LOW BACK PAIN AT NEW WORKING AMBIENT IN ERA OF NEW ECONOMY: A SYSTEMATIC REVIEW ABOUT OCCUPATIONAL RISK FACTORS

Cilj rada jest identifi kacija profesionalnih čimbenika rizika za lumbalni bolni sindrom (ILBP – od engl. Low Back Pain) u novom radnom okružju, gdje je dizanje tereta zamijenio dugotrajan rad u sjedećem položaju s prisilnim i nepravilnim ergonomskim pokretima uz nedovoljnu fi zičku aktivnost i predominaciju psihosocijalnog stresa i loše organizacije rada. Sindrom bolnih leđa je najpoznatiji među akutnim bolovima mišićno-koštanog sustava. Za bolje razumijevanje probira ranih simptoma i znakova LBP i u svrhu pravodobnog suzbijanja kumulativnog kroničnog poremećaja nužno je razumjeti razlike i sličnosti, te međusobni odnos između akutne i kronične boli LBP. U ovom su preglednom radu, koji je uključivao pacijente/zaposlenike s LBP, istražene sljedeće baze podataka: Pub Med, EMBASE, Medlinea i Web of Science. LBP je posljedica pogrešnog opterećenja cjelokupne kralježnice i prenaprezanja leđnih mišića na radnom mjestu prilikom dugotrajnog rada u sjedećem položaju s prisilnim i ponavljanim pokretima samo nekih dijelova tijela (nepravilnim ergonomskim faktorima i položajima tijela pri radu), a uz predominaciju psihosocijalnog stresa, loše organizacije posla i nedovoljne fi zičke aktivnosti.Low back pain is the second most common symptom-related reason for physician visits and the fi rst reason of working disability. Low back pain is a ubiquitous complaint, with particularly high prevalence among people in their working years (67%). For many individuals, episodes of back pain are self-limited and resolve without specifi c therapy. For others, however, back pain is recurrent or chronic, causing signifi cant pain that interferes with employment and quality of life. Many occupations have been anecdotally linked to certain low back pain syndrome. However, the relationship between the work environment and the patient’s symptoms, though clearly perceived by the patient to be causative, may be less certain. The injury model of an occupational disorder proposes that specifi c work activities are the cause of the patient’s pain. The injury model for low back pain, implicating a causal connection with specifi c work activities, is complex and controversial. Determining whether a patient’s low back pain is a consequence of his or her occupational activity, and how best to treat symptoms to maximize functionality and potential for a return to full employment capacity, can be challenging. In this systematic review which included patients/employees with low back pain, the following databases were searched: Pub Med, Embase, Medline and Web of science. The role of occupational mechanical exposure e.g. lifting as a risk factors for low back surgery has been debated for several decades. Diagnostic uncertainty exists even for those with back symptoms and well-described fi ndings on scan, as these fi ndings are common even in subjects without back pain, and may be unrelated to the symptoms. As an example, herniated disks can be identifi ed in signifi cant numbers of CT or MRI low back studies in subjects with no back pain. In further analysis, lifestyle factors and occupational psychosocial exposures will be addressed. Many physicians, including those practicing in primary care settings where back pain is most often seen, lack training and confi dence in addressing workplace issues. Occupational factors that have a signifi cant infl uence on the development of low back pain disorders are not only mechanical and postural order but also organisational, social and psychological. Organisational changes and physical and psychological job demands should not be overestimated as causal factors. In the early phase of a work disability more emphasis should be laid however on appropriate information and medication and, in case of persistant impairment, active treatment (after 3 weeks or relapse). There is some evidence that catastrophizing as a stress coping strategy might lead to delayed recovery. Long- term work (sick) absence can be estimated through evaluation and observation of LBP risks and characteristics of the each individual case. An early return at workplace and to activities of daily life is urgent. To reduce LBS and its consequences, employers need to adopt a multifaced approach: concentrate on improving physical conditions as well as the psychosocial and environmental aspects of working environment. In cases at risk for chronifi cation and/or with obstacles to reintegration at work an interdisciplinary workoriented rehabilitation and occupational rehabilitation interventions (occupational reintegration) should be provided

Mobbing, stress, and work ability index among physicians in Bosnia and Herzegovina: survey study

Aim: To assess the frequency of reported mobbing and the association among mobbing, working environment factors, stress, health outcome, personality type, and work ability index in a sample of physicians in Bosnia and Herzegovina. ----- Method: We conducted a questionnaire survey using a validated selfreported questionnaire among 511 physicians in national health sector of Bosnia and Herzegovina. The questions covered five major categories of mobbing behavior. Characteristics of the work, perceived work environment and its effects, stress, health, and satisfaction with work and life were assessed by the standardized abridged form of Occupational Stress Questionnaire (OSQ). A standardized questionnaire Work Ability Index (WAI) was used to determine the relation between mobbing and work ability. ----- Results: Of 511 surveyed physicians, 387 (76%) physicians self-reported mobbing behavior in the working environment and 136 (26%) was exposed to persistent mobbing. More than a half of the physicians experienced threats to their professional status and almost a half felt isolated. Logistic regression analysis showed that lack of motivation, loss of self-esteem, loss of confidence, fatigue, and depressiveness were significantly associated with lack of support from colleagues. Intention to leave work was associated with lack of support from colleagues (OR 2.3, 95% CI, 1.065-3.535; t = 4.296, P = 0.003) and lack of support from superiors (OR 1.526, 95% CI, 0.976-2.076; t = 5.753; P = 0.001). Isolation or exclusion and threats to professional status were predictors for mental health symptoms. Persistent mobbing experience was a significant predictor for sick leave. ----- Conclusion: Exposure to persistent threat to professional status and isolation or exclusion as forms of mobbing are associated with mental health disturbances and lack of self-esteem and confidence. Setting up a system of support for physicians exposed to mobbing may have important benefits