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Work conditions, musculoskeletal disorders and productivity of dentists in public dental care in Sweden: Are dentists working smarter instead of harder?
Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
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: urn:nbn:se:liu:diva-65428ISBN: 978-91-7393-348-3 (print)OAI: oai:DiVA.org:liu-65428DiVA: diva2:395603
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
List of papers
1. Experience of musculo-skeletal disorders,intensity of pain, and general conditions in work: The case of employees in non-private dental clinics in a county in southern Sweden.
Open this publication in new window or tab >>Experience of musculo-skeletal disorders,intensity of pain, and general conditions in work: The case of employees in non-private dental clinics in a county in southern Sweden.
2001 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, Vol. 17, 65-73 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: (1) To identify perceived musculo-skeletal disorders and intensity of pain among the employees in the nonprivate dental clinics; (2) To assess perceived psychosocial and physical work conditions on the localization and intensity of musculo-skeletal disorders and pain. Study design: A questionnaire, comprising four sections (demographic, self-reported psychosocial and physical work conditions, self-reported disorders from the musculo-skeletal system, self-reported intensity of pain on nine different localization on the body) was mailed to 391 employees. Of these, 338 reported musculo-skeletal disorders. In this latter group, 239 reported work as the cause. These employees completed the questionnaire. Results: The greatest amount of pain was reported for the cervico-brachial region. Among all participants, a response pattern was found where the physical work demands were very high, the psychosocial work demands fairly high, the work climate supportive, and the control over work moderate. At an occupational group level, theoretical inconsistencies were identified in terms of a lack of anticipated relationships, especially for the dentist groups. Conclusions: For a scientific and social purpose, more research, which identifies relationships between workrelated musculo-skeletal pain and dos-response [8], effortreward [16], and demand-control [12] aspects of the working conditions, is clearly needed.

Keyword
Physical and psychosocial work conditions, dosresponse model, effort-reward model, demand-control model, musculo-skeletal disorders and pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45095 (URN)79661 (Local ID)79661 (Archive number)79661 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2011-02-07
2. Perceived contra observed physical work load in Swedish dentists.
Open this publication in new window or tab >>Perceived contra observed physical work load in Swedish dentists.
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2005 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, Vol. 25, 253-262 p.Article in journal (Refereed) Published
Abstract [en]

In an earlier questionnaire study, dentists reported high experienced physical work load in their profession, but low to moderate complaints from their musculoskeletal system. The correlation between reported physical work load and pain from the musculoskeletal system was weak. This discrepancy could not be satisfactorily explained. Therefore, a second study was undertaken, in which the same 27 dentists who reported musculoskeletal problems were video recorded during one hour of clinical work, and the records were later analyzed using PEO (Portable Ergonomic Observation). PEO is a frequency analysis method which allows observation of work in real time using a portable computer or video recordings. PEO can be adjusted for registration of single or multiple work operations. Output data are presented as frequency, duration, and sequence of the various work operations. The aim of the present study was to investigate if there was a relation between observed work load recorded with PEO, and subjectively estimated work load and musculoskeletal complaints recorded with a questionnaire based on Visual Analogue Scales. Sitting and standing postures, and head, trunk and arm movements were analyzed. The PEO observations showed that dentists generally perform their clinical work in a sitting position, with the head bent forward almost half of the time. Only weak to moderate correlations (r = 0.0-0.6) were found between observed physical work load and subjective estimations of experienced physical work load and musculoskeletal complaints. These findings support the results in our previous study, but they do not explain the large difference between the observed low work load and the subjectively experienced high work load. The study will be followed up by EMG measurements and free interviews, where both muscular load and psychosocial factors will be evaluated.

Keyword
Ergonomics, muscle fatigue, work load, musculoskeletal complaints, dental clinics, musculoskeletal disorders, physical demands
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45096 (URN)79662 (Local ID)79662 (Archive number)79662 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2011-02-07
3. Evaluation of muscular activity, local muscular fatigue, and muscular rest patterns among dentists
Open this publication in new window or tab >>Evaluation of muscular activity, local muscular fatigue, and muscular rest patterns among dentists
2005 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, 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.

Keyword
Dentistry, ergonomics, surface electromyography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45097 (URN)10.1080/00016350510019964 (DOI)79663 (Local ID)79663 (Archive number)79663 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2011-02-07
4. Relationships between psychosocial work environmental factors, personality, physical work demands and workload in a group of Swedish dentists
Open this publication in new window or tab >>Relationships between psychosocial work environmental factors, personality, physical work demands and workload in a group of Swedish dentists
2008 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 32, no 4, 197-204 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to investigate, in a group of 77 Swedish dentists (36 males, 41 females) working in dental clinics, possible effects of psychosocial work environmental factors, personality traits, and social desirability tendencies on their reporting of their workload and of the physical demands placed on them.

Participants were given questionnaires for assessing their workload, the physical and psychosocial demands of their job,their social support at work, and their control over their work situation, using a 10-cm visual analogue scale (V.A.S.). The Eysenck Personality Questionnaire (EPO) was also given to assess neuroticism and extraversion and the Marlowe-Crown SD-scale to measure tendencies to answer questions in a socially desirable manner.

As in two earlier studies of ours, very high assessments were made of workload, physical work demands and social support. Higher assessments of workload and of physical work demands were found in those assessing the psychosocial work demands placed on them to be higher. Those assessing the work load of their job as higher also considered themselves to have less control over their work situation and were less extraverted.

Despite these dentists perceiving themselves as being faced with a stressful work situation involving a high workload, strong physical and psychosocial demands being placed on them and their having a low degree of control over their work situation, the high degree of social support they experienced may have made their work situation less stressful.

Keyword
Workload, physical demands, psychosocial work factors, personality, dentists
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16403 (URN)
Available from: 2009-01-23 Created: 2009-01-23 Last updated: 2014-01-10
5. Working conditions, health and productivity among dentists: a prospective study during rationalization in public dental care
Open this publication in new window or tab >>Working conditions, health and productivity among dentists: a prospective study during rationalization in public dental care
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Rationalizations comprising technological and organizational changes have been implemented in public dentistry in Sweden during the last decades. The effects on dentists´ work conditions health and production has not been investigated.

Aim: This study aims to analyze changes and associations in dentists´ working conditions, health/illness and production during a period of rationalizations.

Material: Sixty-five dentists responded to a questionnaire in 2003 and 2008, measuring work conditions and health. Production was followed in registers.

Results: During the rationalization period the number of treated adult patients increased. Perceived physical work conditions improved, while work control conditions and perception of the leadership deteriorated. Health/illness was a mediating factor between work conditions and production.

Conclusions: Rationalizations aiming to increase production must take into account employees' work conditions and effects on health/illness in order to achieve its goal.

Keyword
Dentistry; Rationalizations; Physical working conditions; Health, Structural Equation Modeling
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-65427 (URN)
Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2013-09-03

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