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Occupational Hazards: Applying New Solutions to Aching Problems Although most industries in the US have had health and safety guidelines in place for decades, work-related injuries and illnesses still occur at an alarming rate. This phenomenon cannot be blamed solely on human nature -- people will ignore safety precautions in order to accomplish a task quickly and cheaply -- nor on the fact that some jobs are inherently dangerous.
Work-related musculoskeletal disorders (WRMDs) are increasing faster than any other occupational illness, according to the Bureau of Labor Statistics. Each year, WRMDs cost the US $60 billion, including $15-$20 billion in workers' compensation costs, according to the Occupational Safety and Health Administration (OSHA). Industries heavily reliant upon manufacturing and manual handling operations have particularly high rates of WRMDs, according to OSHA. In the absence of any federal ergonomic guidelines, some of these industries have nevertheless developed and implemented cost-effective strategies for reducing risk to their employees while also maintaining, or even boosting, productivity. However, some industries have not adopted these safer work practices, nor have they reviewed their work processes to find ways of preventing work-related injuries and illnesses. Occupational health researchers at UCSF's School of Nursing are assessing the risks of work-related musculoskeletal disorders and developing safer work practices in these understudied industries. Julia Faucett, an associate professor at UCSF and director of the Occupational Health Nursing Program, is among a team of UC researchers developing tools to decrease the musculoskeletal injury rate of workers in California's agriculture industry. Meanwhile, Marion Gillen, an assistant professor on the nursing faculty, is studying the construction industry to find ways of better preventing injuries and assessing injury severity so that clinicians may be better able to expedite the worker's return to work. Agriculture -- An Industry of Challenges Julia Faucett and other researchers from the UC Center for Occupational and Environmental Health are conducting intervention trials in large commercial nurseries and vineyards, with the goal of reducing WRMDs among workers performing highly repetitive lifting and carrying tasks. "One of the things about these projects that excites me the most is that there are practices in agriculture that haven't changed for hundreds of years," Faucett says. "Yet, with all of our knowledge about ergonomics and tool design, we ought to be able to find ways to reduce the risk of injury. This is a very vulnerable and underserved group of workers." California's agricultural workers do many repetitive and physically challenging tasks, and, as a result, a large proportion of them are at risk for some form of musculoskeletal injury, mainly strained backs, tendinitis, carpal tunnel syndrome, and myalgia (muscle pain). Faucett and her collaborators decided to first study California's huge commercial nurseries because they have processes similar to assembly-line work, allowing the researchers to apply some proven ergonomic methods developed in other industries. Workers at these nurseries are involved in tasks such as propagation, which is working with little leaflets and small plants in tiny pots, to repotting the plants over and over as they grow, putting the pots out into the fields to turn into mature plants, and moving these mature plants to a shipping area. "There's a lot of repetitive activity because there are thousands of these pots to process continuously," Faucett says. "When the workers bring the pots out to the field, they bend over and lift hundreds and hundreds of times a day. With that kind of repeated activity, they're going to get back strain, upper extremity problems, neck and shoulder pain, or even knee problems from stooping to put the pots on the ground."
After the UC team identified the appropriate areas for intervention in the nurseries, engineers from UC Davis developed a feasible tool to implement. In this case, they developed an 18-inch handle with a horseshoe-like grabber at the bottom. The horseshoe fits around the pot and the handle reaches up to the worker's waist, so the worker can move the pot without bending. A major challenge in developing occupational health interventions, says Faucett, is trying to balance the economic and productivity needs of the employer with the health and safety needs of the workers. "We try to keep the interventions fairly simple and economic because obviously the employers would not be interested in expensive remedies or ones that impair productivity," Faucett says. The tool they developed is popular with the nursery workers, who report fewer incidences of work-related symptoms, as well as with the employers because it's easy to use, inexpensive and easily reproducible - "something that the growers could even develop in their repair shops," Faucett says. Faucett and her colleagues next studied workers in Northern California's vineyards and developed an intervention that, at least by preliminary data, is also proving successful. By simply reducing the weight of the bins into which the workers put grapes before carrying them off to a larger central bin, the research team has created a solution that protects worker health and employer productivity during grape harvesting. The California agriculture industry presents many challenges for researchers, not just because the research is literally "field work," but also because of the unique characteristics of its employees. The industry's workers are mostly Mexican immigrants, who, Faucett says, tend to have a different cultural view of work and pain than other populations. The Mexican immigrant workers Faucett has studied tend to consider pain unavoidable -- pain is part of work and work is part of life. "We don't look at it that way," Faucett says. "We look at work as something you can make better to protect the workers."
These workers may consider a sore back a nuisance, but certainly not a symptom of a disorder or illness. "Constructing a survey to reflect those cultural attitudes was critical. Otherwise we wouldn't have results -- they would have said they didn't have any pain or musculoskeletal symptoms," Faucett says. The research team developed a culturally sensitive method to assess pain, which may hold the most clinical promise of all their findings, says Faucett. She hopes it will give clinicians who see a significant population of Mexican patients a more effective way of providing care. Assessing Disability and Its Socioeconomic Costs Like their peers in the agriculture industry, construction workers are at a high risk of occupational injury. In addition to suffering from musculoskeletal injuries from heavy lifting and repetitive tasks, a relatively high percentage become severely -- sometimes fatally -- injured from falls. Marion Gillen studies worker safety in the construction industry and the level of disability caused by nonfatal falls. Distinguishing how functionally disabled a worker is after a fall has been problematic, because researchers in the past have used a measurement called a trauma or injury severity score, which suggests how likely someone is to die from their injury, not how likely somebody is to be disabled from their injury. "You can be a carpenter and lacerate a tendon in your hand and never be able to use your hand again and still get a low trauma score because it's not a life-threatening injury," Gillen says. In an effort to find a better measure of injury severity in construction workers, Gillen used a functional limitation measure called the Health Assessment Questionnaire (HAQ) -- a measurement of how able a person is to do simple daily tasks, such as tying shoelaces. The research results suggest that Gillen has found a more useful tool for measuring how disabled a worker is, as well as a potential method for predicting when an injured worker will be able to return to work. Gillen will be using functional limitation scores again in her current research with injured San Francisco city workers. She will be administering the HAQ, as well as the Short Form 36 (sf-36), four times over a three-month period to determine which measurement better captures how functionally limited people are from their injuries. "The findings might be helpful for clinicians who are trying to get injured people back to work," Gillen says. "It will assist them in developing a rehabilitation plan to help get the workers back to work sooner and in better shape." In this same study, Gillen is also looking at the social and economic effects of workplace injuries. "People have not been able to put a price tag on some of the out-of-pocket expenses and pain and inconvenience suffered," says Gillen. "Researchers have looked at lost time and direct medical costs but not at these other areas." In another project, Gillen returns to the construction site to investigate employee and employer perceptions of workplace safety. Construction has one of the highest rates of fatalities, non-fatal injuries and lost time from work, partly because workers have to be acutely aware of their surroundings, which change on a daily basis and are often fraught with danger. Another challenge is that the industry is made up of many small businesses, making the application of consistent safety practices difficult. "I would really like to work with small construction companies at some point and develop safety and health programs that help them implement safer workers' practices," Gillen says.
Source:
Paula Murphy |
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Rather,
the changing nature of work and the modern tools that accompany it are
causing a range of musculoskeletal disorders that are rapidly rising
among a new generation of workers. (Just think of all the computer users
and grocery checkout scanners who have acquired carpal tunnel syndrome
and other repetitive stress disorders.) And as these illnesses and injuries
become common complaints in America's workplaces, workers in less modern
industries are becoming aware that their aches and pains might too be
symptoms of a larger disorder.