Objectives-To examine the variation of symptoms from the neck, shoulders, and back over a three year period among female nursing personnel and the relation between job strain and musculoskeletal symptoms. Methods-At a county hospital the female nursing personnel answered a questionnaire at baseline and then once a year over a period of three years. There were 565, 553, 562, and 419 subjects who answered the questionnaire at the first, second, third, and fourth survey, respectively. Of the study group, 285 nursing personnel answered the questionnaire on four occasions. Ongoing symptoms of the neck, shoulders, and back were assessed by means of a 10 point (0-9) scale with the verbal end points "no symptoms" and "very intense symptoms." Cases were defined as nursing personnel reporting ongoing symptoms, score >6, from at least one of the body regions. For assessments of job strain, a Swedish version of Karasek and Theorell's model was used. Results-Of the 285 subjects, 13% were defined as cases at all four assessments, and 46% varied between cases and not cases during the study period. In the repeated cross sectional surveys the estimated rate ratio (RR) for being a case was between 1.1 and 1.5 when comparing the group with job strain and the group without job strain. For the combination of job strain and perceived high physical exertion the estimated RR was between 1.5 and 2.1. When the potential risk factors were assessed one, two, or three years before the assessment ofsymptoms the estimated RR for becoming a case was between 1.4 and 2.2 when comparing the group with job strain and the group without job strain. Conclusion-Almost half ofthe healthcare workers varied between being a case and not, over a three year period. The analysis indicated that job strain is a risk factor for musculoskeletal symptoms and that the risk is higher when it is combined with perceived high physical exertion. (Occup Environ Med 1997;54:681-685)

The relationship between individual factors, physical and psychosocial exposure at work, and musculoskeletal symptoms in the neck, shoulders, low back, hands, and knees was studied among female nursing personnel working at a Swedish hospital. The personnel had participated in a course in work technique (patient transfer and handling principles). Prior to the course, the subjects had filled in a questionnaire (n = 688). The aim of this cross-sectional study was to elucidate whether different individual and work factors are related to musculoskeletal symptoms in a specific body region. Due to the cross-sectional design, however, causality cannot be discussed. Univariate analyses and multiple logistic regression analyses were performed and yielded similar results. The latter analyses showed that in the present hospital setting, individual factors together with physical and psychosocial work factors were related to symptoms in the neck, low back, and hands; individual factors and psychosocial work factors were related to symptoms in the shoulders; while only individual factors were related to symptoms in the knees. The results of the present study showed that various individual factors and physical and psychosocial work factors were related to musculoskeletal symptoms in the different body regions. Thus, the identification of risk factors might have far-reaching implications for the way in which effective health programs for prevention should be designed in the hospital setting.

Current and past physical and psychosocial occupational factors, both separately and combined, seem to be gender-specific, and to have a moderate impact on care-seeking for low back pain in a general working population.

We conducted a case-referent study to identify and quantify work-related and non-work-related risk indicators for reported over-exertion back injuries among nursing personnel. The source population was all nursing personnel employed in the Stockholm County hospitals during a 32-month period. The 240 cases and 614 referents completed questionnaires about occupation, type of clinic, working hours, shift work, patient transfers, perceived exertion, back pain, prior back injury, job strain, body mass index (BMI), smoking, immigrant status, physical training, and self-rated fitness. The highest relative risks (RR) were observed for work-related factors: working at an orthopedic clinic (RR = 5.2; 95% CI = 2.7-10.2), > or =1 patient transfer/shift (RR = 2.7; 95% CI = 1.6-4.5), and working full-time (RR = 2.4; 95% CI = 1.6-3.6). Training in the use of transfer devices, and regular use of transfer devices, reduced the relative risk from patient transfer. Among the non-work-related factors, only body mass index > or =25 kg/m2 and immigrant status was associated with a slight increase in relative risk.

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