Occupational Demands Research Articles

Strategies to Improve Physiological and Psychological Components of Resiliency in Firefighters

Firefighters are exposed to dangerous and often traumatic events due to the nature of their occupational demands. This repeated exposure to trauma combined with stressful work demands increases their risk for negative physiological and psychological health outcomes. The high prevalence of adverse health outcomes highlights the need for interventions to improve resiliency in firefighters. Resiliency is the ability to reduce the effect of crisis, rebound from adversity, and recover to pre-stimulus homeostasis. When traumatic exposures are unavoidable, as is the case with firefighters, it is important to buffer the resulting consequences on health. While resilience has a genetic component, interventions targeting physiological, psychological, and social components have been successful at improving resilience. These factors are of specific interest as increases in resilience have been linked to improved PTSD symptomology/severity, depression, anxiety, autonomic nervous system activation, hypothalamus–pituitary axis balance, and brain-derived neurotrophic factor. Therefore, the purpose of this review is to identify physiological and psychological components associated with resiliency and discuss strategies that may improve those components to ultimately increase resiliency in firefighters. The strategies discussed include exercise, social support, and mindfulness.

Addressing personalized thermal comfort in residential settings: A novel dual-supply vent air conditioner

A new approach was proposed for meeting diverse thermal comfort demands of different occupants by using a dual-supply vent air conditioner with independent control of the air supply parameters at each vent to establish distinct thermal environments. The feasibility of this method was tested in a living room environment, and numerical simulation was conducted to explore the differences in thermal environment at various locations under different air supply temperatures, velocities, directions, and vent positions. The results indicated that, within the targeted air supply zone, the maximum temperature difference could reach around 2.5 °C. Considering the Cooling Effect of air velocity, the maximum Equivalent Temperature difference was around 4.5 °C, which could address the differences in common personalized thermal comfort preference. Utilizing the differential air supply velocities of different vents was an effective means of achieving diverse thermal environments, although attention should be paid to local thermal discomfort caused by drafts. This approach may offer a new perspective in addressing the differing thermal comfort preferences among occupants within the same residential room, additionally providing innovative insights for improving traditional air conditioning systems.

Psychological flexibility for the well-being of musicians: New possibilities for psychological counseling

Musicians face demands such as long-term practice, skill assessment, mental preparation difficulties, anxiety, depression, and study addiction. These challenges extend to their professional life with occupational demands influencing well-being, which underlines the necessity for psychological interventions and preventive programs. Acceptance and Commitment Therapy/training, based on the psychological flexibility model (acceptance, defusion, self as context, committed action, values, and contacting the present moment), has recently been implemented in work with musicians and appears to be effective in lowering performance anxiety and enhancing performance. This study aimed to conceptualize the psychological functioning of musicians using the psychological flexibility model and to qualitatively analyze possible differences between musicians with high and low experiential avoidance measured with the Measurement of Experiential Avoidance Questionnaire (MEAQ-30PL). The survey was administered twice, with slight modifications the second time, to two samples of 57 and 63 musicians, respectively. In both experiential avoidance groups, we observed flexibility processes such as values and engaged actions, and inflexibility processes such as fusion with thoughts and avoidance of unease. We also found differences between the ways in which committed actions, fusion, and inflexible attention were expressed by participants with high and low experiential avoidance. We discuss these results in light of preventive programs in music education, with an indication of improvements that could be made on the basis of the psychological flexibility model.

Associations between teacher stress and school leadership: A mixed methods study with implications for school psychologists.

School psychologists have the psychological and consultative expertise necessary to support teachers who are vulnerable to stress. Transactional theory offers a lens to guide such support, as it posits that each teacher's unique appraisals of their work demands and resources determine the degree to which they are at risk for stress. This study used a multiphase sequential mixed method design with a transactional theory lens to examine the association of leadership quality and stability with teachers' ratings of workplace conditions. The four phases consisted of (a) input from an expert panel, (b) scale development and validation, (c) interviews with key informants, and (d) multilevel modeling informed by all previous phases. Through key informant interviews, district-level administrators provided ratings of the quality and stability of school leadership. The researchers examined the associations between these ratings and teacher appraisals of classroom demands, classroom resources, job satisfaction, and perceived levels of instructional support collected via a district-wide climate survey. Multilevel models with key informant ratings and school characteristics at Level 2 (Nschools = 47) and teacher characteristics and perceptions at Level 1 (Nteachers = 1,850) demonstrated that the quality and stability of school leadership were associated with teachers' appraisals of their occupational demands and resources, job satisfaction, and ratings of instructional support. Findings show that the quality and stability of school leadership play an important role in the incidence of stress vulnerability, suggesting important pathways for school psychologists seeking to promote the occupational health of teachers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association of Physical Frailty and Cognitive Function in a Population-Based Cross-Sectional Study of American Older Adults

Introduction: Cognitive impairment and frailty are prevalent in older persons. Physical frailty is associated with cognitive decline; however, the role of effect modifiers such as age, sex, race/ethnicity, and cognitive reserve is not well understood. Methods: Cross-sectional data from the National Health and Nutrition Examination Survey (2011–2014) were obtained for participants aged ≥60 years. Complete availability of cognitive scores was an inclusion criterion. Physical frailty was defined by the presence of exhaustion, weakness, low body mass, and/or low physical activity, and categorized into three groups: robust (0 present), pre-frail (1–2 present), or frail (3–4 present). Four cognitive test scores were converted to z-scores, and global cognition (composite z-score) was calculated by averaging the four-individual z-scores. Multivariable linear regression models were fit to estimate the associations between frailty and cognitive function. Frailty was also evaluated as a risk factor for self-reported subjective memory complaint (SMC) using logistic regression. All models were adjusted for age, sex, race/ethnicity, education, alcohol use, income, marital status, diabetes, hypertension, and history of stroke. Effect measure modification analyses were conducted by age, sex, race/ethnicity, education, and occupational cognitive demand. Results: The study population comprised 2,863 participants aged ≥60 years. 50.6% of the participants were categorized into robust, 43.2% pre-frail, and 6.2% frail. After adjusting for covariates, compared to robust participants, frail and prefrail participants had lower adjusted mean global cognitive z-scores, <inline-formula><mml:math id="m1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover accent="true"><mml:mi>β</mml:mi><mml:mo>^</mml:mo></mml:mover></mml:mrow></mml:math></inline-formula> = −0.61, 95% CI: −0.83, −0.38 and <inline-formula><mml:math id="m2" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover accent="true"><mml:mi>β</mml:mi><mml:mo>^</mml:mo></mml:mover></mml:mrow></mml:math></inline-formula> = −0.21, 95% CI: −0.30, −0.12, respectively. Both prefrail and frail participants had higher odds of SMC compared to the robust participants. We did not see strong evidence that the association between frailty and cognition was modified by the factors we studied. Discussion/Conclusion: Both pre-frailty and frailty were associated with lower cognitive performance and were more likely to report subjective memory complaints relative to persons without frailty. These findings provide additional evidence that physical frailty may serve as a prognostic factor for cognitive deterioration or dementia, and prevention of frailty may be an important public health strategy.

Predictors of pain development for contralateral asymptomatic degenerative rotator cuff tears based on features of an ipsilateral painful cuff tear: a prospective longitudinal cohort study

Prior rotator cuff disease natural history studies have focused on tear-related factors that predict disease progression within a given shoulder. The purpose of this study is to examine both patient and tear-related characteristics of a painful rotator cuff tear that predict future pain development and functional impairment in a shoulder with a contralateral asymptomatic cuff tear. This is prospective longitudinal cohort study of subjects ≤65 years who underwent surgery for a painful degenerative rotator cuff tear and possessed an asymptomatic contralateral tear. Subjects were followed prospectively with shoulder ultrasound, physical examination and functional score assessment. Primary outcome was change in ASES score at 2 years. Secondary outcomes included WORC, PROMIS, HADS depression/anxiety, and VR-12 mental component scores. Sixty-five subjects were included with mean follow-up 37 (range 24-42) months. Seventeen (26%) developed contralateral shoulder pain at median 15.2(10.5) months. No difference in age, sex, CCI, occupational demand noted between subjects who did and did not develop pain. In the presenting painful shoulder there was no difference in baseline tear size, muscle degeneration, or biceps pathology between groups. The mean baseline tear length (8.6 vs. 3.8 mm, p=0.0008) and width (8.4 vs. 3.2 mm, p=0.0004) were larger in asymptomatic shoulders that subsequently developed pain compared to those that did not. However, there was no difference mean tear enlargement (length p=0.51, width p=0.90). There were no differences in baseline ASES, WORC, PROMIS scores or HADS depression/anxiety scores between shoulders that did and did not develop pain; however, subjects who developed pain reported lower baseline VR-12 MCS scores (53.3 vs 57.6, p=0.04). Shoulders that developed pain had higher VAS pain scores (2.9 [2.5] vs. 0.6 [1.0], p=0.016, lower ASES scores (7 [33] vs. 100[11.6], p=0.001) and significant changes in all WORC scales with pain onset compared to those that remained asymptomatic. There was no significant difference in changes of HADS anxiety/depression scores but a significant increase in VR-12 MCS scores in subjects who developed pain (7.1[12.6] vs. -1.9[8.7], p=0.036). A quarter of patients with painful cuff tear developed pain in a contralateral asymptomatic cuff tear that resulted in a measurable decline in function within 3 years. Analysis showed only baseline tear size of the asymptomatic shoulder was predictive of pain development. There were no tear-related features of the presenting painful rotator cuff tear or indices of mental health and physical function/occupational demand that were predictive of future pain development at short-term follow-up.

Glenohumeral Translations in Overhead Workers with Sub-Acromial Impingement Syndrome: A Review

Introduction: The third most common musculoskeletal condition is shoulder pain with a prevalence of up to 70%. The second most frequent shoulder condition is subacromial impingement syndrome. Impingement can be classified as either anterosuperior or posterosuperior. Faulty posture, altered scapular or glenohumeral kinematics, posterior capsular tightness, and acromial or coracoacromial arch pathology are all potential extrinsic mechanics that can lead to Subacromial impingement syndrome. The purpose of this review is to find the different variation in translation that takes place in the glenohumeral joint in Subacromial impingement syndrome in overhead workers. Methods: We performed a review of the various translations observed in the glenohumeral joint in subacromial impingement syndrome and discussed the evidence-based studies. For the review, an electronic search for relevant articles using PUBMED, Pedro, Research Gate, and Google Scholar databases up to Dec 2022 was done wherein MeSH search terms and free words were used. Articles underwent the selection process and were selected on the basis of inclusion criteria. Articles were selected based on the author's expertise, self-knowledge and reflective practice. Results: The current study included 11 articles that fulfilled the inclusion criteria suggesting that various humeral translations in overhead workers. The above-reviewed studies provided evidence that based on occupational demands abnormal variations occur. Conclusion: This review has provided an overview of the previous and recent literature on humeral head translation seen in sub-acromial impingement. This study concludes that superior translation is more common as compared to anterior-superior translation and posterior-superior translation.

Managers' experience of causes and prevention of sick leave among young employees with Common Mental Disorders (CMDs)-A qualitative interview study with a gender perspective.

Young adults entering the workforce have an almost 40% greater risk of work-related mental health problems than other working age groups. Common mental disorders (CMDs) constitute the majority of such mental health problems. Managers are crucial in promoting a good psychosocial work environment and preventing sick leave. The study aims to explore managers' experience of 1) causes of sick leave in the personal and work-life of young employees with CMDs, and 2) prevention of such sick leave. A gender perspective is applied to examine managers' experience of causes and prevention of sick leave in relation to male and female employees and male and female-dominated occupations. A qualitative design was applied and 23 semi-structured interviews were conducted with Swedish managers experienced in supervising young employees with CMDs. The interviews were analysed with conventional content analysis and the managers' experience of similarities and differences between young female and male employees and occupations were explored through reflective notes. Four main categories and eight subcategories describe the managers' experience of the causes of sick leave due to CMD among young employees. The main categories are: 1) entering work life when already worn-out, 2) struggling with too high expectations at work, 3) having a challenging personal life, and 4) being unable to manage specific occupational challenges and demands. Gender differences were found in six subcategories regarding, e.g., work demands and problems in personal relationships. One main category and three subcategories describe how this type of sick leave might be prevented, with managers emphasizing the need to ease the transition into work life. Gender differences in the prevention of sick leave were found in one subcategory regarding communication about workers' health and problems at work. Our findings show that gender norms and the expectations of young men and women are factors of importance in managers' experience of the development and prevention of CMDs. These results can inform their preventive work and their supervision and introduction of newly-employed young adults.

Beneficial and harmful effects of physical activity on care-seeking for low back pain: the AUTBACK study

PurposePeople who seek more care for low back pain (LBP) tend to experience poorer recovery (e.g. higher pain and disability levels). Understanding the factors associated with care-seeking for LBP might improve patient outcomes and potentially alleviate the burden of LBP on global health systems. This study aimed to investigate the relationship between different intensities, volumes, and domains of physical activity and care-seeking behaviours, in people with a history of LBP.MethodsLongitudinal data from adult twins were drawn from the AUstralian Twin BACK study. The primary outcome was the total self-reported frequency (counts) of overall utilisation of care for LBP, over 1 year. Secondary outcomes were the utilisation of health services, and the utilisation of self-management strategies, for LBP (assessed as total frequency over 1 year). Explanatory variables were device-based measures of sedentary behaviour and moderate-to-vigorous intensity physical activity, and self-reported physical workload, and work, transport, household, and leisure domain physical activity, at baseline.ResultsData from 340 individuals were included. Median age was 56.4 years (IQR 44.9–62.3 years) and 73% of participants were female. Medium-to-high baseline volumes of sedentary behaviour were significantly associated with greater counts of overall care utilisation (IRR 1.60, 95%CI 1.04–2.44) and utilisation of self-management strategies (IRR 1.60, 95%CI 1.02–2.50) for LBP, over 1 year. Medium-to-high baseline volumes of household domain physical activity were significantly associated with greater counts of utilising self-management strategies for LBP over 1 year (IRR 1.62, 95%CI 1.04–2.53). No explanatory variables were associated with the utilisation of health services for LBP.ConclusionPeople who engage in higher baseline volumes of sedentary behaviour or physical activity in the household setting (e.g. housework, gardening, yard work, general household maintenance) utilise 1.6 times more care for LBP over 1 year. Findings suggest that higher volumes of these behaviours may be harmful for LBP. No intensities, volumes, or domains of physical activity demonstrated clear benefits for LBP. Where feasible, patients and clinicians should collaborate to screen and develop strategies to reduce engagement in sedentary behaviour or physical activity in the household setting. Contextual factors (e.g. patient symptom severity, sociocultural roles, occupational demands) should be considered when devising appropriate behaviour change strategies.

The discourse of organizational resilience before and after the global pandemic.

Background: Over the past decade, there has been a surge in public and academic discussions about organizational resilience, particularly in the wake of the coronavirus disease (COVID-19) pandemic. It is essential to understand the changes in the discourse of organizational resilience before and after the pandemic. This study aims to understand how the concept of organizational resilience evolved before and after the pandemic. Methods: This study is qualitative in nature, employing discourse analysis techniques on scholarly documents on organizational resilience. Our analysis considers the global context of organizational resilience discussions and highlights the most frequently discussed industries, such as tourism and hospitality, manufacturing, and healthcare. The documents were searched on Scopus academic databases with the key search term of organizational AND resilience. Results: Our findings indicate that themes related to "response to external threats" and "supply chain vulnerabilities and disruptions" have gained significant attention post-pandemic. Meanwhile, discussions around "preparedness and organizational reliability" and "coping with occupational and job demands" have remained consistent before and after the pandemic. Conclusions: This study contributes to the academic understanding and practical application of organizational resilience evolution by discourse before and after the pandemic. It highlights the significance of being prepared for external threats and managing supply chain disruptions while recognizing the importance of preparedness and organizational reliability.

Extended water stagnation in buildings during the COVID-19 pandemic increases the risks posed by opportunistic pathogens

The regrowth and subsequent exposure of opportunistic pathogens (OPs) whilst reopening buildings that have been locked down due to the stay-at-home restrictions to limit the spread of COVID-19, is a public health concern. To better understand such microbiological risks due to lowered occupancy and water demand in buildings, first and post-flush water samples (n = 48) were sampled from 24 drinking water outlets from eight university buildings in two campuses (urban and rural), with various end-user occupancies. Both campuses were served with chlorinated water originating from a single drinking water distribution system in South-East Queensland, situated 14 km apart, where the rural campus had lower chlorine residuals. Culture-dependent and culture-independent methods (such as flow cytometry, qPCR and 16S rRNA gene amplicon sequencing) were used concurrently to comprehensively characterise the OPs of interest (Legionella spp., Pseudomonas aeruginosa, and nontuberculous mycobacteria (NTM)) and the premise plumbing microbiome. Results showed that buildings with extended levels of stagnation had higher and diverse levels of microbial growth, as observed in taxonomic structure and composition of the microbial communities. NTM were ubiquitous in all the outlets sampled, regardless of campus or end-user occupancy of the buildings. qPCR and culture demonstrated prevalent and higher concentrations of NTM in buildings (averaging 3.25 log10[estimated genomic copies/mL]) with extended stagnation in the urban campus. Furthermore, flushing the outlets for 30 minutes restored residual and total chlorine, and subsequently decreased the levels of Legionella by a reduction of 1 log. However, this approach was insufficient to restore total and residual chlorine levels for the outlets in the rural campus, where both Legionella and NTM levels detected by qPCR remained unchanged, regardless of building occupancy. Our findings highlight that regular monitoring of operational parameters such as residual chlorine levels, and the implementation of water risk management plans are important for non-healthcare public buildings, as the levels of OPs in these environments are typically not assessed.

Occupational Stress of Long Covid Rehabilitants and Return to Work After Pneumological Rehabilitation

The Long Covid syndrome, a condition that is induced by SARS-CoV-2, affects patients in their social and professional life due to persistent symptoms and functional deficits. Medical rehabilitation aims to reduce participation incapacity and restore the ability to work. So far, it is not known what happens to the occupational situation of people affected by Long Covid after pneumological rehabilitation. The overall study is designed as a multicentric and prospective observational study with a mixed-method design. Covid-19 rehabilitation patients undergoing pneumological rehabilitation aged between 18 and 65 years were recruited. The questionnaire data of persons that were employed at baseline were evaluated. The written survey took place at the beginning and at end of rehabilitation and, additionally, after six months. The data collected included terms such as return to work, occupational stress and changes, subjective prognosis of gainful employment (SPE scale) and occupational performance and working ability (WAI). The sample comprised N=173 participants (68.2% female) and the average age was 52.5 years. 85.5% of the rehabilitation patients were fit for work six months after rehabilitation and returned to a job. Absenteeism, subjectively perceived performance, and work ability improved statistically significantly over time (p<0.01). The risk of early retirement still existed six months after rehabilitation in 41.3% of the study participants. The participation limitations were statistically significantly reduced during the follow-up with a medium effect size (ES=0.60, p<0.01). In the logistic regression, the WAI proved to be a significantly protective predictor of return to work, while cognitive corona symptoms and high levels of cognitive fatigue proved to be risk factors. The majority of rehabilitation patients are gainfully employed six months after pneumological rehabilitation, although persistent symptoms and a reduced ability to work are also reported even after rehabilitation. In the rehabilitation of employed persons, work-related elements, for example clarification of work-related questions and preparation for occupational demands (e. g. concentration, stress, physical demands), could support a sustained return to work.

Multi-objective optimization of energy, thermal and visual comfort for dormitory buildings in the cold climate of China

The dormitory building design is a comprehensive procedure that requires the integration of multiple objectives to meet the demands of occupants and society. However, building energy consumption and thermal and visual comfort are often contradictory during the preliminary design process. This study proposes a multi-objective optimization framework based on Pareto front solutions to optimize the energy, thermal and visual performance of dormitory buildings in a cold climate. Three typical spatial layouts and important design variables of dormitory buildings, including orientation, geometric dimension, window-to-wall ratio, U-value and solar heat gain coefficient of glazing, shading type, openable window area ratio and green roof are systematically discussed. The results show that compared to the reference design, the multi-objective optimization method can simultaneously reduce energy use density by 27%–46% and summer thermal discomfort time by 6%–10% and improve Useful Daylight Illuminance by 0%–5%. The potential for energy saving and thermal comfort of the double-sided corridor layout is the greatest, while the single-sided open corridor layout has the greatest daylighting potential. Furthermore, optimal ranges of design variables for different spatial layout types are recommended. Architects can choose appropriate space layout types and corresponding design variable values according to actual engineering needs towards a sustainable indoor built environment.

Body Mass Index and Its Influence on Chronic Low Back Pain in the Spanish Population: A Secondary Analysis from the European Health Survey (2020).

To describe how body mass index (BMI) influences the prevalence of chronic low back pain in the general Spanish population and assess this influence given other factors as sex, age, physical occupational demands, and recreational physical activity. An analytical cross-sectional design was performed based on secondary data from the European Health Survey in Spain (2020). Data on age, gender, physical occupational demands, physical activity, BMI, and presence of chronic low back pain were extracted. A total of 19,716 (52.2% women) subjects with a median age of 53 years old were analyzed. Of these, 18.3% had chronic low back pain, 39% were overweight, and 16.1% were obese. The adjusted generalized linear model showed that being obese increased the odds of chronic low back pain by 1.719 times (p < 0.001). Being a woman increased the odds by 1.683 times (p < 0.001). Performing occupational tasks requiring high physical demands increased the odds by 1.403 times (p < 0.001). Performing physical activity in leisure time several times a week decreased the odds by 0.598 times (p < 0.001). For every additional year of age, the odds of chronic low back pain increased by 3.3% (p < 0.001). Obesity is related with the presence of chronic low back pain in the general Spanish population. This association persists, being the more relevant factor, after adjusting the association of BMI and chronic low back pain with other factors such as sex, age, physical occupational demands, and recreational physical activity.

Twelve weeks of concurrent resistance and interval training improves military occupational task performance in men and women

ABSTRACT In the British Army, ground close combat roles have opened to women, however, they must pass the newly developed, gender-neutral Role Fitness Tests for Soldiers (RFT(S)). Due to physiological differences between sexes, training that optimally prepares both sexes for military occupational demands and the RFT(S) is needed. The purpose of this study was to determine the efficacy of a 12-week periodized strength and power programme with concurrent interval training on RFT(S) performance and determine if performance adaptations differed between sexes. 39 recruit-aged (18–35 yrs) participants, including 21 men (29 ± 1 yrs) and 18 women (27 ± 1 yrs), completed the study. Participants performed 3 training sessions per week that included strength and power resistance training followed by interval training. Pre- to post-training, improvements were observed for seated medicine ball throw (4.5%, p < 0.001), casualty drag (29.8%, p < 0.001), single lift (8.9%, p < 0.001), water can carry (13.8%, p = 0.012), repeated lift and carry (6.5%, p < 0.001), 2-km load carriage (7.2%, p < 0.001) and 2-km run (3.2%, p = 0.021). Pre- to post-training improvements were also observed for maximal squat (27.0%, p < 0.001), bench press (8.9%, p < 0.001) and deadlift (24.6%, p < 0.001) maximal strength, but not upper body power or aerobic capacity. No differences in RFT(S) improvements were observed between sexes, however men performed better than women in all RFT(S) and physical performance measures. Concurrent resistance and interval training improves military occupational performance in men and women; however, women may need more training than men to pass the gender-neutral RFT(S).

Technology and the Task Content of Jobs across the Development Spectrum

Abstract The tasks workers perform on the job are informative about the direction and the impact of technological change. We harmonize occupational task-content measures between two worker-level surveys, which separately cover developing and developed countries. Developing countries use routine-cognitive tasks and routine-manual tasks more intensively than developed countries, but less intensively use non-routine analytical tasks and non-routine interpersonal tasks. This is partly because developing countries have more workers in occupations with high routine content and fewer workers in occupations with high non-routine content. More importantly, a given occupation has more routine content and less non-routine content in developing countries than in developed countries. Since 2006, occupations with high non-routine content gained employment relative to those with high routine content in most countries, regardless of their income level or initial task intensity, indicating the global reaches of the technological change that reduces the demand for occupations with high routine content.

Assessing the physiological basis for resilience in military personnel.

Military personnel experience training and operational demands that are different from civilian populations, including frequent deployment, exposure to austere environments, and dislocation from family. These unique occupational demands may result in negative impacts on health, performance, and career success. As such, resilience, defined as a system's capacity to resist, recover, recover better, or adapt, to perturbation from a challenge or stressor, is a critical factor in assuring the health and safety of military personnel. In recent years, the Department of Defense (DoD) has funded research programs assessing the physiological basis of resilience. This review will overview research programs, review salient findings from recent studies, and highlight potential future areas of research. Physiological factors influencing or predicting resilience in US military populations, including physical performance, anthropometrics and body composition, nutrition and dietary supplements, and other biomarkers will be highlighted. Finally, this manuscript will detail potential future studies, including interventions, aimed at optimising physiological resilience in military personnel.

Paper 22: High Tibial Osteotomy: Return to Duty in an Active Duty Military Population

Objectives: Evidence on both return to sport and work following high tibial osteotomy (HTO) has been limited, especially in a young, military population with high occupational demands. The purpose of this study was two-fold: 1) to identify if objective measures of preoperative knee condition severity or intraoperative correction were associated with successful return to duty and 2) to assess if postoperative complications and return to the operating room were associated with successful return to duty. Methods: A retrospective cohort study was performed of patients in the Military Health System who underwent HTO between 2003 and 2018. All patients were between 18 and 55 years and presented with osteoarthritis isolated to the medial compartment with or without other knee injuries. Concomitant meniscal and cartilage procedures were included while ligamentous procedures were excluded as they were viewed as a separate pathology. The inclusion criteria were as follows: active duty status at the time of the index procedure and two-year minimum follow-up with both preoperative knee radiographs and pre- and postoperative long-leg alignment radiographs. Preoperative Kellgren-Lawrence grade, pre- and postoperative hip-knee-ankle angle, and postoperative weightbearing axis were collected. The primary outcome was return to duty, stratified by failure defined as medical separation from the military or conversion to total knee arthroplasty. Success was defined as remaining on active duty without restriction while modified success was defined as remaining on active duty with permanent activity restrictions. The secondary outcome was reoperation for any reason. Results: Fifty-five HTOs were performed in 50 patients with a mean age of 39.0 years (range 22.8-55.0). Mean follow up was 5.0 years (range 2.1-10.7). 18.2% (10/55 knees) failed HTO (one conversion to TKA, nine medical separations), 27.3% (15/55 additional knees) had permanent activity restrictions, and 54.5% (30/55 knees) returned to active duty without restriction. 34.5% of HTOs had reoperation at any time point and return to the operating room was associated with medical separation (p=0.027). Reoperation occurred for unplanned removal of hardware (7), irrigation and debridement (4), revision HTO (3), meniscal transplant (2), meniscal repair (1), spinal cord stimulator placement (1), and decompressive fasciotomies (1). Younger age was associated with both medical separation (p=0.003) and permanent restrictions (p=0.006) following HTO and was the only significant variable identified on multiple logistic regression analysis. Patients with residual postoperative varus deformity &gt;5 degrees were more likely to undergo medical separation (p=0.023). Conclusions: When performed in a military population, HTO succeeded in returning 54.5% of knees to full duty without restriction despite 34.5% of knees requiring reoperation for complications. However, HTOs with residual varus deformity or complications requiring additional procedures were associated with lower return to duty rates. No correlation was identified between return to duty and osteoarthritis grading or amount of deformity. [Table: see text][Table: see text]

Can home care work be organized to promote health among the workers while maintaining productivity? An investigation into stakeholders’ perspectives on organizational work redesign concepts based on the Goldilocks Work principles

BackgroundDue to the aging population, the need for home care services is increasing in most Western countries, including Norway. However, the highly physical nature of this job could contribute to make recruiting and retaining qualified home care workers (HCWs) challenging. This issue may be overcome by adopting the Goldilocks Work principles, aiming at promoting workers’ physical health by determining a “just right” balance between work demands and recovery periods while maintaining productivity. The aim of this study was to 1) gather suggestions from home care employees on suitable organizational (re)design concepts for promoting HCWs’ physical health and 2) have researchers and managers define actionable behavioral aims for the HCWs for each proposed (re)design concept and evaluate them in the context of the Goldilocks Work principles.MethodsHCWs, safety representatives, and operation coordinators (n = 14) from three Norwegian home care units participated in digital workshops led by a researcher. They suggested, ranked, and discussed redesign concepts aimed at promoting HCWs’ health. The redesign concepts were subsequently operationalized and evaluated by three researchers and three home care managers.ResultsWorkshop participants suggested five redesign concepts, namely "operation coordinators should distribute work lists with different occupational physical activity demands more evenly between HCWs", "operation coordinators should distribute transportation modes more evenly between HCWs", "Managers should facilitate correct use of ergonomic aids and techniques", "HCWs should use the stairs instead of the elevator", and "HCWs should participate in home-based exercise training with clients". Only the first two redesign concepts were considered to be aligned with the Goldilocks Work principles. A corresponding behavioral aim for a “just right” workload was defined: reduce inter-individual differences in occupational physical activity throughout a work week.ConclusionsOperation coordinators could have a key role in health-promoting organizational work redesign based on the Goldilocks Work principles in home care. By reducing the inter-individual differences in occupational physical activity throughout a work week, HCWs’ health may be improved, thus reducing absenteeism and increasing the sustainability of home care services. The two suggested redesign concepts should be considered areas for evaluation and adoption in practice by researchers and home care services in similar settings.

Evaluation of Genetic and Nongenetic Risk Factors for Degenerative Cervical Myelopathy.

Cohort study. We aimed to evaluate the associations of genetic and nongenetic factors with degenerative cervical myelopathy (DCM). There is mounting evidence for an inherited predisposition for DCM, but uncertainty remains regarding specific genetic markers involved. Similarly, nongenetic factors are thought to play a role. Using diagnosis codes from hospital records linked to the UK Biobank cohort, patients with cervical spondylosis were identified followed by the identification of a subset with DCM. Nongenetic variables evaluated included age, sex, race, Townsend deprivation index, body mass index, occupational demands, osteoporosis, and smoking. Genome-wide association analyses were conducted using logistic regression adjusted for age, sex, population principal components, and follow-up. A total of 851 DCM cases out of 2787 cervical spondylosis patients were identified. Several nongenetic factors were independently associated with DCM including age [odds ratio (OR)=1.11, 95% CI=1.01-1.21, P =0.024], male sex (OR=1.63, 95% CI=1.37-1.93, P <0.001), and relative socioeconomic deprivation (OR=1.03, 95% CI=1.00-1.06, P =0.030). Asian race was associated with lower DCM risk (OR=0.44, 95% CI=0.22-0.85, P =0.014). We did not identify genome-wide significant (≤5×10 -8 ) single-nucleotide polymorphisms (SNPs) associated with DCM. The strongest genome-wide signals were at SNP rs67256809 in the intergenic region of the genes LINC02582 and FBXO15 on chromosome 18 ( P =1.12×10 -7 ) and rs577081672 in the GTPBP1 gene on chromosome 22 ( P =2.9×10 -7 ). No SNPs reported in prior DCM studies were significant after adjusting for replication attempts. Increasing age, male sex, and relative socioeconomic deprivation were identified as independent risk factors for DCM, whereas Asian race was inversely associated. SNPs of potential interest were identified in GTPBP1 and an intergenic region on chromosome 18, but these associations did not reach genome-wide significance. Identification of genetic and nongenetic DCM susceptibility markers may guide understanding of DCM disease processes, inform risk, guide prevention and potentially inform surgical outcomes. Prognostic level III.