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Ambulance Work: Relationships between occupational demands, individual characteristics and health-related outcomes
Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
2005 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Although musculoskeletal disorders (MSDs) and other health complaints are an occupational problem for ambulance personnel, there is a lack of knowledge regarding work-related factors associated with MSDs and other health complaints. The overall aim of this thesis was to investigate the relationships between occupational demands, individual characteristics and health-related outcomes among ambulance personnel.

A random sample of 234 female and 953 male ambulance personnel participated in a national questionnaire survey on work-related factors, and musculoskeletal and other health complaints. Physical demands was associated with activity limitation due to neck-shoulder and low-back complaints among the female personnel. Among the male personnel, physical demands was associated with low-back complaints and activity limitation due to low-back complaints. Psychological demands was significantly associated with neck-shoulder complaints, sleeping problems, headache and stomach symptoms among both female and male ambulance personnel. Worry about work conditions was associated with musculoskeletal disorders and sleeping problems, headache and stomach symptoms.

A local sample of 26 ambulance personnel was followed during a 24-hour work shift and for the next two work-free days. Subjective stress- and energy levels, and cortisol levels were measured at regular intervals, and heart rate was registered continuously by electrocardiogram (ECG). Autonomic reactivity to standardized tests before (pre-work) and at the end of the work shift (post-work) was also investigated. For the whole group, baseline values of heart rate were higher pre-work than post-work, but autonomic reactivity did not differ. Increased reactivity to the mental test, modest deviation in heart rate variability (HRV) pattern during the late night hours at work and higher morning cortisol values during work than during leisure time were observed in personnel with many health complaints, but not among their co-workers without or with few complaints. Ambulance personnel with many health complaints also reported higher psychological demands and tended to be more worried about work conditions.

Heart rate (HR), lactate level (LL) and perceived exertion (RPE) were investigated in 17 female and 48 male ambulance personnel during a simulated standardized work task “carry a loaded stretcher”. The ambulance personnel had to carry the loaded stretcher (920 N) up and down three flights of stairs twice. The high physiological strain (HR, LL, RPE) for the male, and near or at maximal strain for the female ambulance personnel, implied the importance to identify what kind of physical capacity is most important for ambulance personnel. Therefore, the explained variance of developed fatigue by tests of cardiorespiratory capacity, muscular strength and endurance, and coordination was investigated. The results showed that VO2max and isometric back endurance were important predictors for development of fatigue when carrying a loaded stretcher.

The influence of body size on the relationships between maximal strength and functional performance was investigated in a methodological study. The results confirm that the assessment of physical performance could be confounded by the body weight. Therefore, the models for explaining development of fatigue when carrying the loaded stretcher were adjusted for height and weight. Including height in the models significantly increased the explained variance of accumulated lactate among female, but not among male personnel. Lactate levels were higher among short compared to tall female personnel. Weight had no effect on any of the models.

In conclusion, the national survey showed that self-reported physical demands was a risk factor of having MSDs, and that self-reported psychological demands and worry about work were important risk factors of having MSDs and other health complaints. Stress monitoring of ambulance personnel during work and leisure time showed that physiological and subjective stress markers did not show any differences between the 24-hour ambulance work shift and leisure time afterwards. However, ambulance personnel with many health complaints had certain physiological changes during the work shift in comparison with the next two work-free days. The physiological and subjective responses during carrying a loaded stretcher, especially among the female ambulance personnel, showed that female and male ambulance personnel could be exposed to internal exposures at different levels when performing the same work task. A better understanding of the relationships between occupational demands and health-related outcomes require further studies on age- and gender matched groups in long-term perspective studies.

sted, utgiver, år, opplag, sider
2005. , s. 75
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 943
Emneord [en]
ambulance, autonomic reactivity, body size, cortisol, demand-control-support, emergency personnel, fitness, gender, heart rate variability, low-back pain, neck-shoulder pain, occupational, physical capacity, work simulated test, worry
Forskningsprogram
arbets- och miljömedicin
Identifikatorer
URN: urn:nbn:se:umu:diva-478ISBN: 91-7305-820-3 (tryckt)OAI: oai:DiVA.org:umu-478DiVA, id: diva2:143546
Disputas
2005-04-08, Stora föreläsningssalen, Arbetslivsinstitutet, Umeå, 09:00 (engelsk)
Opponent
Tilgjengelig fra: 2005-03-17 Laget: 2005-03-17 Sist oppdatert: 2010-02-19bibliografisk kontrollert
Delarbeid
1. Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel.
Åpne denne publikasjonen i ny fane eller vindu >>Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel.
2005 (engelsk)Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, nr 3, s. 251-258Artikkel i tidsskrift (Fagfellevurdert) Published
Emneord
Adult, Ambulances/organization & administration, Analysis of Variance, Attitude to Health, Burnout; Professional/*epidemiology/etiology/psychology, Decision Making; Organizational, Emergency Medical Technicians/education/organization & administration/*psychology, Female, Headache/epidemiology, Humans, Job Satisfaction, Logistic Models, Male, Occupational Diseases/*epidemiology/etiology/psychology, Occupational Health, Prevalence, Questionnaires, Risk Factors, Sex Distribution, Sleep Disorders/epidemiology, Social Support, Stomach Diseases/epidemiology, Sweden/epidemiology, Workplace/organization & administration/*psychology
Forskningsprogram
sjukgymnastik
Identifikatorer
urn:nbn:se:umu:diva-16963 (URN)10.1111/j.1471-6712.2005.00333.x (DOI)16101853 (PubMedID)
Tilgjengelig fra: 2007-12-04 Laget: 2007-12-04 Sist oppdatert: 2018-06-09bibliografisk kontrollert
2. Relationships between work-related factors and disorders in the neck-shoulder and low-back region among female and male ambulance personnel.
Åpne denne publikasjonen i ny fane eller vindu >>Relationships between work-related factors and disorders in the neck-shoulder and low-back region among female and male ambulance personnel.
2005 (engelsk)Inngår i: Journal of Occupational Health, ISSN 1341-9145, E-ISSN 1348-9585, Vol. 47, nr 6, s. 481-9Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

This cross-sectional study on a random sample of 1,500 ambulance personnel investigated the relationships between self-reported work-related physical and psychosocial factors, worry about work conditions, and musculoskeletal disorders among female and male ambulance personnel. Three different outcomes, complaints, activity limitation, and sick leave, for the neck-shoulder and low-back region, respectively, were chosen. Among the female personnel, physical demands was significantly associated with activity limitation in the neck-shoulder (OR 4.13) and low-back region (OR 2.17), and psychological demands with neck-shoulder (OR 2.37) and low-back (OR 2.28) complaints. Among the male personnel, physical demands was significantly associated with low-back complaints (OR 1.41) and activity limitation (OR 1.62). Psychological demands and lack of social support were significantly associated with neck-shoulder complaints (OR 1.86 and OR 1.58, respectively) and activity limitation (OR 3.46 and OR 1.71) as well as activity limitation due to low-back complaints (OR 2.22 and OR 1.63). Worry about work conditions was independently associated with activity limitation due to low-back complaints among the female (OR 5.28), and to both neck-shoulder and low-back complaints (OR 1.79 and OR 2.04, respectively) and activity limitation (OR 2.32 and OR 1.95) among the male personnel. In conclusion, the association patterns between physical and psychological demands and MSDs suggest opportunities for intervention.

Emneord
Adult, Ambulances, Cross-Sectional Studies, Emergency Medical Technicians, Female, Humans, Low Back Pain/*etiology, Male, Middle Aged, Neck Pain/*etiology, Occupational Diseases/*etiology, Psychology, Shoulder Pain/*etiology, Sweden/epidemiology
Identifikatorer
urn:nbn:se:umu:diva-6698 (URN)10.1539/joh.47.481 (DOI)16369110 (PubMedID)
Tilgjengelig fra: 2008-01-04 Laget: 2008-01-04 Sist oppdatert: 2018-06-09bibliografisk kontrollert
3. Stress monitoring of ambulance personnel during work and leisure time.
Åpne denne publikasjonen i ny fane eller vindu >>Stress monitoring of ambulance personnel during work and leisure time.
Vise andre…
(engelsk)Manuskript (Annet vitenskapelig)
Identifikatorer
urn:nbn:se:umu:diva-4435 (URN)
Tilgjengelig fra: 2005-03-17 Laget: 2005-03-17 Sist oppdatert: 2016-04-11bibliografisk kontrollert
4. Muscle strength assessment from functional performance tests: role of body size
Åpne denne publikasjonen i ny fane eller vindu >>Muscle strength assessment from functional performance tests: role of body size
2003 (engelsk)Inngår i: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 17, nr 4, s. 664-670Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

The aim of the study was to test the hypothesis that the body size plays an important role in assessment of muscle ability to exert force by standard functional performance tests. Twenty-one male students were tested on maximal isometric lift, one leg rising, vertical jump, and box lift tests, and the maximal isokinetic strength of hip and knee extensors was also recorded. When indices of the 4 functional performance tests were related to the strength of each of the 2 leg extensor muscle groups, only maximal isometric lift demonstrated positive correlation with knee extensors strength. When muscle strength was corrected for body mass, however, the aforementioned relationship became insignificant, but the 1 leg rising performance demonstrated a positive relationship with knee extensor strength. In addition, maximal isometric lift and 1 leg rising test performance provided positive and negative correlation, respectively, with body mass. The obtained findings were in line with the effects of scale applied on the tested performance. We generally conclude that the assessment of muscle capability to exert force based on some standard functional performance tests could be confounded by the body size effect.

Emneord
effects of scale, isokinetic force, movement task, body mass
Identifikatorer
urn:nbn:se:umu:diva-4436 (URN)14636094 (PubMedID)
Tilgjengelig fra: 2005-03-17 Laget: 2005-03-17 Sist oppdatert: 2018-06-09bibliografisk kontrollert
5. Prediction of development of fatigue during a simulated ambulance work task from physical performance tests.
Åpne denne publikasjonen i ny fane eller vindu >>Prediction of development of fatigue during a simulated ambulance work task from physical performance tests.
2004 (engelsk)Inngår i: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 47, nr 11, s. 1238-1250Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

The aims of this study were (1) to identify which physical performance tests could best explain the development of fatigue during a simulated ambulance work task, (2) to investigate the effect of height and weight and (3) to investigate in what respects these findings differ between female and male ambulance personnel. Forty-eight male and 17 female ambulance personnel completed a test battery assessing cardio-respiratory capacity, muscular strength and endurance, and co-ordination. The subjects also completed a simulated ambulance work task -- carrying a loaded stretcher. The work task was evaluated by development of fatigue. Univariate and multiple regression analyses were used to investigate to what extent the tests in the test battery were able to explain the variance of developed fatigue. The explained variance was higher for female than for male ambulance personnel (time > 70% of HRpeak: R2 = 0.75 vs 0.10, accumulated lactate: R2 = 0.62 vs 0.42, perceived exertion: R2 = 0.75 vs 0.10). Significant predictors in the models were VO2max, isometric back endurance, one-leg rising, isokinetic knee flexion and shoulder extension strength. Height, but not weight, could further explain the variance. The high physical strain during carrying the loaded stretcher implies the importance of investigating whether improved performance, matching the occupational demands, could decrease the development of fatigue during strenuous tasks.

Emneord
Adult, Ambulances/*manpower, Body Height, Body Mass Index, Body Weight, Cross-Sectional Studies, Emergency Medical Technicians, Fatigue/*etiology/physiopathology, Female, Humans, Lifting, Male, Occupational Exposure/*adverse effects, Prognosis, Questionnaires, Reference Values, Sex Factors, Task Performance and Analysis, Weight-Bearing/physiology, Work Schedule Tolerance
Identifikatorer
urn:nbn:se:umu:diva-16907 (URN)10.1080/00140130410001714751 (DOI)15370859 (PubMedID)
Tilgjengelig fra: 2007-10-19 Laget: 2007-10-19 Sist oppdatert: 2018-06-09bibliografisk kontrollert

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