Journal of Health and Safety at Work

---

Introduction: Many methods exist for evaluating ergonomic risk factors for LBP at workplace, including biomechanical, physiological and psycho-physical methods. Digital Human Modeling (DHM) as a tool based on computer for ergonomic evaluation that Because having advantages such as saving time and costs in assessment and actively evaluation of ergonomic solutions in the digital environment.Aim of this study was evaluation occupational causes of LBP with the use of digital human modeling.

.

Method and Materials: This study was a case quasi-experimental study in the engine assembly of the car manufacturing industry was conducted. First, The characteristics of job and risk factors for low back pain In all workstations were documented, then workstations with high risk of low back disorders were selected. Finally, a workstation for simulating and evaluating in the human digital modeling softwares, which includes 3DSSPP and Catia were selected. A total 22 posture of the lifting and lowering moment of the three tasks of workstation selected for simulation. After evaluation in the digital environment, the risk areas identified and solutions were presented.

.

Results: The results showed that compressive and shear forces on the L5/S1 disc increased with increase of anthropometric dimensions and Horizontal distance from the body and decrease of height Lowering the site, and the percentage of people capable to perform a task in joint, decreased with increase of anthropometric dimensions. Ligament strain in postures with sever bending trunk were more increasing. RULA scores increased with the Unsuitable conditions of back and arms. High risk areas, were mainly related to the low height of pallets in lifting and lowering and high Horizontal distance from the body.

.

Conclusion: According to The results of this study, Biomechanical Causes for LBP, including anthropometric characteristics (height and weight), Horizontal distance of object to the body, height of lifting and lowering location and trunk bending and torsion. This study showed that DHM is an effective tool in the evaluation of job tasks and workplace design, that can be identified risk area in each task and to achieve the ideal design. Using DHM can be implement Desired solution in a virtual environment and With the re-evaluation, Be sure of having effective solutions in the real environment.

---

Introduction: Low back pain (LBP) is a common and costly health problem. It has high prevalence in nursing job and caused shortage of nursing staff. This study was conducted to determine the prevalence of LBP, knowledge level of LBP risk factors and assess relationship between LBP prevalence and nurses’ knowledge level of LBP risk factors among nurses of Shiraz University of Medical Sciences (SUMS).

.

Material and Method: In this cross-sectional study, 118 randomly selected registered nurses participated from SUMS hospitals with at least one year of job tenure. In order to assess nurses’ knowledge of LBP risk factors, a self-administered survey questionnaire consisted of four parts was used as data collecting tool. Statistical analyses were performed using SPSS (version 11.5). Duncan, T-test and ANOVA tests were used for data analysis.

.

Result: LBP prevalence rate was found to be 79.7% (94 nurses) during the previous year from which 12 nurses were male (63.2%) and 82 nurses were female (82.8%). Nurses’ knowledge level of LBP risk factors in different hospitals was not significantly different. The Results showed that nearly half of the nurses had poor knowledge about LBP risk factors and the remaining had good knowledge level. The main source of information about LBP risk factors among nurses were related to their university education.

.

Conclusion: A high prevalence of the LBP was found among nurses working at SUMS hospital. Knowledge level of nurses about LBP risk factors needs improvement. In addition to university education, which is the main source of information of nurses about LBP risk factors, on-the-job training seems essential in this field.

---

Introduction: In theexperienceof pain,thesensory andthe emotional components should be considered. Emotionalcomponents of the painincludea variety of emotional states which depression is the most importantone. Thus, in this study, first, musculoskeletal pain was compared between depressedand non-depressed industrial workersand then otherphysical anddemographicfactorsinfluencing thedepression andmusculoskeletal disorderwere studied.
 

Method and material: Thiscross-sectional and descriptive-analytical study was conductedin 2012, among 179 industrial workers in Shiraz city.In this study,the participantswere selected throughcensus.The data collection instruments were three questionnaires including Body Discomfort Chart (BDC), visual analogue scale type, Beck Depression Inventory (BDI) and demographic informationquestionnaire. The collected data were analyzed using SPSSsoftware version 16. Mann-Whitney and Kruskal-Wallis statistical tests wereemployedfor comparison of variables and Kendall correlationwas used for determining the relationship between variables.
 

Results: Findings of the study showed that the maximum (19%) and the minimum (3.4%) painwere belonged to back and arm/forearm, respectively. Furthermore, 36.2% of participantshad a low-to-acute level of depression. Comparison of musculoskeletal disorders betweendepressed and non-depressed workers with Mann-Whitney Test manifested a significant different in head/neck, back,left hand/wrist,right hip and knee (p<0.05).Also Kruskal Wallis statistical test showed no significant differences in depression levelamong various occupational groups,however, painsignificantly differed among various groupsin a way that its rate was higher for office workers,comparing to other groups.
 

Conclusion: The higher score of depression among workerswith musculoskeletal pain can be due to failure in pain relief achievement. Psychological problemsthatoccurfollowingchronicpainarerelated to continuous discomfort, frustration and thinking about the pain. This situation causes the feelings of inadequacy and inefficiency and consequently the increase ofprobability of depression.

---

Introduction: Adverse effects of volatile organic compounds (VOCs) including general and specific effects like carcinogenic of benzene are well known. The aim of this study was to evaluate occupational exposure to BTEX compounds in the painting unit of an automotive industry and subsequently health risk assessment of exposure to these compounds.

Material and Method: This cross-sectional study was conducted in the paint unit of an automotive industry including painting cabin, pre-painting salon and painting salon sections. After analyzing samples, gathered from different sections, by GC-MS, BTEX compound were identified as the main contaminants. In the next step, NIOSH1501 and EPA methods were used to measure and analysis of BTEX and risk assessment, respectively.

Result: Findings showed that benzene concentration in painting cabin was higher than occupational exposure limits provided by the Environmental and Occupational Health Center of Iran. Life time cancer risk for benzene per 1000 has been reported10, 3.63 and 1.27in the painting cabin, pre-painting and salon sections, respectively. It was also for ethyl benzene 2.5m 1.8 and 38.0 in the mentioned sections, respectively. The non-cancer risk for benzene and xylene in the painting cabin and pre-painting sections were higher than recommended allowable level.

Conclusion: Regarding the high level of cancer risk values obtained for benzene and ethylbenzene in the studied units and also high values of non-cancer risk for benzene and xylene, it is recommended to conduct biological exposure assessmnet of the workers and improve existence control systems using modern engineering control systems.

---

Introduction: Skin disease caused by exposure to the chemicals is one of the major health-related problems in the workplaces. This study has done to prioritize the strategies for skin exposure with chemical in a painting company.
Material and Method: In this analytical cross-sectional study 7 criteria and 8 selection control methods were initially chosen by surveying the existing records and through the assessments of expert panel and checking the result of previous studies. Subsequently, control strategies were prioritized according to the criteria using Fuzzy Analytical Hierarchy process & Topsis.
Result: Results of the paired comparison showed that the safety of the control strategy (w=0.298) and it’s up to date (w=0.0138) were the most and least important criteria for skin control strategies. Among skin control strategies for chemical exposure, the highest and lowest importance were for training (w=0.817) and work-rest schedule (w=0.233), respectively.
Conclusion: In this study, training was determined as the best control strategies for skin chemical exposure in the studied painting company according to the investigated criteria. This decision-making process could be applied for promotion of the skin health among workers.

---

Introduction: Exposure to organic solvents cause adverse effects on various systems such as the central nervous system, behavioral and cognitive changes, sleep disorders, as well as changes in mood. This study was aimed to evaluate the effect of long term exposure to mixed organic solvents on positive and negative aspects of the mood of the workers of a painting industry.  
Material and Methods: In this cross-sectional study, based on the obtained results of Gas chromatography–mass spectrometry (GC-MS) analysis and neuro-behavioral effects of benzene, toluene, ethylbenzene and xylene (BTEX) compounds, these compounds were selected as the main organic solvents for the study and the amount of these compounds was quantitatively determined according to the National Institute for Occupational Safety and Health (NIOSH) 1501. Furthermore, the mood status of workers was evaluated by the validated Persian version of BRUMS (The Brunel Mood Scale) questionnaire and the obtained data were analyzed using SPSS software, version 24.
Results: The mean of exposure to mixed organic solvents in different sections of the exposed group was reported to be 0, 0.27, 0.76, and 2.6 ppm. By increasing exposure to mixed organic solvents from the first quartile to the fourth quartile, fatigue and calmness scores were increased with a strong correlation (r = 0.7). Also the fatigue and calmness scores in the groups having elevated exposure were significantly higher than the control group. Furthermore, the obtained scores for tension, depression and anger in the exposed group were significantly higher than control group (p- value <0.05). There was no significant relationship between demographic data such as age, work experience and smoking with different subscale of mood status.
Conclusion: Long term exposure to low level of BTEX compounds has made an adverse effect on positive and negative mood status in different aspects. Also, increasing the level of exposure to mixed organic solvents was positively correlated to the obtained scores for fatigue and calmness.

---

Introduction: Workers in car manufacturing industry are at risk of a high prevalence of musculoskeletal disorders, especially low back pain. Therefore, in the present study aimed to design and fabricate a portable device to evaluate the low back kinematics and to compare these variables in workers with and without low back pain (LBP) in assembly lines of an automotive industry.
Material and Methods: In the present research workers postures were assessed using OWAS direct observational method. Moreover, simultaneously, prevalence and intensity of low back pain were evaluated by Dutch Musculoskeletal Questionnaire (DMQ) and Visual Analogue Scale (VAS). After fabricating motion analysis device, a field study was conducted using the designed device among 16 volunteers to investigate low back kinematic variables in two groups of workers: LBP and non-LBP.
Results: The results showed that 62.1 percent of all working postures were high risk with corrective action levels of 3 and 4. On average, 86.1 percent of workers experienced LBP in the previous 12 months. Regarding comparison of kinematic variable in the two groups of LBP and non-LBP, workers without LBP had higher degree and duration (in second) of movements (forward flexion, lateral bending, extension, and twisting), as compared to those with LBP. However, only movement range of forward flexion in non-LBP group (mean: 64.29 and SD: 8.41), was significantly higher than those with LBP (mean: 58.97 and SD: 11.34).  
Conclusion: The device can be used as an effective tool in the ergonomics studies in the field of back pain, due to its potential to record the kinematics of the trunk, as well as its lightweight and non-interference with the task. Device’s validity was acceptable based on the comparison of the results of this device with those obtained from inclinometer.

---

Introduction: Given the high prevalence of low back pain in manual handling activities, its known relationship with spinal loads, and the role of muscular fatigue and the body’s adaptive mechanisms to counteract fatigue, this study investigated the effect of repetitive lifting tasks on trunk muscular fatigue and the kinematics of the spine and load-in-hand.
Material and Methods: Eighteen male volunteers lifted a box from the floor to their waist height at a pace of ten lifts per minute until they could no longer continue the task and reported the highest level of exhaustion. Kinematic data and muscle electromyographic activity were simultaneously recorded using a motion capture system and an electromyography device. In this study, average trunk flexion angle and trunk angular velocity were calculated as trunk kinematic variables, while average box vertical travel distance, average box horizontal displacement from L5-S1, and average box vertical displacement velocity were considered as box kinematic variables. The median frequency of electromyographic signals from selected muscles was quantified as a muscle fatigue indicator. Since subjects performed different lifting cycles, the total number of cycles was divided into five distinct blocks for data analysis.
Results: The results showed significant effects of lifting trial blocks on trunk angle (p=0.004) and vertical box displacement (p<0.001). Median frequency was significantly affected by lifting blocks for right (p=0.016) and left erector spinae (p=0.014), right (p=0.021) and left multifidus (p<0.001), right latissimus dorsi (p=0.001), and left rectus abdominis (p=0.039).
Conclusion: Overall, the results highlight variations in most kinematic parameters and a reduction in the frequency content of EMG signal spectra. These changes serve as indices of the central nervous system’s control over lifting behavior under dynamic conditions. A better understanding of these central nervous system adaptations could have practical applications in interventions such as workstation design, exoskeleton development, and worker training to manage musculoskeletal disorders.

---

Introduction: Lifting loads in awkward postures is a main cause of low back musculoskeletal disorders. In this context, researchers have used various indicators to determine the relationship between biomechanical variables and the risk of these disorders. This study aimed to investigate the correlation between plantar pressure distribution and the values of UTAH back-compressive forces (BCF) and lifting index (LI) during symmetrical load-lifting tasks.
Material and Methods: Thirteen healthy men, aged 25 to 35, took part in this study. The participants were instructed to symmetrically lift loads weighing 7.5 kg and 15 kg in 15 different postures, considering three horizontal distances (A, B, C) and five different heights (1-5). Pressure on the foot soles was recorded using 16 force-sensitive resistors (FSR) corresponding to eight anatomical areas on each foot. The BCF and LI were also calculated using the UTAH method and the NIOSH equation, respectively. Statistical analysis was performed using SPSS (version 21) software.
Results: Based on the results, when the load was closest to the body (A1-A5), the highest pressure was recorded in the heel and the 4th and 5th metatarsal of both feet. In lifting a load of 15 kg in the A2, B1, B2, C1, C2 postures and lifting a load of 7.5 kg in the C2 posture, the average BCF exceeded 700 pounds. The LI was greater than 1 for specific postures (B1, B2, B4, B5, C1-C5) at 15 kg and (C1, C2, C4, C5) at 7.5 kg load-lifting. During the 7.5 kg and 15 kg load-lifting, there was a significant correlation between the plantar pressure and the values of LI and UTAH (p-values < 0.05) in most postures.
Conclusion: The results showed a significant correlation between plantar pressure distribution and load-lifting postures. The study findings, which identify risk levels associated with lifting postures, lay the groundwork for future research aimed at categorizing safe and unsafe plantar pressure patterns.

---

Introduction: Sugarcane is an important and strategic product in many countries, including Iran. While the introduction of mechanization, e.g., sugarcane harvesting machines, has significantly enhanced the production process, operators of these machines still face many ergonomic and safety challenges. 
Material and Methods: The present study investigated the ergonomic status of sugarcane harvester operators by examining some of their physiological and physical evaluations. Physiological evaluations included heart rate, oral temperature, and energy consumption of the operators, perceptual strain index, and physiological strain index. Physical evaluation included estimating the amount of pain and discomfort in body segments. The correlation between pain and discomfort of body parts with some demographic and physiological indices of users was investigated using IBM SPSS 24 software.
Results: Sugarcane harvester operators’ heart rate, energy consumption, and physiological strain index were 79.05 beats/min, 18.81 kJ/min, and 0.83, respectively. The average of three indices of thermal sensation, perceived exertion of activity, and perceptual strain index were estimated as 4.40, 9.21, and 8.86, respectively.
Conclusion: Pain and discomfort in the neck and back segments, like many agricultural activities, had the highest rate among the body parts. Also, shorter and thinner operators reported higher pain and discomfort in some segments of the body. 
 

---

Introduction: Operating room personnel are involved with occupational physical activities such as repetitive bending, holding surgical tools and standing for long hours that can lead to musculoskeletal disorders (MSDs). Low back pain (LBP) is the most prevalent and costly problem among these disorders. The aim of this study was to determine the relationship between occupational physical activity, LBP and disability among operating room personnel.
Material and Methods: A total of 60 operating room personnel voluntarily participated in the study, all of which had at least two years of working experience. At the end of a working week, the degree of disability and pain were assessed by Graded Chronic Pain (GCP) questionnaire. The International Physical Activity Questionnaire (IPAQ) was used to evaluate the level of physical activity. Simple linear regression was conducted to investigate the relationship between physical activity, LBP and disability. 
Results: The survey using the GCP questionnaire revealed that 58.3% of participants reported experiencing occupational back pain, while 41.7% reported no back pain.  Among those with back pain, the average pain intensity was rated 43.11 (18.22) on the scale.  Pain remained stable for an average of 2.3 days (standard deviation = 0.95).  The average level of disability associated with back pain was 32.09 (27.44). Statistical analysis using simple linear regression showed a significant relationship between back pain and several factors: vigorous physical activity (p-value = 0.02), prolonged sitting time (p-value = 0.01), and chronic pain (p-value < 0.001).
Conclusion: Occupational physical activity characterized by low intensity, but high repetition and standing for a long time in fixed postures were the most significant contributors to lumbar back pain among operating room personnel. Chronic pain in this population was reported as grade 2, indicating severe pain with minimal disability; if left unaddressed, this could lead to movement restrictions.