolonged standing is associated with discomfort and cardiovascular problems. Moving may alleviate the problems, but optimum mobility is unknown. The effects of variations in mobility were explored among (1) 34 health care workers whose symptoms of orthostatic intolerance (OI) were recorded after work; (2) 45 factory and laundry workers. Postures were observed over a workday and blood pressure (BP) and heart rate (HR) of both groups were recorded before and after work. Among health care workers, 65% manifested OI symptoms. In a multiple logistic regression, presence of >or= 1 symptom of OI was associated with static postures and being female (p=0.001). More static standing was associated with a larger drop in BP (p=0.04) in both populations. The results suggest that more static standing postures are associated with OI and musculoskeletal symptoms and with a subclinical drop in BP.

Broken English, broken bones? Mechanisms linking language proficiency and occupational health in a Montreal garment factory

Language barriers are often cited as a factor contributing to ethnic inequalities in occupational health; however, little information is available about the mechanisms at play. The authors describe the multiple ways in which language influences occupational health in a large garment factory employing many immigrants in Montreal. Between 2004 and 2006, individual, semi-structured interviews were conducted with 15 women and 10 men from 14 countries of birth. Interviews were conducted in French and English, Canada's official languages, as well as in non-official languages with the help of colleague-interpreters. Observation within the workplace was also carried out at various times during the project. The authors describe how proficiency in the official languages influences occupational health by affecting workers' ability to understand and communicate information, and supporting relationships that can affect work-related health. They also describe workers' strategies to address communication barriers and discuss the implications of these strategies from an occupational health standpoint. Along with the longer-term objectives of integrating immigrants into the linguistic majority and addressing structural conditions that can affect health, policies and practices need to be put in place to protect the health and well-being of those who face language barriers in the short term.