Journal of Occupational & Environmental Medicine

ObjectivesThe aim of this study was to clarify which workers symptoms led to unemployment during the COVID-19 pandemic. MethodsThis was a prospective cohort study using questionnaires about COVID-19 administered to Japanese workers. A baseline survey conducted in December 2020 was used to determine workers health history. Unemployment since the baseline survey was ascertained with a follow-up survey in December 2021. The odds ratios (ORs) of unemployment were estimated using a multilevel logistic model with adjusted covariates nested in prefecture of residence. ResultsMales (n = 8,682) accounted for 58.2% of the total sample (n = 14,910), and the mean age was 48.2 years. Multivariate analysis showed that workers with "pain-related problems," "limited physical movement and mobility," "fatigue, loss of strength or appetite, fever, dizziness, and moodiness," "mental health problems," or "sleep" had a greater probability of resigning for health reasons, resigning for all reasons other than retirement, and being unemployed. Those with "skin, hair, and cosmetic concerns" or "eye-related matters" had a greater probability of becoming unemployed. ConclusionsWe identified an association between workers symptoms and resignation or unemployment, with different symptoms having different ORs. Furthermore, there were differences in the associations among the effects of symptoms, work dysfunction, resignation/unemployment, and attitudes of others. Preventive interventions to help workers resolve or improve their symptoms could prevent their becoming unemployed or resigning.

IntroductionMachine learning (ML) is increasingly used by Canadian workplaces. Concerningly, the impact of ML may be inequitable and disrupt social determinants of health. The aim of this study is to estimate the number of workers in occupations highly exposed to ML and describe differences in ML exposure represents according to occupational and worker sociodemographic factors. MethodsCanadian occupations were scored according to the extent to which they were made up of job tasks that could be performed by ML. Eight years of data from Canadas Labour Force Survey were pooled and the number of Canadians in occupations with high or low exposed to machine learning were estimated. The relationship between gender, hourly wages, educational attainment and occupational job skills, experience and training requirements and ML exposure was examined using stratified logistic regression models. ResultsApproximately, 1.9 million Canadians are working in occupations with high ML exposure and 744,250 workers were employed in occupations with low ML exposure. Women were more likely to be employed in occupations with high ML exposure than men. Workers with greater educational attainment and in occupations with higher wages and greater job skills requirements were more likely to experience high ML exposure. Women, especially those with less educational attainment and in jobs with greater job skills, training and experience requirements, were disproportionately exposed to ML. ConclusionML has the potential to widen inequities in the working population. Disadvantaged segments of the workforce may be most likely to be employed in occupations with high ML exposure. ML may have a gendered effect and disproportionately impact certain groups of women when compared to men. We provide a critical evidence base to develop strategic responses that ensure inclusion in a working world where ML is commonplace. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIThe Canadian labour market is undergoing an artificial intelligence (AI) revolution that has the potential to have widespread impact on a range of occupations and worker groups. C_LIO_LIIt is unclear how which the adoption of machine learning (ML), an AI subfield, within the working world might contribute to inequities within the labour market. C_LI What this study addsO_LISegments of the workforce which have been previously disadvantaged may be most likely to work in occupations most likely to be affected by ML. C_LIO_LIML may have a gendered effect and disproportionately impact some groups of women when compared to men. C_LI How this study might affect research, practice or policyFindings can inform targeted policies and programs that optimize the economic benefits of ML while addressing disparities that can emerge because of the adoption of the technology on workers.

ObjectivesOur research questions are often chosen based on the existence of suitable data for analysis or prior research in the area. For new interdisciplinary research areas, such as occupational health equity, suitable data might not yet exist. In this manuscript, we describe how we approached a research project in the absence of suitable data, using the example of identifying inequities in adequate bathrooms in U.S. workplaces. MethodsWe created a conceptual model that explained the causation of occupational health inequities, and from this model identified a series of questions that could be answered using separate datasets. Breaking up the analysis into multiple steps allowed us to use multiple data sources and analysis methods, which helped compensate for limitations in each dataset. ResultsUsing the conceptual model as a guide, we were able to identify jobs that likely have inadequate bathrooms as well as subpopulations potentially at higher risk for inadequate bathrooms. We also identified specific data gaps by reflecting on the challenges we faced in our multi-step analysis. ConclusionsWe share our conceptual model and our example analysis to motivate epidemiologists to avoid letting availability of data limit the research questions they pursue. What is already known on this topicConducting research in interdisciplinary research areas, such as occupational health equity, can be challenging because suitable data often do not exist. What this study addsWe created a conceptual model that explains the causation of occupational health inequities, which helps conduct analyses with less than optimal data. How this study might affect research, practice or policyUsing this approach allows researchers to combine multiple data sources and analysis methods to answer a single research question, expanding the research questions that can be addressed with existing data.

BackgroundThe healthcare sector has a shortage of physicians. Strategies to better retain medical professionals in the workforce in General Internal Medicine must rely on an in-depth understanding of factors associated with wanting to quit their job. Here, we investigated sex-specific associations of workplace-related and personal factors associated with wanting to quit work among physicians. MethodsIn a cross-sectional questionnaire among physicians working in General Internal Medicine in Switzerland, we assessed personal and workplace-related factors in association with the desire to quit their job. The outcome variable of wanting to quit ones job was dichotomized from a 6-point Likert scale. We performed sex-stratified analyses by Wilcoxon rank sum test, Chi-square test and multiple logistic regression adjusting for demographic variables. ResultsThis study included 682 physicians, 278 (41%) men and 404 (59%) women aged 37{+/-}11 years (mean {+/-} standard deviation). A majority of 78% men and 75% worked in hospitals. Overall, a desire to quit their job was prevalent in 33% of respondents of either sex. Almost all workplace-related items were associated with the probability of wanting to quit among both sexes: Having a good network, mentoring or supervisors support were associated with a lower probability of wanting to quit, whereas having a bad work-life balance or dissatisfaction with autonomy at work. Problematic or workplace inclusiveness and experienced gender-related discrimination at work were associated with a higher probability of wanting to quit in univariable analysis in both sexes. The main sex difference was that the associations of workplace inclusiveness or gender discrimination with wanting to quit were robust to adjustment by type of workplace and language region in men, whereas in women upon multivariable adjustments the associations disappeared. Finally, in men (but not women) having no adequate childcare was more likely to desire quitting their job. ConclusionThis study identified several factors of which some may exert a causal relationship with the desire to quit a physician job. Modifying such factors by interventions may ultimately increase the likelihood of a physician continuing working in his profession.

Employees post-pandemic telework preference is an important consideration for navigating post-pandemic work arrangements and can inform organizational planning and workforce management. A cross-sectional survey of employees (n=400, participation rate =36.4%) of a regional health authority who teleworked during the COVID-19 pandemic was conducted. The most common post-pandemic telework preference was all the time (52%) followed by over half but not all the time (32%) and less than half the time or not at all (16%). Using hierarchical multinomial logistic regression models and less than half the time or not at all as the reference outcome, being a provider of direct patient care and productivity while teleworking were strong determinants of post-pandemic telework preference while two or more weekly teleconference hours, work-life balance and having one or more people over five years of age in the home while teleworking were moderate determinants.

ObjectiveWe examined the association between presenteeism and risk of job resignations and unemployment among Japanese workers during the COVID-19 pandemic. MethodsA prospective study of 27,036 Internet monitors was conducted, starting in December 2020, with 18,560 (68.7%) participating in the follow-up by December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment. ResultsThe group with the highest WFun scores had higher odds ratios (ORs) for both retirement and unemployment for health reasons than the group with the lowest WFun scores. ORs were 2.97 (95%CI: 2.46-3.59, p<0. 001) and 1.80 (95%CI: 1.64-1.98, p<0.001), respectively. ConclusionsWorkers with work functioning impairment were at increased risk of resignation or unemployment. Management strategies for workers with work functioning impairment are needed to reduce their disadvantages in employment.

Few risk prediction scores are available to identify people at increased risk of work disability, particularly for those with an existing morbidity. We examined the predictive performance of disability risk scores for employees with chronic disease. We used prospective data from 88,521 employed participants (mean age 43.1) in the Finnish Public Sector Study which included people with chronic disorders: musculoskeletal disorder, depression, migraine, respiratory disease, hypertension, cancer, coronary heart disease, diabetes and comorbid depression and cardiometabolic disease. 105 predictors were assessed at baseline and participants were linked to a national disability pension register. During a mean follow-up of 8.6 years, 6836 (7.7%) participants got a disability pension, the incidence varying between 9.9% among participants with migraine and 27.7% in those with comorbid depression and cardiometabolic disease. C-statistics for an 8-item risk score, comprising age, self-rated health, number of sickness absences, socioeconomic position, number of chronic illnesses, sleep problems, BMI, and smoking at baseline, was 0.80 (95%CI: 0.80-0.81) for musculoskeletal disorders (N=33,601), 0.83 (0.82-0.84) for migraine (N=22,065), 0.82 (0.81-0.83) for respiratory disease (N=15,372) and exceeded 0.72 for other disease groups. With 30% estimated risk as a threshold, a positive test detection rate and false positive rate ranged from 42.2% and 18.8% (cancer) to 79.8% and 45.2% (comorbid depression and cardiometabolic disease). Predictive performance was not improved in models with a new set of predictors or re-estimated coefficients. In conclusion, the 8-item work disability risk score may serve as a scalable screening tool in identifying individuals with increased risk for work disability.

Background: Work-related musculoskeletal pain (MSP) is a prevalent concern among factory workers, impacting productivity, absenteeism, and overall quality of life. Factory workers, who perform repetitive tasks and engage in physically demanding work, are particularly susceptible to work-related MSP. Methods: This descriptive cross-sectional quantitative study included 148 factory workers (29 females and 119 males) from two factories in Kigali, surveyed between November 2023 and January 2024. Data were collected using a structured questionnaire that included demographic items, the Modified Nordic Musculoskeletal Questionnaire (M-NMQ) to assess work-related musculoskeletal pain (MSP) symptoms in nine body regions over the previous 12 months and seven days, and questions regarding interference of symptoms with normal work activities. The Coping Strategies Questionnaire (CSQ) was administered to identify coping practices among factory workers. Data analysis comprised descriptive statistics, including mean, frequency, Wilson 95% confidence intervals, and percentage values, calculated using SPSS version 25.0. Results: Participants were predominantly male (119/148, 80.4%), and 98/148 (66.2%) had worked at the factory for more than five years. Overall, 113/148 reported symptoms in at least one body region during the previous 12 months (76.4%, 95% CI 68.9-82.5). The lower back (90/148, 60.8%), shoulders (71/148, 48.0%), neck (61/148, 41.2%), and knees (58/148, 39.2%) were most frequently affected. Symptoms prevented normal work for 41/148 (27.7%, 95% CI 21.1-35.4), and 57/148 reported symptoms during the previous seven days (38.5%, 95% CI 31.1-46.5). Among 113 participants with 12-month symptoms, the most frequent Always responses were seeking medical help (78/113, 69.0%), rest and recovery (75/113, 66.4%), and medication use (59/113, 52.2%); ergonomic adjustment was least frequent (10/113, 8.8%). Conclusion: Self-reported work-related MSP symptoms were common, particularly in the lower back and shoulder, while ergonomic adjustments were uncommon. Frequent medication use highlights the need for comprehensive interventions combining ergonomic training, physiotherapy, and adequate recovery; however, these findings do not establish causation or intervention effectiveness.

BackgroundLittle is known about the distribution of specific sites where occupational falls frequently occur within the workplace. This study aimed to examine the distribution of occupational falls by sites of occurrence in Japan. MethodsNational data of occupational falls resulting in absences of four or more days in 2023 were extracted from a website managed by the Ministry of Health, Labour and Welfare, Japan. Fall sites were classified as either outdoor or indoor. Indoor sites were further categorized as walkways, work platforms/walking planks, indoor stairs, or other sites. Walkways and work platforms/walking planks were defined as indoor level surfaces. The distribution of occupational fall by sites was described. ResultsAmong all occupational falls, 63.2% occurred at indoor sites (22,780/36,058). The most frequently reported site was indoor level surfaces, accounting for 49.0%, while indoor stairs accounted for 5.9%. When stratified by sex, 65.9% occurred at indoor sites among female workers while 59.0% occurred among male workers. The difference was largely attributable to a higher proportion of falls on indoor level surfaces among females (52.7% in females and 43.5% in males). ConclusionsIn Japan, a substantial proportion of occupational falls occurred at indoor sites, particularly on indoor level surfaces.

ObjectivesThe pandemic of the new coronavirus disease (COVID-19) has created a challenging environment for workers. This study aimed to investigate the risk factors for workplace bullying and mental health outcomes during the pandemic among workers. MethodsWe conducted a nationwide online cross-sectional survey from August to September 2020 in Japan (N = 16,384). Workplace bullying was measured by one item from the Brief Job Stress Questionnaire; severe psychological distress (SPD) by K6 ([&ge;]13); and suicidal ideation by one item. Prevalence ratios were calculated by Poisson regression analyses adjusting for potential confounders such as gender, age, occupational characteristics, and a prior history of depression. ResultsOverall, 15% of workers experienced workplace bullying, 9% had SPD, and 12% had suicidal ideation during the second and third wave of the COVID-19 pandemic in Japan. The results of this study showed men, executives, managers, and permanent employees had a higher risk of bullying compared to women or part-time workers. Increased physical and psychological demands were common risk factors for bullying, SPD, and suicidal ideation. Newly starting working from home was a significant predictor for adverse mental health outcomes, however, it was found to be a preventive factor against workplace bullying. ConclusionsThe results of this study found different high-risk groups for bullying or mental health during the pandemic. When intervening to decrease workplace bullying or mental health problems, we should focus on not only previously reported vulnerable workers but also workers who experienced a change of their working styles or job demands. Key messagesO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIWorkplace bullying is one of the severe job stressors in the workplace that cause mental health problems. C_LIO_LIHealth care workers, less-educated workers, and non-regular female workers have been reported to have greater psychological distress during the COVID-19 pandemic. C_LI What are the new findings?O_LIAbout 15% of workers experienced workplace bullying, 9% had SPD, and 12% had suicidal ideation during the pandemic in Japan. C_LIO_LIMen, executives, managers, and permanent workers had a higher risk of bullying compared to women or part-time workers. C_LIO_LIIncreased physical or psychological demands were common risk factors for bullying, SPD, and suicidal ideation. C_LIO_LIWhile newly starting working from home was a preventive factor against workplace bullying, it was found to be a significant risk factor for adverse mental health outcomes. C_LI How might this impact on policy or clinical practice in the foreseeable future?O_LIThe results of this study indicate a different pattern of high-risk groups for bullying or mental health during the pandemic. C_LIO_LIWhen intervening to decrease workplace bullying or mental health problems, we should focus on not only previously reported vulnerable workers but also workers who experienced a change of their working styles or job demands. C_LI

BackgroundCOVID-19 pandemic impacted the physical and mental health of Brazilian workers, especially those who started acting in home-office. Changes in the workplace, increased physical inactivity and fear of contracting the disease, known as coronophobia, may be related to increased musculoskeletal pain. ObjectiveTo analyze the prevalence of musculoskeletal pain and coronophobia in home-office workers during the COVID-19 pandemic, as well as evaluating the relationship between these variables. MethodA cross-sectional, observational and descriptive study with 736 participants was conducted through online questionnaire. Sociodemographic data, working conditions, pain, besides the evaluation of coronophobia using COVID-19 Phobia scale (C19P-S) and pain with the Nordic questionnaire of osteomuscular symptoms (NMQ) were collected. ResultsMost participants were female (78%), with an average age of 32.8 {+/-} 10.7 years. During the pandemic, 71% reported some osteomuscular symptoms, and of these, 64% began to have new paintings of pain in the pandemic, with higher incidence in the lower back and neck. Participants who began to perform their functions in home-office presented a higher incidence of pain and, among them, 53% reported that the furniture was not suitable for homework. Most had little fear of Covid-19, but moderate levels of coronophobia increased the chance of musculoskeletal pain (RP=1,74; IC 95%). There was a significant association between coronophobia and musculoskeletal pain. ConclusionsThe pandemic raised the prevalence of musculoskeletal pain, especially in cervical and lumba regions, and the fear of Covid-19 influenced this relationship.

PurposeThe GIG-OSH cohort was established to investigate the impact of digital platform work on occupational safety and health (OSH), working and employment conditions, and health in seven countries in Europe. ParticipantsThe cohort comprises 3,945 digital platform workers from seven European countries. The sample includes both web-based workers (e.g., micro-tasking, freelance design) and on-location workers (e.g., delivery, transport). Participants were recruited using non-probabilistic sampling strategies tailored to national contexts, including social media advertising, recruitment through micro-task platforms, and on-site field outreach. Multidimensional data have been collected through online surveys (implemented via REDCap) covering sociodemographic characteristics, working and employment conditions, psychosocial risks, algorithmic management, and physical and mental health indicators. Findings to dateParticipants had a mean age of 32.6 years at baseline (SD 10.4), and the majority are male (58.8%), with a higher concentration of migrants in on-location tasks (62.2%) compared to web-based tasks (48.8%). Regarding educational attainment, 55.4% of the total cohort holds a tertiary degree, reaching 64.4% among web-based workers. Platform work intensity varies significantly: on-location workers averaged 85.4 hours of work in the last month, while web-based workers averaged 47.0 hours. Mean income from platform work as a percentage of the national median was 20.6% (SD 22.2). The mean WHO-5 Well-Being Index score was 58.7 (SD 20.3), which is notably lower than the European general population average (69.4), indicating poorer mental health outcomes among cohort members. Future plansThe GIG-OSH cohort represents the first large-scale, longitudinal study examining occupational safety and health among digital platform workers across multiple European countries. Future waves will prioritize developing precise tools to measure hourly earnings and unpaid waiting time. Future research should aim to include underrepresented subgroups, such as medical and domestic care workers, and explore potential linkage with administrative records to evaluate long-term health trajectories and the impact of new EU labour regulations. Strengths and limitations of this studyO_LIThis is the first large-scale longitudinal cohort to examine occupational safety and health among platform workers across multiple European countries, addressing an important evidence gap. C_LIO_LIThe inclusion of both web-based and on-location workers enables comparative analyses across diverse task types, employment conditions, and national contexts. C_LIO_LIRecruitment strategies tailored to national contexts enhanced feasibility but limited the representativeness of samples and precluded national-level weighting or benchmarking. C_LIO_LIHigh attrition between waves and the absence of harmonized classifications (e.g., education levels) across countries may constrain the generalizability and longitudinal consistency of findings. C_LIO_LIDespite relying on self-reported data, the study used stakeholder-informed instruments and captured a wide range of occupational hazards--such as psychosocial and algorithmic risks--not typically addressed in conventional labour surveys. C_LI

BackgroundCompared to the numerous reports on mental health outcomes of workplace bullying victims, research on organizational outcomes of witnesses and physical health outcomes of victims and witnesses is scarce. Therefore, the purpose of this study was to investigate the relationship between bullying victimization and witnessing and various physical and mental health outcomes and organizational outcomes such as sickness absence, work performance, and job satisfaction. MethodsThis study used cross-sectional data from a nationally representative, community-based sample of 5,000 Japanese residents aged 20-60. We analyzed data from 1,496 respondents after excluding those not working at the time of the survey and those with missing values. Workplace bullying, psychological distress, physical complaints, and job satisfaction were assessed with the New Brief Job Stress Questionnaire and work performance with the World Health Organizations Health and Work Performance Questionnaire. In addition, subjective health status, physician-diagnosed mental or physical illness, and sickness absence were asked as one item. Hierarchical multiple regression analysis or Poisson regression analysis was conducted to assess the association between victimization/witnessing workplace bullying and health and organizational outcomes. ResultsBoth victimization and witnessing workplace bullying were significantly associated with psychological distress, physical complaints, subjective poor health, physician-diagnosed mental disorders, and job dissatisfaction. Victimization of workplace bullying was further associated with physician-diagnosed respiratory diseases, sickness absence ([&ge;]7 days), and poor work performance. Victims were absent from work for 4.5 more sick days and had 11.2% lower work performance than non-victims. ConclusionsThe results showed that both victimization and witnessing workplace bullying were significantly associated with physical and mental outcomes and various organizational outcomes. Organizations should implement further measures to prevent personal and organizational losses due to workplace bullying.

We aimed to describe the characteristics and current practices of Swiss health professionals who manage patients with occupational burnout (POB), namely the general practitioners (GP), psychiatrist-psychotherapists (PP), occupational physicians (OP) and psychologists. Among 3216 respondents, 2951 reported to consult POB, and 1130 (713 physicians and 410 psychologists) to treat them. The study showed that POB management constitutes 5 to 25% of health care professionals consultations, with an inequal distribution of POBs across professionals specialties and specializations, but also across geographic regions. The profile of POB consulted also differs across professionals. Work psychologists see more often POB at early burnout stage, GPs have most patients with moderate burnout, while PPs report the largest proportion of patients with severe burnout. The treatment practices depend on burnout severity. Psychiatrists and physicians with double specialty (GP-OPs and GP-PPs) treat patients with more severe burnout than GPs. Psychologists treating patients with severe burnout collaborate with other health professionals and contact the POBs employer and/or health insurance. Treatment practices and burnout severity are not associated with the proportion of relapsed patients and patients who return to work. Yet, the former is associated with professionals age, sex, and specialty. Physicians with waiting time >3 months have a higher proportion of relapsed patients. GPs prescribe most often sick leaves, while PPs are the most frequent prescribers of pharmacological treatment. PPs collaborate significantly more often than GPs with pharmacologists and contact POBs employer and health insurance. Among psychologists, work psychologists differ from other psychologists by a more frequent POB (psycho)education and coaching, namely on how to negotiate with employer and family, as well as on physical exercise. They also more often contact POBs employer. Besides profession and specialization, we observed important regional variation in treatment modalities chosen by both physicians and psychologists.

The massive incorporation of women to the labour market has increased academic and applied interest on work-life issues throughout the years. This article aims to describe the domestic burden and difficulties in work-life balance (WLB) and at understanding the intersection of work and family spheres among hotel housekeepers (HHs). A cross-sectional study was conducted through Primary Health Care in the Balearic Islands (Spain); 1,043 HHs were enrolled. 56.7% report difficulties in WLB. Risk factors for perceiving difficulties in WLB were: living with one or two co-habitants, low social support, having difficulties making ends meet, being the main responsible person for domestic tasks, having a dependant, presenting higher levels of stress at work and being younger. Protective factors from experiencing work-family conflict (WFC) were job and wage satisfaction. WFC is strongly influenced by individual, economic, labour and domestic factors: these relationships show that labour and domestic spheres are non-separate worlds.

ObjectivesTo identify the association between heated tobacco product (HTP) smoking and occupational falls, particularly combined with other lifestyle variables, including sleeping duration and comorbidities. MethodsThis web-based nationwide cross-sectional study (September-November 2023) involved 18,440 current workers (mean age, 43 years; women, 43.9%) in Japan. The primary outcome was occupational fall incidence in the past year. The secondary outcome was fall-related fractures. Smoking status was categorized as never, former, or current smokers; current smokers further classified into exclusive cigarette, exclusive HTP, and dual smokers (both cigarettes and HTPs). Other behavioral factors and covariates included alcohol consumption, sleep duration, physical activity, comorbidities, body mass index, hypnotics/anxiolytics use, and sociodemographic variables. Incidence ratios (IRs) and 95% confidence intervals (CIs) for occupational falls were estimated using multilevel Poisson regression with robust variance. ResultsOccupational falls and fall-related fractures were reported by 7.3% and 2.8% participants, respectively, in the past year. Younger workers were more likely to experience occupational falls. Compared with never smokers, current smokers had higher occupational fall incidence (IR = 1.36, 95% CI: 1.20-1.54), with exclusive HTP (IR = 1.78) and dual smokers (IR = 1.64) showing particularly elevated incidences. Similar patterns were observed for fall-related fractures. Elevated IRs were also observed for other lifestyle variables, including short sleep duration and diabetes, with the strongest associations found among younger workers. ConclusionsCurrent smoking, particularly HTP use, and lifestyle behaviors were significantly associated with occupational falls in Japan. These findings highlight the importance of lifestyle modifications to prevent occupational falls. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSIndividual lifestyle behaviors, including physical activity, sedentary behaviors, and sleep quality, are associated with the risk of falls. However, the association between the risk of falls and smoking habits, including heated tobacco product (HTP) use, which has emerged as a public health concern in Japan, remains poorly understood. What this study addsCurrent smoking, particularly HTP use, is associated with occupational falls. How this study might affect research, practice or policySmoking cessation can be considered a modifiable behavior for occupational fall prevention. Further studies are needed to investigate the relationship between smoking and the incidence of falls.

BackgroundLow back pain (LBP) is prevalent, costly, and a common reason for a visit to a primary care provider (PCP). Clinical practice guidelines (CPG) recommend a stepped approach to management. ObjectiveFor individuals with LBP initially contacting a PCP, examine the association between the incorporation of first-line therapies, use of second- and third-line services and total episode cost. DesignRetrospective cohort study Setting/PatientsNational sample of individuals with non-surgical LBP occurring in 2017-2019. MeasurementsIndependent variables were initial contact with a PCP, and the timing of incorporation of 5 types of first-line therapies. Dependent measures included use of 13 types of health care services and total episode cost. Results8.5% of 118,503 PCPs initially contacted by 308,790 individuals with 347,627 episodes of non-surgical LBP were associated with an episode including any first-line service at any time. 17.5% of episodes included any first-line service at any time. Active care (11.6% of episodes), manual therapy (8.0%) and chiropractic manipulative therapy (7.0%) were the most common first-line services. 5.4% of episodes included a first-line service during the first 7 days with these episodes associated with a modest reduction (risk ratio 0.34 to 0.89) in the use of prescription pharmaceuticals. First-line services were associated with an increase in total episode cost with the smallest increase associated with chiropractic and osteopathic manipulation. Younger individuals from ZIP codes with higher adjusted gross income were more likely to receive a first-line service in the first 7 days of an episode. LimitationsAs a retrospective observational analysis of associations there are numerous potential confounders and limitations. ConclusionsIndividuals with non-surgical LBP initially contacting a PCP infrequently receive a first-line service, and if received, it is typically in addition to second- and third-line pharmaceutical, imaging, and interventional services. There is an opportunity to improve concordance with the stepped approach to management described in LBP CPGs.

ObjectiveTo identify the prevalence and predictors of burnout among academic family medicine faculty. DesignA comprehensive survey of academic family medicine faculty on burnout, perceptions of work life, and practice in 2011. SettingA large, distributed Department of Family and Community Medicine at the University of Toronto. ParticipantsAll 1029 faculty members were invited to participate. Main outcome measuresMaslach Burnout Inventory three subscales (emotional exhaustion, depersonalization, personal accomplishment). ResultsThe survey response rate was 66.8% (687/1029). The prevalence of high emotional exhaustion scores was 27.0% and high depersonalization was 9.2%, whereas the prevalence of high personal accomplishment scores was 99.4%. Bivariate analyses identified 27 variables associated with emotional exhaustion and 18 variables associated with depersonalization, including: ratings of the practice setting; leadership and mentorship experiences; job satisfaction; health status; and demographic variables. Multivariate analyses found four predictors of emotional exhaustion: lower ratings of job satisfaction, poorer ratings of workplace quality, working [&ge;]50 hrs/week, and poorer ratings of health status. Predictors of depersonalization included lower ratings of job satisfaction, [&le;]5 years in practice, lower ratings of health status, and poor ratings of mentorship received. ConclusionsThis study describes the prevalence and predictors of burnout among physicians prior to the COVID-19 pandemic. Predictors that are potentially modifiable at local practice and systems levels include job satisfaction, workplace quality, hours worked, and mentorship received. New family physicians ([&le;]5 years in practice) were at increased risk of depersonalization; strategies specific to this group may limit burnout and address the healthcare workforce crisis. Periodic studies are recommended to identify the impact of strategies implemented, emergent predictors, trends, and mitigating factors associated with burnout. The current crisis in family medicine indicates an urgent need to look back and plan forward.

BackgroundWork-related musculoskeletal symptoms such as pain, stiffness, and swelling are a common occupational health issue that affect well-being and increase healthcare costs. Continuous physical effort, long hours of sitting, and poor awareness of proper ergonomics often lead to or worsen these conditions. ObjectiveThis study determined the frequency of musculoskeletal symptoms and the associated risk factors with musculoskeletal symptoms among field health workers in Bin Qasim Town, Karachi. Material & MethodsA cross-sectional study was employed and collected data from Karachi based pre-urban communities i.e.: Ibrahim Hydri, Rehri Goth and Bhains Colony. Study duration was 9 months. MSK symptoms were assessed using the standardized Nordic Musculoskeletal Questionnaire (NMQ). Prevalence of MSK symptoms was assessed over 12 months and 7 days. Participants with pain in [&ge;]2 regions of the upper or lower limbs were classified as having upper or lower limb symptoms, respectively. Multivariable logistic regression was used to identify associated factors for MSK symptoms in last 12 months. Results132 participants were recruited. Most frequently reported pain region in the last 12 months was lower back 111(84%) and shoulder 81(61%). Similarly, the most affected region in the last 7 days was also lower back 39(29%) followed by shoulder 33(25%). Upper limb MSK symptoms were significantly associated with bachelors or higher educated (OR=3.38; 95% CI: 0.67-7.42), sitting 3-4 h/day (OR=3.46; 95% CI: 1.11-10.75), and walking 3-4 h/day (OR=2.88; 95% CI: 1.05-7.85). In lower limb, married workers had 2 times higher odds of lower limb MSK symptoms (OR=2.36; 95% CI:1.04 - 5.35), while those who worked > 30 hours/week had 67% lower odds of having lower limb MSK symptoms (OR=0.33, 95% CI:0.15 - 0.72). ConclusionField health workers frequently reported MSK symptoms in both limbs. Preventive strategies such as ergonomic training, task rotation, and targeted support for married female workers are recommended to reduce the long-term impact.

The personal well-being of workers may be influenced by the risk of job automation brought about by technological innovation. Here we use data from the Understanding Society survey in the UK and a fixed-effects model to examine associations between working in a highly automatable job and life and job satisfaction. We find that employees in highly automatable jobs report significantly lower job satisfaction, a result that holds across demographic groups categorised by gender, age and education, with higher negative association among men, higher degree holders and younger workers. On the other hand, life satisfaction of workers is not generally associated with the risk of job automation, a result that persists among groups disaggregated by gender and education, but with age differences, since the life satisfaction of workers aged 30 to 49 is negatively associated with job automation risk. Our analysis also reveals differences in these associations across UK industries and regions.