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Evaluation of muscular activity, local muscular fatigue, and muscular rest patterns among dentists
Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
School of Health Sciences, Jönköping University, Jönköping, Sweden.
School of Health Sciences, Jönköping University, Jönköping, Sweden.
2005 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 63, 189-195 p.Article in journal (Refereed) Published
Abstract [en]

In a previous study, dentists reported very high scores for perceived physical workload, but only low to moderate scores for the musculoskeletal system. This is difficult to explain when other occupational groups in the dental services are compared, and is the main reason why the present study was performed. To measure muscular activity, a surface electromyography (sEMG) study was done, and included the subjects who reported neck and shoulder complaints in the previous study. A portable sEMG system (MyoGuard) was used to collect a myoelectric signal on-line and analysis of the myoelectric signal in a computer. sEMG was recorded from both trapezius muscles for approximately 4 h during an ordinary working day. Twentyseven dentists participated in the study. The results show accumulated rest% fairly close to that of female cashiers and supermarket employees and increased average rectified value percent (ARV%) during work that could contribute to the very high workload perceived by dentists.

Place, publisher, year, edition, pages
2005. Vol. 63, 189-195 p.
Keyword [en]
Dentistry, ergonomics, surface electromyography
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-45097DOI: 10.1080/00016350510019964Local ID: 79663OAI: oai:DiVA.org:liu-45097DiVA: diva2:265959
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
In thesis
1. Self-assessed and direct measured physical workload among dentists in public dental clinics in Sweden during a period of rationalizations
Open this publication in new window or tab >>Self-assessed and direct measured physical workload among dentists in public dental clinics in Sweden during a period of rationalizations
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Much research has been done on interventions to reduce work-related musculoskeletal disorders (WMSDs) at the workplace. However, this problem is still a major concern in working life. The economic cost for WMSDs corresponds to between 0.5% and 2% of the gross national product in some European countries, and in 2007, 8.6% of workers in the EU had experienced work-related health problems during the previous 12 months. In Sweden, one in five of all employees have rated occurrence of WMSDs during the previous 12 months.

In spite of comprehensive ergonomic improvements of workplace and tool design in dentistry the prevalence of musculoskeletal disorders in neck, upper arms and back is reported to be between 64% and 93%.

The present thesis investigates if the perceived high exertion during work corresponds to actual physical exposures. Further, it is investigated if risk full physical exposures may be generated due to rationalisations. Specifically, changes in physical exposures are investigated prospectively during a period of rationalisations. Empirical data on production system performance, individual measured physical workload, and self-rated physical workload are provided.

High estimates of self-rated workload were found. These high scores for perceived workload were associated with high measured muscular workload in the upper trapezius muscles. Also, negative correlations were found between low angular velocities in the head, neck and upper extremities on the one hand, and estimates for perceived workload on the other. Both measured muscular workload and mechanical exposure among dentists indicate a higher risk of developing WMSDs than in occupational groups with more varied work content. Value-Adding Work (VAW) comprised about 57% of the total working time and compared to industrial work an increase with about 20 percent units is hypothesised. Furthermore, VAW compared to non-VAW (“waste”) implies more awkward postures and especially low angular velocities interpreted as constrained postures.

Consequently, when increasing the proportion of time spent in VAW due to rationalisations, work intensification is expected. However, at follow up, we did not find such work intensification.

Previous research indicates that rationalisation in working life may be a key factor in the development of WMSD. The present thesis suggests that ergonomics may then be considered proactively as part of the rationalisation process.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 65 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1192
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-65422 (URN)978-91-7393-347-6 (ISBN)
Public defence
2010-10-28, Aulan, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2013-09-03Bibliographically approved
2. Work conditions, musculoskeletal disorders and productivity of dentists in public dental care in Sweden: Are dentists working smarter instead of harder?
Open this publication in new window or tab >>Work conditions, musculoskeletal disorders and productivity of dentists in public dental care in Sweden: Are dentists working smarter instead of harder?
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: During the last 20 years, Sweden and other countries have been adjusting their models of welfare to a changed economic environment. Rationalization, influenced by New Public Management, has been implemented in public dentistry in order to improve efficiency and to streamline activities. This has involved transferring some of dentists’ tasks to dental hygienists and dental nurses. The goal is to achieve a more efficient mix of skills and more interaction between professional groups, in order to utilize all skills better in a more efficient work organization. Organizational changes may have an effect on the work environment both with regard to physical and to psychosocial work conditions and affect health and well-being. In many cases these changes have a profound negative effect on musculoskeletal and mental health, and corresponding risk factors, by reducing the number of natural breaks and thus reducing the efficacy of targeted ergonomic interventions. Dentists in Jönköping County in Sweden perceive high precision demands and poor working postures in their work. The five studies in this thesis describe organizational changes and analyse the risk of illness among dentists in the public sector in Jönköping County.

Aim: The main aim is to study dentists’ physical and psychosocial work conditions and investigate associations with musculoskeletal disorders, work ability and sick leave during a period of extensive rationalizations; secondly, to assess the risk of illness as a basis for recommending preventive measures.

Methods: The present thesis was designed with four cross-sectional studies (Paper I-IV) and one prospective longitudinal study (Paper V). In Paper I, a questionnaire concerning physical and psychosocial work conditions and health was sent out to all employees working in public dental care in Jönköping County in Sweden. To obtain more information on the difficult physical work situation for dentists (Paper I), an observation study with Portable Ergonomic Observation (Paper II) and an sEMG study (Paper III) was then conducted. Paper IV deals with psychosocial issues (using the same survey as in Paper I) and questions in the Eysenk Personality Questionnaire (EPQ) and the Marlowe-Crown scale SD (MCSD), to analyse their impact on perceived physical load. In Paper V, data about physical and psychosocial conditions and health from a survey, as well as production data (number of adult treatments per year per dentist) from computerized patient records (T4), are analysed with regard to changes and associations during a period of extensive rationalizations (2003 – 2008).

Results: In Paper I, dentists reported the poorest physical work conditions of all occupational groups and high prevalence of musculoskeletal disorders. However, relatively low intensity of pain was reported and only a small proportion thought that work was affected. Paper II and Paper III confirmed that dentists’ work is physically demanding, with sitting postures and head bent forward, as well as prolonged low muscle loading. Paper IV shows that physical load is mainly influenced by psychosocial demands and to some extent by loss of work control. The results in Paper V show that during the period of extensive rationalizations between 2003 and 2008, dentists perceive improved precision demands and fewer uncomfortable work postures, but still a high level of physical load. The number of adults treated per dentist also improved, but there was a slight deterioration in work control and leadership.

Conclusions: The results in this thesis show a consistent picture of high perceived physical load due to high precision demands and uncomfortable work postures, supported by observation of body movements (Portable Ergonomic Observation) and sEMG signs during psychosocially demanding circumstances. The rationalizations implemented in Jönköping County during the period 2003-2008 have not resulted in a deterioration of the physical environment, in spite of the fact that dentists produce more treatments of adult patients than before. This result may indicate that rationalizations do not always lead to increased health risks; it depends how they are implemented. Dentists may have changed the way they work for the better, and due to task delegation and SMS reminders a smoother patient flow has probably resulting in a reduction of workload and perceived stress regarding financial loss.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1191
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-65428 (URN)978-91-7393-348-3 (ISBN)
Public defence
2010-10-29, Originalet, Qulturumhuset, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2013-09-03Bibliographically approved

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