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Ambulance work: relationships between occupational demands, individual characteristics and health-related outcomes
University of Gävle, Belastningsskadecentrum.
2005 (English)Doctoral thesis, monograph (Other scientific)
Abstract [en]

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

A random sarnple of 234 female and 953 male ambulance personnel participated in a national questionnaire suTVey on work-related factors, and musculoskeletal and other health cornplaints. 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 cornplaints and activity limitation due to low-back cornplaints. Psychological demands was significantly associated with neck-shoulder complaints, sleeping problerns, headache and stomach syrnptorns among both female and male ambulance personnel. Worry about work conditions was associated with musculoskeletal disorders and sleeping problerns, 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 inteTYals, 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. lncreased reactivity to the mental test, modest deviation in heart rate variability (HRV) pattem during the Jate night hours at work and higher moming cortisol values during work than during leisure time were obseTVed in personnel with many health cornplaints, 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 tlights 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 ofphysical 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. lncluding height in the models significantly increased the exp1ained variance of accumulated lactate among female, but not among male personnel. Lactate levels were higher among short cornpared to tall female personnel. Weight had no effect on any of the models.

In conclusion, the national suTVey 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 cornplaints had certain physiological changes during the work shift in cornparison 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 intemal exposures at different levels when performing the same work task. A better understanding of the relationships between occupational demands and health-related ou tcomes require further studies on age- and gender matched groups in long-term perspective studies.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2005.
Series
Umeå University Medical Dissertations, ISSN 0346-6612 ; 943
Keyword [en]
ambulance, autonomic reactivity, body size, cortisol, demand-controI-support, emergency personnel, fitness, gender, heart rate variability, low-back pain, neck-shoulder pain, occupational, physical capacity, work simulated test, worry
Identifiers
URN: urn:nbn:se:hig:diva-927ISBN: 91-7305-820-3 (print)OAI: oai:DiVA.org:hig-927DiVA: diva2:117589
Public defence
(English)
Available from: 2008-05-27 Created: 2008-05-27 Last updated: 2010-08-23Bibliographically approved

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