Production optimisation systems and consequences for workers health and safety: Lean production and effects on stress and musculoskeletal disorders

This thesis investigates production optimisation systems such as lean production and their consequences for the health and safety of workers. In particular it examines potential positive effects and adverse effects on stress and musculoskeletal disorders (MSDs). The thesis com-prises an extended literature survey and a field study in the manufacturing and the services sector applying lean production. It provides an extensive review of studies carried out in lean production environments in the last 20 years that aims to identify the effects of lean production (negative or positive) on occupational health and related risk factors. Thirty-six studies of lean effects were accepted from the literature search and sorted by sector and type of outcome. Lean production was found to have a negative effect on health and risk factors; the most negative outcomes being found in the earliest studies in the automotive industry. However, examples of mixed and positive effects were also found in the literature. The strongest correlations of lean production with stress were found for characteristics found in Just-In-Time production that related to reduced cycle time and reduction of resources. In-creased musculoskeletal risk symptoms were related to increases of work pace and lack of recovery time also found in Just-In-Time systems. An interaction model is developed to pro-pose a pathway from lean production characteristics to musculoskeletal and psychosocial risk factors and also positive outcomes. An examination is also made of the changing focus of studies investigating the consequences of lean production over a 20-year period. Theories about the effects of lean production have evolved from a conceptualization that it is an inherently harmful management system, to a view that it can have mixed effects depending on the management style of the organization and the specific way it is implemented. The field study was carried out in lean environments in the manufacturing and services sec-tors, namely in the electronics, beverage, and metal industry and call centres in Greece and UK. For the psychosocial factors and recording of MSD symptoms; self reported questionnaires were administrated to the workers. In total 353 workers responded to the questionnaires. Additionally qualitative data were collected through semi-structured interviews with managers and lean officials, safety officers and workers in the sample. Finally, observation visits in the companies completed the data collection process. The lean implementation level of the companies was estimated on a five-point scale, according to a validated model (Conti et al, 2006). A follow up study to collect qualitative data was possible in one company in the sample. The research hypotheses of the field study tested the relationship between job stress and MSDs with quantitative job demands, job control, performance monitoring, and the level of lean implementation. The hypotheses were partly supported in both sectors: In the service sector findings confirm that quantitative job demands are predictors of job stress, consistent with similar studies in call centres. Stress is strongly asso-ciated with MSD development. In the manufacturing sector, quantitative job demands were not predictors of job stress, neither of MSDs. Positive challenges were a mediator of job stress. Stress was not a predictor for MSDs symptoms. Mechanical exposure increased after lean implementation in manufacturing although the opposite was aimed at. Consultation of workers on lean characteristics was another mediator to MSD development. A comparison was made between manufacturing and the services sectors. Differences be-tween sectors in job demands -with the exception of learning demands that are higher in manufacturing- were not significant. Predictability on the other hand was higher in call centres. Employees in the call centres reported statistically significant more frequent MSD symptoms compared to workers in manufacturing. Stress differences were not significant among sectors whereas job satisfaction was significantly higher in manufacturing. This can partly be explained by the positive social context, job security and management commitment to have no lay offs due to lean application; that workers enjoyed in the manufacturing companies of the sample. This was not the case in the call centres. In conclusion it was not the stressors that were higher in the call centres sample but a significant number of job support and control characteristics that were reported as being higher in the manufacturing sample of the study. Analysis of the relationship between job characteristics, stress and leanness revealed a high degree of non-linearity. The best fit was achieved with quadratic curves. At low levels of lean implementation stress was increasing. At a middle level of implementation stress reached a peak after which, with advanced implementation, it decreased. This is consistent with earlier study findings. The study demonstrates that it is not so much the level of lean implementation that is important for the health & safety effects but the lean characteristics that are employed. Characteristics linked to JIT can be critical and can be associated with increased job demands and for some cases increased stress and MSD symptoms. Moreover it is the social context (management mentality and actual workers participation) in lean application that is crucial for the implications of lean work to health. Further research is needed to compare lean effects between sectors including also other services. Finally, more research is needed on alternatives to intensive systems that would have better consequences for the health & safety of workers. Ergonomics has an obligation to pro-pose work redesign that aims at sustainability for all parties

Wegener's Granulomatosis: a Comprehensive Review

Wegener's Granulomatosis (WG) is a systemic multi-organ disease that is specifically characterised by inflammation of small and medium - sized vessels that could lead to tissue damage. Most commonly affected systems are the upper respiratory tract, the pulmonary, renal and ocular systems. Even though no diagnostic criteria have been established, the Chapel Hill Consensus definitions and the American College of Rheumatology classification criteria are widely used in clinical practice to identify WG. Definite diagnosis is confirmed by biopsy of the affected organ. This article reviews the epidemiology, pathophysiology, clinical manifestations, laboratory markers, diagnosis and disease assessment and, finally, the conventional and therapeutic options in WG

Original Sins of Insurance systems: The case of the Greek Occupational Risk Insurance Scheme, IKA-ETAM

This paper aims to estimate the cost of pensions, compensations and foregone contributions due to occupational accidents for the main Greek social security institution IKA-ETAM. Through this process, conclusions transferable to other occupational risk insurance systems are drawn. Both prevalence and incidence approach are applied on analytical data for active and new occupational accident pensions and compensations of IKA-ETAM for 2007. Cost is estimated as the difference of all costs and benefits with and without the accident. Prevalence approach leads to an estimate of €148,539,548.40 against an estimate of €77,707,206.98 with incidence approach. In both approaches, cost of temporary disability is estimated at €18,464,021.61 and foregone contributions (opportunity cost) account for 27% of total cost. Although wages raised, contribution and compensation rates remained stable and accidents decreased for IKA-ETAM contribution payers during last decades, the viability of the system is threatened. The reasons identified are a) the increase of the average time off-work per accident and b) the backload, due to the large number of accidents and pensions in the past

Microarray analysis of human leucocyte subsets: the advantages of positive selection and rapid purification.

BACKGROUND: For expression profiling to have a practical impact in the management of immune-related disease it is essential that it can be applied to peripheral blood cells. Early studies have used total peripheral blood mononuclear cells, and as a consequence the majority of the disease-related signatures identified have simply reflected differences in the relative abundance of individual cell types between patients and controls. To identify cell-specific changes in transcription it would be necessary to profile purified leucocyte subsets. RESULTS: We have used sequential rounds of positive selection to isolate CD4 and CD8 T cells, CD19 B cells, CD14 monocytes and CD16 neutrophils for microarray analysis from a single blood sample. We compared gene expression in cells isolated in parallel using either positive or negative selection and demonstrate that there are no significant consistent changes due to positive selection, and that the far inferior results obtained by negative selection are largely due to reduced purity. Finally, we demonstrate that storing cells prior to separation leads to profound changes in expression, predominantly in cells of the myeloid lineage. CONCLUSION: Leukocyte subsets should be prepared for microarray analysis by rapid positive selection.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Managing risks to drivers in road transport

This report presents a number of case studies in managing risks to road transport drivers. The cases feature a variety of initiatives and interventions to protect drivers.In the road transport sector, as with any other, it is important to pay attention to working conditions in order to ensure a skilled and motivated workforce. Certain characteristics of the sector make it more difficult to practice risk management than in other sectors. But by taking account of how the sector operates in practice, and the characteristics of drivers themselves and the way they work, risks can be successfully manage

Percutaneous Catheter Dilatation of Benign Ureteroenteric Anastomotic Strictures Followed or not by Retrograde Transconduit Placement of a Catheter: Long Term Results

BACKGROUND: We report our experience on multiple balloon dilatations for benign ureteroenteric anastomotic strictures after total cystectomy and urinal deviation by ileal conduit, followed or not by retrograde placement of a permanent catheter through the stoma of the ileal conduit. PATIENTS AND METHODS: Patients were classified in two groups: Group A included patients treated only by multiple balloon dilatations and Group B patients in whom multiple dilatations were followed by retrograde insertion of a permanent catheter through the stoma of the ileal conduit, which then had to be replaced regularly. Records of survival and patency rates were recorded. RESULTS: Twenty patients with 24 benign ureteroenteric anastomotic strictures referred to radiology department. Long-term results were available in only 15 patients, who finally included in the study. In Group A long term follow-up was achieved in five patients. Mean primary patency time of stenoses (interval between initial dilatation and recurrence) was 33.2 months. This time-period proved to be the same as the survival time of Group A patients, since all five patients eventually succumbed to the underlying disease or other reasons. In Group B, 6 patients are still alive and 4 patients eventually succumbed to the underlying disease or other reasons. Mean primary patency time of stenoses was 38.1 months. CONCLUSIONS: Balloon dilatations of benign ureteroenteric anastomotic strictures, due to radical cystectomy and urinal deviation by ileal conduit, were technically successful in all cases. Patency rate was comparable in the two study groups. However, regular catheter replacement through the ileal conduit is well tolerated and gives a sense of security to both patient and physician

New risks and trends in the safety and health of women at work

In 2009 and 2010, the Agency commissioned an update to its previous research on gender issues at work (EU-OSHA, 2003), which found that inequality both within and outside the workplace can have an effect on the health and safety of women at work. This report provides that update and the first figures on the effects of the recent economic downturn on women at work. It aims to fulfil the task outlined by the European strategy on health and safety at work (EC, 2002) for EU-OSHA’s European Risk Observatory: ‘examining the specific challenges in terms of health and safety posed by the more extensive integration of women in the labour market’. Gender inequalities in the workplace and work–life balance issues have become increasingly important as the employment rates of women have continued to grow in all Member States. Although in 2012 58.6 % of working age women (in the EU-27) were in employment and women filled 59 % of all newly created jobs in 2009(1 ), the extent to which women contribute economically still seems to be underestimated. At its start, women were affected less than men by the recent economic crisis, as the first jobs to be lost were mostly in the male-dominated construction and manufacturing industries. However, between 2008 and 2012, European gender differences in employment fell by an average of 7.6 to 6.3 percentage points, mainly because male employment rates fell more than those of women, which have returned to the 2007 level. A modern organisation of work, a knowledge economy, competitiveness and more and better jobs are central to the post-2010 Lisbon Strategy and the EU’s 2020 Strategy. Women are essential to the workforce in terms of providing an active and sustainable source of labour, and in June 2010 the European Council set a new, ambitious target aiming to raise the employment rate for women and men aged 20–64 to 75 % by 2020, partly through the greater participation of young people, older workers and low-skilled workers and the better integration of legal migrants. However, although employment rates for women are rising, much remains to be done, especially for older and younger women, to reach this goal and at the same time ensure decent work for all. The issue of occupational safety and health (OSH) for women who work in the European Union (EU) is central to an understanding of the working environment. Previous research has shown that women’s OSH has to be improved. Research from the European Commission illustrates that, even by 1995, women accounted for close to or above half of all cases of work-associated ill health, including allergies (45 %), infectious illnesses (61 %), neurological complaints (55 %) and hepatic and dermatological complaints (48 %). The situation has not improved. Further, for ‘women’s jobs’, such as those in the health and social services, retail and hospitality sectors, there is a stagnation in accident rates in some countries; women are more likely to be bullied and harassed, subjected to sexual harassment and have to use poorly fitting personal protective equipment that is not usually sized for a smaller frame. The aims of this review are to: Provide a statistical overview of the trends in employment and integration of women in the labour market, and explore how they impact on their occupational safety and health. Identify and highlight the main issues and trends in employment characteristics, working conditions, hazard exposure and work-related accidents and health problems for women at work and explore more in-depth selected issues not addressed thoroughly before, such as combined exposures, informal work and the rehabilitation of women into work. Identify emerging issues for OSH research and the prevention of occupational diseases and accidents affecting women at work. This focus on OSH benefits not only women but also men who work, and thus reinforces the considerable potential to be gained by improved workplaces. A summary of the findings and trends and a more detailed list of suggestions is included in every chapter of this report and in the conclusions

A CD8+ T cell transcription signature predicts prognosis in autoimmune disease.

Autoimmune diseases are common and debilitating, but their severe manifestations could be reduced if biomarkers were available to allow individual tailoring of potentially toxic immunosuppressive therapy. Gene expression-based biomarkers facilitating such tailoring of chemotherapy in cancer, but not autoimmunity, have been identified and translated into clinical practice. We show that transcriptional profiling of purified CD8(+) T cells, which avoids the confounding influences of unseparated cells, identifies two distinct subject subgroups predicting long-term prognosis in two autoimmune diseases, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), a chronic, severe disease characterized by inflammation of medium-sized and small blood vessels, and systemic lupus erythematosus (SLE), characterized by autoantibodies, immune complex deposition and diverse clinical manifestations ranging from glomerulonephritis to neurological dysfunction. We show that the subset of genes defining the poor prognostic group is enriched for genes involved in the interleukin-7 receptor (IL-7R) pathway and T cell receptor (TCR) signaling and those expressed by memory T cells. Furthermore, the poor prognostic group is associated with an expanded CD8(+) T cell memory population. These subgroups, which are also found in the normal population and can be identified by measuring expression of only three genes, raise the prospect of individualized therapy and suggest new potential therapeutic targets in autoimmunity

Is psychosocial risk prevention possible? Deconstructing common presumptions

This paper tackles a much debated and often misunderstood issue in the modern world of work, psychosocial risks. Although the prevalence and impact of psychosocial risks is now widely acknowledged as a priority in health and safety in Europe, there remains resistance by key stakeholders in prioritizing psychosocial risk management both in business and policy making. This paper explores why this is still the case by discussing three presumptions in relation to the current state of the art in this area. It examines the validity of these presumptions by summarizing key evidence, policies and practices. It is concluded that, although guidance on psychosocial risks and their management exists in abundance as does evidence to support the ‘case’ for psychosocial risk management, the concept of psychosocial risk is still not clearly understood in its entirety with discussions being focused on negative impacts and not opportunities that can be capitalized upon through effective psychosocial risk management at the organizational and societal levels. A key issue is the false distinction often made between psychosocial factors and issues pertaining to work organization, since psychosocial risks are embedded in certain forms of work organization. The suitability of available methods and tools is also considered as well as existing capabilities in the context of socioeconomic changes and constraints. On the basis of the current state of the art, an action plan for the prevention of psychosocial risks in the workplace is proposed, linked to sustainability and a value-based perspective