Physical Safety

7/28/2019 Physical Safety

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Expert forecast on emerging physical risks

related to occupational safety and health

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E u r o p e a n A g e n c y o r S a e t y a n d H e a l t h a t W o r k

RISK OBSERVATORY

EXPERT FORECAST ON EMERGING PHYSICAL RISKS

RELATED TO OCCUPATIONAL SAFETY AND HEALTH


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Expert orecast on emerging physical risks related to occupational saety and health

Authors:

Eva Flaspler & Dietmar Reinert, BGIA, Germany (Topic Centre Research)

Emmanuelle Brun, BGIA, Germany (Topic Centre Research) & European Agency orSaety and Health at Work

In cooperation with:

Topic Centre Research members:

Manred Hinker and Silvia Springer, AUVA, Austria

Karen Peirens, Prevent, Belgium

Kari Lindstrm and Krista Pahkin, FIOH, Finland

Jean-Marie Mur, INRS, France

Karl Kuhn and Ellen Zwink, BAuA, Germany

Victor Hrymak, OSHII, Ireland

Antonio Leva, ISPESL, ItalyPilar Hervs and Mercedes Tejedor, INSHT, Spain

Richard Brown and Lee Kenny, HSL, UK

Anneke Goudswaard, Irene Houtman, Elco Miedema and Martin van de Bovenkamp,

TNO Work and Employment, Netherlands

European Agency or Saety and Health at Work: William Cockburn

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Expert forecast on emerging physical risks related to occupational safety and health

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Foreword 5

Executive summary 7

1 Introduction 11

2 Methodology 15

3 Expert participation 19

4 Results 23

4.1. R isks related to musculoskeletal disorders (MSDs). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244.2. Risks related to noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

4.3. Risks related to vibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

4.4. Thermal risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

4.5. Risks related to non-ionising radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 6

4.6. Risks related to ionising radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

4.7. Risks related to machinery, work processes and technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

4.8. Other ergonomic risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

5 Literature review 47

5.1. Lack o physical activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

5.2. Combined exposure to MSD risk actors and psychosocial risk actors .. . . . . . . . . . . . . . . . . . . . . . . . . . 50

5.3. Multi-actorial risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525.4. Complex human-machine interaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

5.5. Ultraviolet radiation (UVR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

6 Conclusion and perspectives 59

7 Annexes 65

7.1. Annex 1: Organisations contacted or the survey on emerging OSH physical risks. . . . . . . . . . . . . . . . . 66

7.2. Annex 2: Reerences used in the l iterature review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68


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F O R E W O R D

The evolution o society and the changing world o work bring new risks andchallenges or workers and employers. Indeed, working environments have changedconsiderably during the last 15 years and are continuing to evolve as a result o chan-ges in the structure o the workorce related to the ageing workorce and increasingparticipation o women; o changes in the structure o the labour market due toglobalisation and growth o the service sector; o new orms o employment and jobs;o the intensication o work; and o the introduction o new technologies and workprocesses.

In 2002, the Lisbon summit identied specic objectives to create quality jobs andincrease workorce participation. Improving working conditions to keep people in

work is a condition to achieve these objectives. In this context, the need to identiyand anticipate emerging risks related to occupational saety and health (OSH) hasbeen emphasised at the European political level so as to assist in better targeting oresources and to enable more timely and eective interventions.

The Community strategy on health and saety at work 200206 called on theEuropean Agency or Health and Saety at Work to set up a risk observatory. Oneo the priorities identied in the strategy is the need to anticipate new and emer-ging risks, whether they be linked to technical innovation or caused by social change.

This is to be done by ongoing observation o the risks themselves, based on the sys-tematic collection o inormation and scientic opinions. Additionally, the strategyemphasised that this kind o analysis is an integral part o a preventive approach.

Responding to these needs, the Agency commissioned its Topic Centre Researchon Work and Health (TCWH) with the identication o emerging OSH risks. A rstorecasting exercise ocused on physical risks has been carried out. This has then beenrepeated or risks related to human, social and organisational actors, chemical risksand biological risks so as to provide as comprehensive a picture as possible o thepotential emerging risks in the world o work.

The report presents the results o the expert orecast on emerging physical OSH riskscomplemented by a literature review. These results should provide a basis or debateand refection between policy-makers at various level or setting research and actionpriorities.

The Agency would like to thank Emmanuelle Brun, Eva Flaspler and Dietmar Reinertrom BGIA or their contributions to the drating o this report, as well as ManredHinker and Silvia Springer rom AUVA, Karen Peirens rom Prevent, Kari Lindstrm andKrista Pahkin rom FIOH, Jean-Marie Mur rom INRS, Karl Kuhn and Ellen Zwink romBAuA, Victor Hrymak rom OSHII, Antonio Leva rom ISPESL, Pilar Hervs and Mercedes

Tejedor rom INSHT, Richard Brown and Lee Kenny rom HSL, and Anneke Goudswaard,Irene Houtman, Elco Miedema and Martin van de Bovenkamp rom TNO Work andEmployment or their contributions to the project. The Agency would particularlylike to thank the respondents to the survey, whose participation was essential or theaccomplishment o the project. The Agency would also like to thank its Focal Points,Expert Group and Advisory Group or their valuable comments and suggestions.

European Agency or Saety and Health at WorkOctober 2005


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EXECUTIVE SUMMARY

Context

The evolution o society and the changing world o work bring new risks and challen-ges or workers and employers. In this context, the Community strategy on health andsaety at work 200206 called on the European Agency or Health and Saety at Workto set up a risk observatory. One o the priorities identied in the strategy is the needto anticipate new and emerging risks, whether they be linked to technical innovationor caused by social change. This is to be done by ongoing observation o the risksthemselves, based on the systematic collection o inormation and scientic opinions.Additionally, the strategy emphasised that this kind o analysis is an integral part o apreventive approach.

This report presents the results o a orecast based on an expert survey and a literaturereview that aimed to identiy emerging physical risks related to occupational saetyand health (OSH). These activities are part o a larger project, the goal o which is theearlier identication o emerging trends and risks in order to assist in better targetingo resources and to enable more timely and eective interventions.

Method

Within the scope o this project, an emerging OSH risk has been dened as any occu-pational risk that is both new and increasing.

By new is meant that: the risk was previously unknown and is caused by new processes, new techno-

logies, new types o workplace, or social or organisational change; or a long-standing issue is newly considered as a risk due to a change in social or

public perceptions; or new scientic knowledge allows a long-standing issue to be identied as a risk.

The risk is increasing i: the number o hazards leading to the risk is growing; or the likelihood o exposure to the hazard leading to the risk is increasing (exposure

level and/or the number o people exposed); or the eect o the hazard on workers health is getting worse (seriousness o health

eects and/or the number o people aected).

For the ormulation o the expert orecast on emerging OSH physical risks, a question-naire-based survey was run in three consecutive rounds ollowing the Delphi method.

This method was chosen so as to reach a broad consensus and to obtain scienticallyounded opinions. In total, 137 experts were invited to participate in the survey ol-lowing their nomination by the Agencys Focal Points and Topic Centre Research. Six-ty-six valid questionnaires were returned rom 53 organisations covering 14 Europeancountries and the USA (response rate: 48 %). Participating experts were required tohave at least ve years experience in the eld o OSH and physical risks. Respondentswere mainly researchers (33 %) and heads o departments in organisations involvedin OSH activities (33 %). Other respondents included labour inspectors, proessors

and lecturers, those in charge o policy or standards development, or o enorcement,consultants, or those involved in testing and certication.


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The top emerging risks identified

The main risks identied in the orecast refect a growing concern or multi-actorial issues.

Lack o physical activity, which is the risk the experts agree on the most as being

emerging, is to some extent the result o poor work organisation and harms the phy-

sical health o workers. The reasons mentioned or this lack o activity are the growing

use o visual display units ( VDU) and o automated systems resulting in prolonged sit-

ting at the workplace, as well as the increasing time spent sitting during business tra-

vel. A literature review showed that occupations with very little physical activity and

increased prevalence o musculoskeletal disorders (MSDs) usually involve prolonged

sitting, but prolonged-standing workplaces are also a concern. The health outcomes

identied in the literature are MSDs o the upper-limbs and o the back, varicose veins

and deep-vein thrombosis, obesity, and certain types o cancers.

A urther multi-actorial emerging risk related to MSDs and identied with a high de-

gree o consensus is the combined exposure to MSD risk actors and psychosocial

risk actors. According to the experts, job insecurity and ear o the uture resultingrom the unstable labour market both accentuate the eects o physical risk actors

such as poor ergonomic design, thus contributing to an increase in the incidence o

MSDs. Regarding this combined exposure, the literature mainly ocuses on VDUs and

call centre jobs and on the healthcare sector. The psychosocial actors identied are

stress generated by poor ergonomic design o the work equipment; high job demand

but also too low job demand; complex tasks leading to mental exhaustion; high time

pressure; low job control and low decision level; poor support rom colleagues and

rom the hierarchy; ear o downsizing, job insecurity and ear o unemployment; and

harassment, violence and bullying at work. Combined exposure to MSD risk actors

and psychosocial risk actors is shown to have a more serious eect on workers health

than exposure to one single risk actor.

The complexity o technologies and work processes with complex human

system interaces is also a multiactorial risk strongly agreed on. A poor design o the

interace may result in increased mental and emotional demands on the operator.

Hence a potential increase in the incidence o stress, human errors and accidents.

Intelligent but complex humanmachine interaces are ound in the air industry, in

the healthcare sector (computer-aided surgery), in heavy trucks and earth-moving

machinery (in-cab devices such as remote controls and joysticks) and in complex

manuacturing or physically demanding manual handling activities (cobots).

A recurrent issue in the orecast is the insufcient protection o high-risk groups

against long-standing ergonomic risks. Workers with a low employment status

and poor working conditions, who paradoxically are the subject o ewer training and

awareness-raising measures, are identied as being particularly at risk. Examples o

such high-risk groups are illegal workers in the agriculture and construction sectors

with poor knowledge o the thermal risks related to work perormed in cold or hot

environments.

In the eld o thermal risks, the lack o prescriptions against thermal discomort at

industrial workplaces, where only the issue o thermal stress has been addressed so

ar, is also highlighted. According to the respondents, the role that thermal comort

plays on workers overall stress and well-being at work has not been adequately as-

sessed so ar. Thermal discomort may impede workers perormance and saety beha-viour, hence increasing the probability o occupational accidents.


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Ultraviolet radiation (UVR) is strongly agreed to be an emerging risk. The respon-dents do not only reer to occupational exposure but also consider the more generalissue o increasing exposure during leisure time, linked to changing societal valuesand ways o living. As UVR exposure is cumulative, the more the workers are exposed,

the more UVR-sensitive they are. Hence a potentially growing need or preventionmeasures at the workplace. The literature emphasises the need or advice limitingoccupational UVR exposure both indoors and outdoors.

More generally, the experts especially emphasised multi-actorial risks in a genericitem with a high degree o consensus. A lot o literature examines call centre workpla-ces, which are typical workplaces with multi-actorial exposure. The various risk actorscall centre agents are exposed to are prolonged sitting, background noise and poorroom acoustics, inadequate headsets, poor room atmosphere, inadequate lightingconditions, poor ergonomic design o the work equipment, inappropriate arrange-ment o the working premises, and actors o human and organisational nature suchas low job control, high time pressure, poor work organisation, and high mental andemotional demands. Various health outcomes could be observed such as MSDs, vari-cose veins, nose and throat diseases, voice disorders, atigue, stress and burnout.

A more traditional risk identied in the survey is vibration both to the hand-armand to the whole-body systems, which have gained more attention with Directive2002/44/EC (1). The experts particularly highlighted with a high degree o consensusthe combined exposure to vibration and to MSD risk actors such as awkward postu-res and physically demanding work.

Perspectives

The expert orecast on OSH physical risks presented in this report is complementedwith orecasts and literature reviews on human, social and organisational risks, and onchemical and biological risks so as to provide as comprehensive a picture as possibleo the potential emerging risks in the world o work. All results will be linked to urtheractivities o the Risk Observatory, which consists in the collection o data rom Euro-pean and national OSH monitoring systems and identication o research priorities inEurope. The overall aim o the Risk Observatory is to provide an overview o OSH inEurope, to highlight trends on OSH outcomes and risk actors, to provide early identi-cation o newly emerging risks in the workplace and to identiy areas and issues wheremore inormation is needed.

(1

) Directive 2002/44/EC o the European Parliament and o the Council o 25 June 2002 on the minimumhealth and saety requirements regarding the exposure o workers to the risks arising rom physicalagents (vibration). OJ L 177, 6.7.2002, pp. 1319.


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RISK OBSERVATORY

INTRODUCTION1.


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As society evolves under the infuence o new technologies and o shiting econo-

mic and social conditions, workplaces, work practices and production processes are

continuously changing. These new work situations bring new risks and challenges or

workers and employers, which in turn demand political, administrative and technical

approaches that ensure high levels o saety and health at work.

In this context, the need to identiy and anticipate emerging risks related to occupa-

tional saety and health (OSH) has been emphasised on several occasions at the politi-

cal and European level (2) (3) (4) (5). More specically, the Community strategy on health

and saety at work 200206 mandated the European Agency or Saety and Health at

Work (the Agency) to set up a risk observatory. One o the priorities identied in the

strategy is the need to anticipate new and emerging risks, whether they be linked to

technical innovation or caused by social change. This is to be done by ongoing obser-

vation o the risks themselves, based on the systematic collection o inormation and

scientic opinions. Additionally, the strategy emphasised that this kind o analysis is

an integral part o a preventive approach.

A key activity o the risk observatory developed by the Agency is the identication

and dissemination o inormation on emerging OSH risks. In 2002, the Agency com-

missioned its Topic Centre Research on Work and Health ( TCWH) with the identica-

tion o emerging OSH risks, which involved some o the principal OSH institutions in

Europe. Two types o inormation on physical, chemical and biological risks, risks rela-

ted to human, social and organisational actors, as well as combinations thereo, are

collected: published inormation (rom peer-reviewed journals and rom the Internet)

and expert orecasts.

What are emerging risks?

An emerging OSH risk has been dened as any occupational risk that is both new andincreasing.

By new is meant that: the risk was previously unknown and is caused by new processes, new techno-

logies, new types o workplace, or social or organisational change; or

An emerging OSH risk

is any occupational risk

that is both new and

increasing.

(2) Commission o the European Communities: Adapting to change in work and society: a new Commu-nity strategy on health and saety at work, 200206. COM (2002) 118 nal, Brussels, 11.3.2002.http://europe.osha.eu.int/systems/strategies/uture/

(3) Commission o the European Communities: Framework programme 200206 o the European commu-nity or research [] towards the creation o the European research area, COM (2001) 94 nal, Brussels,21.2.2001.

http://europa.eu.int/comm/research/pd/com01-94-en.pd

(4) Diamantopoulou, A. (European Commissioner responsible or Employment and Social Aairs): Preven-ting accidents at work: a new European strategy or saety and health, Speech/01/571 held at the Euro-

pean Conerence on Health and Saety, Brussels, 23.11.2001.http://europa.eu.int/rapid/pressReleasesAction.do?reerence=SPEECH/01/ 571&ormat=HTML&aged=0&language=EN&guiLanguage=en

(5

) European Agency or Saety and Health at Work: Quality o work a uture Community strategy orsaety and health at work, Forum 1, 4.7.2001.http://agency.osha.eu.int/publications/orum/1/en/index.htm


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a long-standing issue is newly considered as a risk due to a change in social orpublic perceptions; or

new scientic knowledge allows a long-standing issue to be identied as a risk.

The risk is increasing i: the number o hazards leading to the risk is growing; or

the likelihood o exposure to the hazard leading to the risk is increasing (exposurelevel and/or the number o people exposed); or

the eect o the hazard on workers health is getting worse (seriousness o healtheects and/or the number o people aected).

This publication presents the results o the expert orecast on emerging physical OSH

risks based on a Delphi survey. The risks which were identied in the expert survey

are related to musculoskeletal disorders (MSDs), noise, vibration, thermal risks, risks

related to ionising and non-ionising radiation, to machinery, work processes and tech-nologies, as well as various ergonomic risks. A literature review explores in more depth

the context and the health outcomes o ve o the main emerging risks singled out in

the orecast: lack o physical activity in the workplace; combined exposure to muscu-

loskeletal risk actors and psychosocial risk actors; multi-actorial risks; complexity o

new technologies leading to increased mental and emotional strain; and increase o

exposure to ultraviolet radiation (UV) at the workplace.


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RISK OBSERVATORY

METHODOLOGY2.


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European experts were surveyed as to what are the emerging OSH physical risks. Inthis matter, the Delphi method was used in order to reach a broad consensus and toavoid non-scientically ounded opinions.

Delphi method (6)

The Delphi method is a widely used methodology to create oresight inormation ontopics or which only uncertain or incomplete knowledge is available. There are seve-ral variations o the Delphi method but all o them are based on an iteration processwith at least two survey rounds in which the results o the previous rounds are edback and submitted again to the experts or new evaluation. The eedback processensures that the experts are aware o the views o other experts and gives them thepossibility to revise their rst evaluation accordingly. At the same time, it avoids grouppressures, which could have the experts not dare giving their real opinion and wouldlead to distorted results.

The Delphi method adopted or ormulating the expert orecast on emerging risks inthis project consisted in three survey rounds (Figure 1).

Figure 1: Delphi process implemented or the expert orecast on emerging OSH physical risks


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(6

) Cuhls, K.: Technikvorausschau in Japan Ein Rckblick au 30 Jahre Delphi-Expertenberagungen. In:Technik, Wirtschat und Politik, vol. 29. Schritenreihe des Fraunhoer-Instituts r Systemtechnik undInnovationsorschung (ISI). Physica, Heidelberg, 1998.

EXPERTS IDENTIFICATION

SURVEY ROUND 1

Exploratory round(N

invited= 62; N

response= 48; RR = 77%)

> Creation o a list o emerging risks

SURVEY ROUND 2

Validation o issues identifed in round 1(N

invited= 110; N


> Prioritised list o emerging risks

complemented by new added risks

SURVEY ROUND 3

Final consultation on prioritised list(N

invited= 137; N


> Consensus on prioritised list o

emerging risks

EXPERT FORECAST

D

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First survey round

A rst exploratory survey round carried out in 2002 aimed at identiying the risks thatthe experts reckoned to be emerging. A questionnaire with open-ended questionswas developed to help the experts in ormulating their views as to what are the emer-ging OSH physical risks o the next 10 years. The experts were invited to either ll inthe questionnaire together with a TCWH member under the scope o a questionnaire-based interview, or to ll in the questionnaire electronically by themselves. Based onall the issues identied in the questionnaires lled in and returned, a list was drawn upin which the risks were sorted into nine categories according to the eld they wererelated to: risks o musculoskeletal disorders (MSDs), noise, vibration, thermal risks,non-ionising radiation, ionising radiation, risks related to machinery, work processesand technologies, mechanical risks and other general ergonomic risks.

Second survey round

A second questionnaire-based survey round was realised in 2003 and aimed at vali-dating and complementing the results o the rst step. The questionnaire presentedthe list drated out o the rst round with eedback on the requency o nomination oeach item. The experts had to indicate which o the issues listed they reckoned to ac-tually be emerging risks (yes or no closed-question) and to rank the emerging ones bydividing 100 points. The ranking was internal to each nine categories o the list. At theend o each category, the experts had the possibility to add new risks to the list. Onlythe answers rom experts who met the selection criteria or the category concernedwere analysed (see 3.1). As a result o the second survey round, a prioritised list o riskswas drawn up based on:

the requency o rating, which indicates the number o experts who considered a

specic item to be an emerging risk; the mean value (MV) o the points attributed to an item, which indicates the weight

the experts allocate to the risk. The standard deviation (SD) o the mean value wasalso calculated as an indication o the degree o consensus amongst the experts.

Third survey round

As the last step towards reaching a consensus, a third consolidation round was carriedout in 2004. Additional experts were invited to participate in the survey in order tohave a larger and better appropriate or statistical calculations number o res-ponses within each risk category.

As all the issues listed under the category mechanical risks in the second round wereactually related to personal protective equipment (PPE) matters, this category wasremoved rom the third questionnaire and the issues were included into the categoryother ergonomic risks.

Unlike the second round, the third questionnaire consisted o a non-comparative sca-ling process whereby the respondents were asked to rate each issue independentlyrom the others on a ve-point Likert scale. The scale ranged rom disagree to agree:

The rst box o the scale meant strongly disagree that the issue is an emerging risk,the third and middle box stand or undecided and the th and last box or stronglyagree that the issue is an emerging risk. As in the second round, only answers rom

experts meeting the selection criteria or the risk category concerned were taken intoconsideration.


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The orecast is the result

o a three-round ques-

tionnaire-based surveyrun ollowing the Delphi

method.


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Analysis o the results

For each risk, the mean values and the standard deviations were calculated. While themean values help prioritising the risks within one risk category, the standard devia-tions refect the level o consensus on one item among the respondents.

The ollowing areas have been dened or the interpretation o the mean values,based on the denition o the ve-point Likert scale used in the survey (see above),and in order to have a reasonable balance o items between the dierent areas:

the risk is strongly agreed to be emerging i the mean value o the rating is aboveour (MV>4);

a mean value between 3.15 and 4 means that the item is considered to be anemerging risk (3.15


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RISK OBSERVATORY

EXPERT PARTICIPATION3.


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(7

) European Commission: Collection and use o expertise by the Commission principles and guidelines,Luxembourg, 2004. ISBN: 9289458216.http://europa.eu.int/comm/research/science-society/pd/guidlines_ss_en.pd

SELECTION CRITERIA FOR PARTICIPANTS

The expertise was collected and used in knowledge o the principles and guidelines

o the European Commission (7).

The experts were proposed by the TCWH members and the Focal Points o the Agen-

cy. Selection criteria were dened so as to ensure a broad coverage o qualied ex-

pertise across Europe. For the rst exploratory survey round, the experts had to meet

ollowing criteria:

be a researcher involed in the areas related to OSH and physical risks;

have at least ve years o experience in the sub-eld he replies to; have authored at least two publications in this sub-eld.

In the urther steps, the rst and last criteria were loosened to also include experts

with a less academic background but still very high-level expertise. Indeed, the expert

group was extended to labour inspectors, policy-makers, saety practitioners and to

people involved in ollowing activities related to the eld o physical OSH risks: re-

search and management planning; testing and certication activities; development;

law, policies and standards development, promotion and enorcement; training and

teaching activities.

RESPONSES

For the rst round, 62 experts were approached by the TCWH and invited to partici-

pate in the survey. Forty-eight experts returned the questionnaire lled in (response

rate: 77 %).

In the second phase, the expert group was extended to 110 experts. Forty-seven

questionnaires lled in were returned (response rate : 43 %). All answers ullled thecriteria at least ve years o experience in the sub-eld replied to.

Some 137 experts were invited to take part in the last survey round. Sixty-six question-

naires all o them valid were returned (response rate: 48 %).

Over the three survey rounds, experts rom 53 organisations (see Annex 1) rom 14

European countries and rom the USA participated in the ormulation o the orecast

on emerging OSH physical risks (Diagram 1).

3.1

3.2

Participating experts

were required to have

at least ve years

experience in the eld

concerned.

137 experts were

approached.

66 questionnaires were

returned. 14 European

countries and the USA

are covered.


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Diagram 1: Country o origin o the respondents to the irst, second and/or third rounds o the survey

CHARACTERISTICS OF RESPONDENTS TO THE THIRD AND FINALSURVEY ROUND

Functions of the respondents

The majority o the respondents were heads o department or researchers (more than

one third respectively). Among the our technicians who responded, one indicated to

be also a labour inspector. Two urther technicians were involved in proessor/lectu-

rer and another one a policy/standards development, consulting, testing/certication

and training/teaching; one was involved in research, policy/standards development,

law enorcement/promotion, work inspection, consulting, testing/certication and

training/teaching.

Twelve experts ticked other. Among them, our additionally ticked another unction:

one proessor lecturer, one researcher and two technician. For eight o the other

cases, the ollowing unctions were specied: lead scientist; engineer; nuclear

inspector; expert; emeritus since 2001; expert (ministerial counsellor, medical aairs).

Two did not give any specication on their unction but indicated to be involved

in the ollowing activities: research planning/management and policy/standardsdevelopment (Diagram 2).

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Diagram 2: Respondents unctions (N=48)

Fields of activity of the respondents

More than hal o the experts whose answers were taken in account in the third survey

round were involved in research. About one third o them were active in consulting

activities, teaching/training activities and policies/standards development. Three ex-

perts ticked other. One o them indicated to be involved in working condition asses-

sment; one specied division head assistant; and one wrote assistance and ticked

the ollowing activities: consulting, development and training/teaching. All these ac-

tivities were considered acceptable and all experts met the selection criteria dened

(Diagram 3).

Diagram 3: Main ields o ac tivities o the respondents (N=48)


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RESULTS4.


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4.1

In the ollowing sections, the exact descriptions o the risks rated by the experts arelisted in tables together with the number o respondents to each item, the meanvalue o the ratings and the standard deviation. These gures are also compiled indiagrams. For some o the risks, reerences are made to literature, legislations and na-tional historical data i relevant and, when available, experts comments are added in

order provide some context and to support the experts evaluation.

RISKS RE LATED TO MUSCULOSKELETAL DISOR DERS (MSDS)

411 Respondents

Twenty-three experts out o the 66 respondents to the survey had more than veyears o experience in the eld o risks related to MSDs and answered this part o the

questionnaire.

Diagram 4: Nationalities o experts who answered the questionnaire part related to risks o MSDs (N=23)

412 Results

Diagram 5: Risks related to MSDs identifed in the survey (Y-axis: mean values on the one-to-fve

point Likert scale and standard deviations)

Y-axis


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Lack o physical activity during working time is very much considered to be an emer-

ging risk by the experts with a high degree o consensus. The suggested reasons are

the growing use o visual display units (VDU) and o automated systems resulting in

prolonged sitting at the workplace, as well as the increasing time spent sitting during

business travel. (See also part 5.1. o the literature review).

Many o the risks agreed as emerging (M>3.15) are commonly considered as classical

ergonomic risks, such as static postures, repetitive movements, awkward postures.

Nevertheless, multi-actorial MSD risks are perceived as important issues to be tackled

in the uture, especially those that include human, social and organisational actors. In-

deed, the emerging risk with the second highest rating is combined exposure to MSD

risk actors and psychosocial risk actors, which achieved a high degree o consensus

(see also part 5.2. o the literature review). Furthermore, the experts indicated that

actors such as job insecurity and ear o the uture resulting rom the unstable labour

market accentuate the eect o physical risk actors such as poor ergonomic design,

thus contributing to an increase in the incidence o MSDs. Longer working hours,increased work-pace and older working age were also singled out as emerging risks

that lead to MSDs.

Lit or the handling o persons in the healthcare sector

Berusgenossenschatliche Unallklinik Ludwigshaen 1996, HVBG/Senn, Germany

It should be noted that the consensus on the ratings among the experts is lower or

the items repetitive movements, poor ergonomic design related to manual handling

in the healthcare sector, poor ergonomic design o non-oce VDU workplaces, lon-

ger working hours, increased work-pace and VDU workplaces.


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Multi-actorial MSD

risks , especially those

combined with human,

social and organisational

actors, are emerging.


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Table 1: Prioritised list o the risks related to MSDs identifed in the survey (N=number o experts answe-

ring the specifc item; mean value; standard deviation)

MV>4: risk strongly agreed as emerging 2.85 MV 3.15: status undecided

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4.2R ISKS RELATED TO NOISE421 Respondents

Sixteen experts out o the 66 respondents to the survey had more than ve years oexperience in the eld o risks related to noise and answered this part o the question-naire.

Diagram 6: Nationalities o experts who answered the part related to noise (N=16)

422 Results

Diagram 7: Risks related to noise identiied in the survey ( Y-axis: mean values on the one-to-fve

point Likert scale and standard deviations)

Y-axis


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Acoustic shocks and excessive noise exposure due to new technologies and workorganisation was identied as an emerging risk mainly because o the increasingnumber o call centres where headphones are used ( 8). Acoustic shocks are abnor-mal sound burst transmitted through the headset caused, or example, by electronicsounds rom ax machines or accidental electronic impulses that can damage the

hearing o the user (9).

Simultaneous exposure to noise and ototoxic substances, also considered by the ex-perts as one o the top emerging risks related to noise, is conrmed too by Frenchnational data (10): those workers most exposed to noise are also those with the highestexposure to dangerous substances. Thereore, the current occupational exposure limito 85 dB(A) concerning noise exposure over an eight-hour working sheet may need tobe reconsidered with regards to combined exposure to ototoxic substances (11).

The expert orecast also highlights noise exposure in classrooms. Workers in educa-tion, health and social work in France, especially women, have increasingly reportednoise exposure since 1984. In 1998, almost hal a million French workers were exposedto occasional very loud or high sounds in these occupations (12). Increases in the per-centages o workers in the education and health sector who report noise exposureare also seen in Finland (13) (29 % reported to be exposed to noise and somewhatbothered in 1997 as opposed to 34 % in 2003) and in the Netherlands ( 14) (13 % repor-ted to regularly have to deal with noise at work in 1998 and 19 % in 2002). Noise inschools is perceived as a disturbing actor impeding the transer o knowledge, whichis mainly based on verbal communication. Teachers try to compensate or the noisybackground by raising their voice (15). As a result, noise levels in the classroom becomeprogressively higher and teachers not only suer higher mental and emotional strain,but vocal chord disorders as well.

Even though below the intensity considered to harm the hearing unction, back-ground noise is seen as an emerging risk in that it makes it harder or workers tohear saety warnings and thus potentially leads to accidents. Nevertheless, one ex-


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(8) Canada Saety Council: Shocking news about call centres. 2004.

http://www.saety-council.org/ino/OSH/acoustic.html

(9) TUC Worksmart: What is acoustic shock? http://www.worksmart.org.uk/health/viewquestion.

php?eny=194

(10) Ministre de lemploi et de la solidarit, DARES , Expositions aux contraintes et nuisances dans le travail Sumer 1994, Les dossiers de la DARES, vol. 56, July 1999, ISSN 1263-1973.

(11) Institut National de Recherche et de Scurit (INRS): Bruit at agents ototoxiques. In: Le point desconnaissance sur ... ED 5028. 2005.

http://www.inrs.r/inrs-pub/inrs01.ns/IntranetObject-accesParReerence/ED 5028/$File/ed5028.pd

(12) Ministre du travail, de lemploi et de la cohsion sociale, DARES: enqute sur les conditions de travail Eorts et risques au travail Environnement de travail Les nuisances sonores. http://www.travail.

gouv.r/etudes/etudes_i.html

(13) Finnish Institute o Occupational Health (FIOH): Finnish work and health survey. http://www.occuphealth.

(14) Central Bureau o Statistics: Permanent Onderzoek Leesituatie (POLS). http://statline.cbs.nl

(15

) Schnwlder, H.-G.; Berndt, J.; Strver, F.; Tiesler, G.: Lrm in Bildungssttten Ursachen und Minde-rung. In: Schritenreihe der Bundesanstalt r Arbeitsschutz und Arbeitsmedizin. Fb 1030. 2004. http://www.baua.de/ors/b04/b1030d_kurz.pd

Acoustic shocks, low-

level noise, noise during

pregnancy, or combined

with vibration or ototoxicsubstances are emerging

risks.


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pert commented that it is less the background sound than the communication soundthat decreases the audibility o inormative signals when wearing communication sys-tems.

The exposure to noise levels below the limit value is also perceived as an emerging

risk leading to atigue and ineciency, which may increase the occurrence o oc-cupational accidents. Low-level noise in open-plan oces generated by equipmentsuch as photocopiers, computers or ventilation systems, or by the ringing o a tele-phone impairs concentration and communication and increases the workers mentaland emotional strain (16). Non-relevant conversations o colleagues also aect a wor-kers perormance. Recent studies show that it is less the content o the conversationthan the acoustic variation o the noise which plays a role (17).

The combined exposure to noise and vibration was identied as an emerging risk notonly by the 16 experts who answered the noise part o the questionnaire, but also bythe 16 experts who answered the vibration part (12 experts rated the item in bothparts). The almost identical mean ratings (3.50 and 3.56 respectively) may be conside-red to validate the orecast.

Noise during pregnancy was also highlighted. Noise has been identied as an agentcausing oetal lesion and/or likely to disrupt placental attachment in Directive 92/85/EEC (18).

The ratings o the items noise and ototoxic substances, background noise decreasingthe audibility o inormative signals and noise exposure below limit values leading toatigue and ineciency did not achieve a high consensus.

Noise exposure leading to non-auditory whole-body eects was not rated as an

emerging risk. One expert specied that environmental noise like trac sound (romcars, lorries, trains, aircrat) is the main problem but not noise at the workplace, asshown by the study NaRoMI (noise and risk o myocardial inarction) published by theUmweltbundesamt (19).


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(16) Canada Saety Council: Oce health and saety noise and acoustics.

http://www.saety-council.org/ino/OSH/noise.htm

(17) AMI: Health eect o noise in the work environment (work-related noise). 2004. http://www.ami.dk/

Nyheder/Nyhedsarkiv/2004/Helbredseekter a st %C3 %B8j i arbejdsmilj %C3 %B8et.aspx?lang=en

(18) Commission o the European Communities, Directive 92/85/EEC o 19 October 1992 on the introduc-tion o measures to encourage improvements in the saety and health at work o pregnant workers and

workers who have recently given birth or are breasteeding, OJ L 348, 28.11.1992, pp. 18. http://euro-pa.eu.int/smartapi/cgi/sga_doc?smartapi!celexapi!prod!CELEXnumdoc&lg=en&numdoc=31992L0085&model=guichett

(19

) Babisch, W.: Die NaRoMI-Studie (noise and risk o myocardial inarction) Auswertung, Bewertungund vertieende Analysen zum Verkehrslaerm. In: WaBoLu-Hete 02/04. I1-I59. Umweltbundesamt.2004. http://www.umweltbundesamt.org/pd-l/2621.pd


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Table 2: Prioritised list o the risks related to noise (N=number o experts answering the specifc item;

mean value; standard deviation)


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4.3R ISKS RELATED TO VIBRATION431 Respondents

Sixteen out o the 66 respondents to the survey had more than ve years o experien-ce in the eld o risks related to vibration and lled in this part o the questionnaire.

Diagram 8: Nationalities o experts who answered the questionnaire part related to vibration (N=16)

432 Results

Diagram 9: Risks related to vibration identiied in the survey (Y-axis: mean values on the one-to-fve point Likert scale and standard deviations)

Y-axis


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(20) Directive 2002/44/EC o the European Parliament and o the Council o 25 June 2002 on the minimum

health and saety requirements regarding the exposure o workers to the risks arising rom physicalagents (vibration), OJ L 177, 6.7.2002, pp. 1319.

(21) European Agency or Saety and Health at Work: Work-related musculoskeletal disorders in Europe.

Factsheet 3, 2000. http://agency.osha.eu.int/publications/actsheets/3/en/acts3_en.pd

(22) European Agency or Saety and Health at Work: Preventing work-related musculoskeletal disorders.

Factsheet 4, 2000. http://agency.osha.eu.int/publications/actsheets/4/en/acts4_en.pd

(23) Ministre de lemploi et de la solidarit, DARES: Expositions aux contraintes et nuisances dans le travail SUMER 1994. Les dossiers de la DARES, vol. 56, July 1999, ISSN 1263-1973.

(24

) AMI: Health eect o noise in the work environment (work-related noise), 2004. http://www.ami.dk/Nyheder/Nyhedsarkiv/2004/Helbredseekter %20a %20st %C3 %B8j %20i %20arbejdsmilj %C3 %B8et.

aspx?lang=en

The risks o vibration both to the hand-arm and to the whole-body systemshave gained more attention with theEuropean Directive 2002/44/EC (20).

They are also perceived as emerging as

the use o transportation systems and oindustrial technologies grows and theworking population exposed increases.

Globally, multi-actorial issues are animportant concern as ve o the ninerisks related to vibration and identiedas emerging (MV> 3,15) are combinedwith other risk actors. Indeed, the twotop emerging risks (MV>4) highlightedby the experts with a high degree oconsensus are combined exposure tovibration and to MSD risk actors suchas awkward postures and physicallydemanding work. Further multi-ac-torial emerging risks highlighted arethe exposure to vibration combinedwith the poor ergonomic design o the

workplace and o the work equipment, with the exposure to dangerous substancesor to physical environmental actors such as cold temperatures. Previous work o theAgency recognised vibration and all these actors as MSD risk actors and particularlyrecommended to pay special attention at combinations thereo (21) (22).

The risk resulting rom combined exposure to vibration and noise identied as emer-ging in the expert orecast is mirrored in French statistical data: those workers mostexposed to noise are also those with the highest exposure to other actors such as vi-bration (23). In the orecast, it was identied as an emerging risk not only by the 16 ex-perts who answered the vibration part o the questionnaire but also by the 16 expertswho answered the noise part (12 experts answered both parts). The almost identicalmean ratings (3,56 and 3,50 respectively) may be considered to validate the orecast.Symptoms o vibroacoustic diseases are generated by long-term exposure to low re-quency noise and vary rom gastrointestinal diseases, pharynx inections, bronchitis,urinary organs disorders and metal allergies, to bleedings in the nose and intestinaltract, varicose veins, ulcer, colitis, arthralgia and muscular disorders, and neurologicaldisturbances ater a ten-year exposure (24).

The new European

Directive 2002/44/EC

has raised concern or

vibration. The orecast

highlights combined ex-

posures to vibration andother physical actors.

Combined exposure to hand-arm vibration and noise

Berusgenossenschatliches Institut r Arbeitsschutz, Germany


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Even i the use o personal protective equipment (PPE) is only to be considered when

removing the hazard at source is not possible and when collective measures do not

reduce the exposure to an acceptable level, PPE made available to workers should be

adapted to their needs, o high quality and properly tested. Otherwise workers may

expose themselves to the hazard without being aware that they are not protected.

Table 3: Prioritised list o the risks related to vibration (N=number o experts answering the specifc

item; mean value; standard deviation)


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Two risks in the area o thermal risks were particularly perceived as emerging (MV>4).The risk with the highest rating is o a social and organisational nature. The expertspoint at the act that workers with a low employment status and poor working condi-tions (or example, workers in sectors such as agriculture and construction) are thesubject o ewer training and awareness-raising measures. Hence their poor knowled-

ge o the risks related to work perormed in cold or hot environments and the in-creased probability o being exposed.

Likewise, the lack o prescriptions against thermal discomort at industrial workplaces,where only the issue o thermal stress has been addressed so ar, is rated almost ashigh and with almost as much consensus. One expert commented that the role ther-mal comort plays on the workers overall stress, on his well-being and hence on hisperormance and saety behaviour, has not been adequately determined so ar.

Concerning thermal stress provoked by wearing special protective clothes, one ex-pert pointed out that the issue is crucial or occupations such as rst responders. In-deed, heat stress casualties amongst wearers o chemical biological radiological nu-clear (CBRN) personal protective equipment (PPE) may severely hamper the abilitieso emergency services to deal with the situation, to decontaminate victims, etc. Thesame expert added that the issue o thermal comort o PPE is not important as longas it does not interere with the wearers task, his cognitive perormance or the waythe PPE is worn. Thermal stress is ar more important as it suggests a hazard or whichthe PPE was not intended. In his opinion, thermal comort and PPE is more a mar-keting issue than a real occupational saety and health problem. Hence the need toocus on heat stress when wearing PPE.

Table 4: Prioritised list o the risks related to thermal risks (N=number o experts answering the item;

mean value; standard deviation)


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Other emerging risks added by the experts in the third round

The exponential increase o cold and reezing work environments, especially in the

ood and transportation sectors, is not being ollowed by an equal increase in our

knowledge o the possible long-term health eects o working in these environments.One issue o concern is risks during pregnancy. A urther issue is inaccurate reporting

procedures: when a worker in a ood preparation cold store cuts his hand, this is recor-

ded as manual handling injury and not as a cold-induced injury.

The impact o global warming and other potential climatic changes on outdoor work

and the changing risks (both the nature o the risks and the severity o the consequen-

ces) need to be considered.

Many o the scientic methods described in thermal standards are o little value in

many environments where workers are at risk o heat stress (or example, glass, steel,

ceramics, bricks, reghting, etc.). High thermal radiation, high humidity and new PPEsare oten outside the scope o heat stress indices. We should thereore concentrate on

developing our knowledge o physiological monitoring equipment which meets the

practical needs o the user. Oten the equipment that works in the laboratory does not

work in the eld (e.g. telemetry or electromagnetic eld (EMF) intererence, or workers

reluctance towards measuring methods such as rectal temperature measurements).

We should thereore develop practical easy-to-use advice which tells the user what

has an eect on equipment perormance, etc.

User-centred standards which give details o physiological, biomechanical and clo-

thing perormance trials or the design and development o PPE are needed in order

to move away rom manuacturer-based standards which oten inadequately address

the thermoregulatory consequences and the thermal and other ergonomic design

criteria o PPE. One classic area o concern is compatibility.

A possible risk cause is the lack o knowledge o actual clothing insulation and pro-

tection rom radiant heat provided by garments. The risk assessment based on such

quantities is subject to potentially dangerous uncertainties.

R ISKS RELATED TO N ON-IONISING RADIATION

451 Respondents

Nineteen experts out o the 66 respondents to the survey had more than ve years oexperience in the eld o risks related to non-ionising radiation and lled in this parto the questionnaire.


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Diagram 12: Nationalities of experts who answered the questionnaire part related to non-ionising radiation (N=19)

452 Results

Diagram 13: Risks related to non-ionising radiation identified in the survey (Y-axis: mean values on the one-

to-fve point Likert scale and standard deviations)

The item related to ultraviolet radiation is rated as strongly agreed to be emerging,

although the consensus amongst the respondents is relatively weak. According to

the experts, it is not only a matter o occupational exposure but also a more ge-

neral issue o increasing exposure during leisure time linked to changing societal

values and ways o living. As the health eects o UV exposure have a cumulative

nature, the more the workers are exposed, the more sensitive to UV radiation they

become. Hence a potentially growing need or prevention measures at the work-

place. (See part 5.5. o the literature review).

Y-axis


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E

Emission o electromagnetic elds by a spot-welding gun


One o the risks highlighted as emerging is actually linked to dangerous substancesresulting rom laser-based material treatment such as nanoparticles and dust. Ultraneparticles have also been identied as emerging risks in the expert survey on emerging

chemical OSH risks (25).

Table 5: Prioritised list o the risks related to non-ionising radiation (N=number o experts answering

the specifc item; mean value; standard deviation)


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EMFs aecting workers with active and passive implants

(e.g. pacemakers), as the likelihood o being exposed is increasing18 4,00 1,188

New laser technologies and light emitting diodes (LEDs)

in communication engineering (optic rays or data transer)18 3,78 1,166

Laser applications creating chemical hazards

(e.g. nanoparticles, dusts, vapours)18 3,72 1,227

Welding with high current creating EMF emission

(especially in the automobile industry)18 3,61 1,243

Electronic article surveillance (EAS) and similiar devices 18 3,56 1,338

New LED technologies becoming widely used in felds other than

communication engineering (e.g. lighting)18 3,50 1,465

Oldlaser technologies combined with unavourable occupational

saety conditions (use o price-code lasers in shops; use o poor quality laser pointers not meeting saety requirements)

18 3,44 1,247

Insucient Electromagnetic Compatibility (EMC) impairing the unction

o machines and o electrical devices in airplanes, vehicles, etc.18 3,17 0,924

EMFs rom high voltage lines 18 2,78 1,353

Other emerging risks added by the experts in the third round

Emerging use o hand operated laser processing devices (in material processing)

R ISKS RELATED TO IONISING RADIATION

461 Respondents

Twenty-two experts out o the 66 respondents to the survey had more than ve yearso experience in the eld o risks related to ionising radiation and answered this parto the questionnaire.

Diagram 14: Nationalities o experts who answered the questionnaire part related to ionising radiation (N=22)


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462 Results

Diagram 15: Risks related to ionising radiation identifed in the survey (Y-axis: mean values on the one-to-

fve point Likert scale and standard deviations)

Only one item was identied as emerging risk in the eld o ionising radiation with arelatively low level o consensus amongst the experts.

Table 6: Prioritised list o the risks related to ionising radiation (N=number o experts answering thespecifc item; mean value; standard deviation)


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4.7

Comments on the risks proposed made by the experts in the third round

The items proposed in the eld o ionising radiation are not really emerging. It israther the interest in these risks which is increasing. For example, the exposure o aircrew is not emerging (neither new, nor increasing), but the growing interest or this

issue is linked to the decrease o annual exposure limits.

The risks related to radon, radiation sources and cosmic radiation have not actually in-creased over the last years. But as there is more debate on these issues today, this givesthe impression that the risks have increased. On the contrary, thanks to the increasedamount o inormation available, the exposure to the risks is rather decreasing.

R ISKS RE LATED TO MACHINERY, WORK PROCESSES AND TECHNOLOGIES

471 Respondents

Twenty out o the 66 respondents to the survey had more than ve years o expe-rience in the eld o risks related to machinery, work processes and technologies andanswered this part o the questionnaire.

Diagram 16: Nationalities o experts who answered the questionnaire part related to machinery, work

processes and technologies (N=20)

472 Results

Diagram 17: Risks related to machinery, work processes and technologies (Y-axis: mean values on the one-

to-fve point Likert scale and standard deviations)

Y-axis


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The one item complex technologies and work processes with complex humansys-

tem-interaces which is strongly agreed to be emerging is a multi-actorial risk. Indeed,

i the design o the interace does not take into consideration the cognitive processes

involved when operating such a system, the mental and emotional demands on the

operator is higher. Hence a potential increase in the incidence o stress, human errorsand accidents. (See part 5.4. o the literature review).

The issue o insucient electromagnetic compatibility, which was identied as an

emerging risk by 18 experts (MV=3,17) in the part non-ionising radiation o the ques-

tionnaire, was also highlighted here by 17 experts as an emerging risk leading to the

alteration o machine unctions and thus causing occupational accidents (MV=3,59)

(six experts answered to both parts o the questionnaire). This may be considered to

validate the orecast.

Dangerous substances resulting rom physical processes, such as material treatment

with laser applications creating nanoparticles, was agreed as emerging risk by 17 ex-

perts in this part, as well as in the part related to non-ionising radiation by 18 experts

(six experts rated the items in both parts). Again, the almost identical mean ratings

(3,47 and 3,72 respectively) may be considered to validate the orecast.


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Material processing with laser beam



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4.8

Table 7: Prioritised list o the risks related to machinery, work processes and technologies identifed in

the survey (N=number o experts answering the specifc item; mean value; standard deviation)


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482 Results

Diagram 19: Other ergonomic risks identiied in the survey (Y-axis: mean values on the one-to-

fve point Likert scale and standard deviations)

Again, multi-actorial risks are considered as issues o growing concern, as it is theitem the most strongly agreed to be an emerging risk with a good consensus. (Seepart 5.3. o the literature review).

The issue insucient protection o high-risk groups against long-standing ergonomicrisks, as well strongly agreed to be emerging with a high consensus by 24 respondents,has also been pinpointed by 10 experts in the part thermal risks o the questionnaire though narrowed to the case o lower status workers exposed to unavourablethermal conditions. Eight experts rated both items in both parts o the questionnaire.

The almost equal mean values (4.21 respectively 4.50) may be considered to validatethe orecast. The issue o lack o awareness o long-standing risks is recurrent as the ex-perts also point out the poor saety culture and ergonomic conditions in oce work-places although with a lower mean rating.

The issue o lipoatrophy semicircularis in oce environment, highlighted here asemerging risk seems to be relatively new and its causes still the subject o controversy.

Very little literature can be ound on this topic and no older than rom 2001 ( 26) (27).Lipoatrophy semicircularis seems to be characterised by band-like horizontal depres-sions o the skin in the lower limbs, the distance between the foor and the horizontalindentations on the lower limbs being identical or all subjects independently o theirheight, weight and body mass index (26).


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Y-axis

(26) P. C. Gruber, L. C. Fuller, Clinical and Experimental Dermatology, vol. 26 (3), May 2001, pp. 269271.http://www.ncbi.nlm.nih.gov/entrez/query.cgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=21315459

(27) Annemarie Maes, Bart Curvers, Luc Verschaeve, Electromagnetic Biology and Medicine, vol. 22 (2&3) (2003).ISSN: 1536-8378. pp. 183193 http://www.dekker.com/servlet/product/DOI/101081JBC120024627


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Table 8: Prioritised list o the risks related to other ergonomic risks identifed in the survey (N=number

o experts answering the specifc item; mean value; standard deviation)


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RISK OBSERVATORY

LITERATURE REVIEW5.


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A literature review explores in more depth the context and the health outcomes ove o the main emerging risks singled out in the orecast. Lack o physical activity,combined exposure to MSD risk actors and psychosocial risk actors, multi-actorialrisks and the complexity o humanmachine interaces leading to increased mentaland emotional strain were chosen or their multi-actorial aspects linked to the chan-

ging world o work (28). Additionally, the general increase o exposure to UV radiationwas selected because o the societal dimension mentioned by the experts related tothe growing UVR exposure during leisure time, which also increases workers sensiti-vity to UVR at work.

The papers selected or this review all originate rom scientic peer-reviewed journals,rom reputable research or OSH organisations, or rom proceedings o congress, theinterventions o which are reviewed by a scientic committee. The papers had to be asrecent as possible and not older than 1995. Nevertheless, out o the more than 110 ree-rences quoted, only nine papers published between 1990 and 1994 were reerred to.

LACK OF PHYSICAL ACTIVITY

The literature shows a clear link between work-related prolonged sitting and thehigher incidence o musculoskeletal disorders (MSDs), such as neck and shoulderpain (Chandrasakaran, Chee, Rampal & Tan, 2003), neck, shoulder and upper backpain (Chee, Rampal & Chandrasakaran, 2004), low back pain (Burdor, Naaktgeboren,de Groot, 1993), as well as diseases o the lumbar spine, which lead to permanentworking incapacity in a large number o cases (Piazzi, Bollino & Mattioli, 1991). Static

postures imply a diminution in the blood circulation through the muscles leading tothe apparition o disorders and dysunctions, hence increasing the incidence o MSDs(Cramer, J.; Ellegast, R.P.; von der Heyden, T.; Liedtke, M.; Peier, W.; Stamm, R, 2001).Examples o occupations with very little physical activity and increased prevalence oMSDs are crane operators and straddle-carrier drivers perorming sustained sedentarywork in non-neutral trunk posture (Burdor, Naaktgeboren, de Groot, 1993; Herda, Elle-gast, Ditchen, 2002), truck drivers (Piazzi, Bollino & Mattioli, 1991), bus drivers (Ellegast,Glitsch, Kniper, 2002), workers in semiconductor actories (Chee, Rampal & Chandra-sakaran, 2004), workers at video display unit (VDU) workplaces (Mitsuya, Ebine, Nozaki,Noro, 2003).

A comparison between call centre agents and secretaries showed that the amount o

time spent in sitting positions at work correlates positively with the amount o phone-call tasks perormed (Herda, C.; Brun, E.; Ellegast, R.P.; Hauke, M., 2002). Indeed, morethan 90 % o the working time was ound to be spent in sitting positions and anadditional 5 % in static standing positions at workplaces involving a high percen-tage o phone-calls. Due to the nature o their tasks, call centre workers are physicallybound to their working equipment (phone or headset and computer) and thus totheir workplace. It was urthermore observed that the longer the time spent in sittingpositions, the worse the back posture evolves over the time. These observations cor-relate with the higher incidence o neck and back pains reported by the call centreagents in a questionnaire (Cramer, J.; Ellegast, R.P.; von der Heyden, T.; Liedtke, M.; Pei-er, W.; Stamm, R, 2001).


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(28) European Agency or Saety and Health at Work: Research on the changing world o work. http://eu-rope.osha.eu.int/research/rtopics/change/

Occupations with little

physical activity and in-

creased MSD prevalence

usually involve prolonged

sitting or prolonged

standing.

Health outcomes are

MSDs o the upper-

limbs, back disorders,

varicose veins, deep-vein

thrombosis, obesity, and

certain cancers


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Conversely, physical activity at work helps prevent neck disorders among sedentary

workers (Korhonen et al., 2003). Besides, ergonomic improvements o the workplace,

changes in the work organisation and management practices, and awareness-raising

measures were shown to reduce the incidence o low back pain, or instance among

proessional drivers (Lyons, 2002).

The literature does not only highlight the lack o physical activity related to prolonged

sitting as an occupational health issue, but also related to prolonged standing, which

causes atigue and may lead to the apparition o oedema in the legs (Zander, King &

Ezenwa, 2003).

In industrial countries, working conditions and especially the growing automation

encourage the lack o physical activity in the workplace, which implies lower energy

consumption. This results in an increase in workers body weight and the prevalence

o obesity rises, which is a risk actor or vascular, metabolic and neoplastic diseases.

Beside the eect on the workers health, the direct and indirect economic costs rela-ted to the emerging prevalence o obesity have grown (Colditz, 1999).

Prolonged sitting at work was also ound to augment the risk o ovarian cancer (Zhang,

Xie, Lee & Binns, 2004), breast cancer (Coogan et al., 1997; Kruk & Aboul-Enein, 2003)

and renal cell cancer (Bergstrom et al., 1999) although the last eect is only obser-

ved among male workers (Bergstrom et al., 1999). Conversely, physical activity in the

workplace was shown to reduce the incidence o such diseases (Coogan et al., 1997;

Kruk & Aboul-Enein, 2003; Bergstrom et al., 1999).

The lack o physical activity also has a hypertensive eect and causes a signicant

increase in gravitational stress on the cardiovascular system (Pekarski, 2004), whichcan result in thrombosis (Beasley et al., 2003). At VDU workplaces, the incidence o

deep-vein thrombosis (DVT) could be linked to the long-term static postures (Mit-

suya, Ebine, Nozaki, Noro, 2003). Further reports conrm the occurrence o DVT or

pulmonary embolism (PE) ollowing prolonged sitting in relation to work (Beasley,

Heuser, Raymond, 2005). Indeed, whereas sitting jobs require less muscular eort,

reports o varicose veins, sti necks, and numbness in the legs are more common

among seated workers than among those perorming heavier tasks (Canadian Centre

or Occupational Health and Saety, 1998).

In order to compensate the lack o physical activity in the workplace, the working equi-

pment should support a dynamic alternation o working positions. For example, somechairs are designed so as to encourage dynamic sitting, that is, the regular alternation

o bending orward or backward positions when sitting. Some working stations can

be arranged so that it is possible to change between sitting and standing positions

(Ellegast, Herda, Hoehne-Hckstdt, Lesser, Kraus, Schwan, 2004). Also, organisational

measures should make possible to alternate tasks and to have a good repartition over

the working time o breaks, during which workers should take dierent positions than

at their workplace (Cramer, Ellegast, V. D. Heyden, Liedtke, Peier, Stamm, 2001). Some

organisations propose on-site wellness programmes to their workers. Nevertheless,

the degree o participation in these programmes is higher or the group o younger

and better-educated workers. These recognise indeed more benets in participating

in these activities, such as increasing their perormance at work, and are less reluctantto practise physical activities with colleagues in their working premises (Alexy, 1991).


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Work equipment and

organisation should

enable to alternate body

positions. On-site health

programmes also help in

preventing the risk.


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COMBINED EXPOSURE TO MSD RISK FACTORS AND PSYCHOSOCIAL

RISK FACTORS

MSDs are the most common work-related diseases in Europe: in 2000, 33 % o workersin EU-15 reported back pain and 23 % reported neck and shoulder pain (EuropeanFoundation or the Improvement o Working and Living Conditions, 2000). As work-re-lated MSDs lead to sick leaves, they have a negative impact on productivity (Buckle &Devereux, 2002) and generate socioeconomic costs in the European Union (EuropeanAgency or Saety and Health at Work, 2000).

Poor psychosocial actors at work can generate work-related MSDs (Bongers, de Win-

ter, Kompier & Hildebrandt, 1993; Carayon, Smith & Haims, 1999; Devereux, 2004;Houtman et al., 1994; Leino & Hanninen, 1995; Malchaire, Roquelaure,Cock & Piette,2001; Warren, 2001) and a lot o research is currently carried out in this eld.

Dierent occupations and sectors exposed to the combination o MSD risk actorsand psychosocial risk actors have been investigated. Complaints in the shoulder/neck region and low back area due to poor physical and psychosocial aspects o theworking environment are oten observed in workers o the healthcare sector, or ins-tance nurses and dentists (Brulin et al., 1998; Gunnarsdottir, Ransdottir, Helgadottir &

Tomasson, 2003; Ylipaa, Arnetz, Benko & Ryden, 1997). Moreover, VDU workers in ge-neral (Eklw, 2004), but also more specic groups such as call centre agents (Halord& Cohen, 2003; Norman et al., 2004), are exposed to work-related psychosocial actors,

which contribute to the incidence o mental and physical health problems (Smith,1997). Shoulder disorders related to psychosocial work actors are also ound amongsupermarket cashiers (Niedhammer et al., 1998).

At VDU workplaces in ordinary occupational settings, perceived muscular tension andemotional stress correlated with musculoskeletal pains and physical load in terms omuscle activity in the trapezius muscles (Joksimovic, Starke, v. d. Knesebeck & Siegrist,2002; Nahit et al., 2003; Wahlstrm, 2003). More generally, stress and mental demandrelated to computer work increases the muscular activity and is positively associa-ted with an increased prevalence o MSDs (Laursen et al., 2002; Smith, 1997; Smith,Conway & Karsh, 1999). Thereore, attention should be paid to the ergonomic designo the working equipment (Smith, 1997).

High job demand is one o the risk actors contributing to MSDs mostly tackled inresearch papers (Bongers, de Winter, Kompier & Hildebrandt, 1993; Joksimovic, Starke,v. d. Knesebeck & Siegrist, 2002). Consequences o highly demanding work are neckand shoulder pain with possible pressure tenderness (Andersen, 2003) and low-backpain (Hoogendoorn et al., 2001). A mentally dicult job, mental exhaustion ater awork shit, as well as intense time pressure, are all actors identied as psychosocial riskactors causing musculoskeletal symptoms (Gunnarsdottir, Ransdottir, Helgadottir &

Tomasson, 2003). However, high job demand not only infuences physical health ne-gatively, but also the mental health o workers (Smith, 1997; Strazdins et al., 2004).

Conversely, a too-low job demand, or instance monotonous work, was also identied

as a risk actor or new onset shoulder pain (Bongers, de Winter, Kompier & Hilde-brandt, 1993; Harkness, 2003; Smith, 1997; Smith, Conway & Karsh, 1999).


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5.2

VDUs and call centres

jobs and the healthcare

sector are exposed to

both MSD and psycho-

social risks.

Stress, too high or low

job demand, complex

tasks, time pressure,

low decision level, poor

support rom colleagues,

ear o unemployment

and bullying increase the

incidence o MSDs.


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Low job control is another o the most common actors associated with MSDs (Bon-gers, de Winter, Kompier & Hildebrandt, 1993; Norman et al., 2004; Smith, 1997; Smith,Conway & Karsh, 1999). More precisely, low decision level induces statistically signi-cant increases in the incidence o sick leaves due to neck pain (Ariens et al., 2002). Fur-

thermore, low infuence at work generates hand-wrist aections and, predominantlyin women, neck symptoms (Jensen, 2003).

Poor support rom colleagues (Bongers, de Winter, Kompier & Hildebrandt, 1993; Nahitet al., 2003) and lack o solidarity (Gunnarsdottir, Ransdottir, Helgadottir & Tomasson,2003) also contribute to musculoskeletal problems. Human aspects such as poor rela-tionships with colleagues at work ( Yip, 2004) or poor relations with supervisors (Smith,1997) should be improved in order to reduce work-related health outcomes, especiallylow back pain (Hoogendoorn et al., 2001; Yip, 2004). Call centre agents who report poorsupport rom their supervisors are more likely to develop musculoskeletal symptoms(Norman et al., 2004). More generally, work-related dissatisaction with the hierarchycontributes to musculoskeletal problems (Gunnarsdottir, Ransdottir, Helgadottir &1997). Evidence o the relationship between lower levels o support at work and severenumbness in the hands and arms was put orward (Faucett & Rempel 1994).

Artist: Piotr Garlicki

Courtesy o the Occupational Saety Poster Competition

organised by the Central Institute or Labour Protection National Research Institute, Poland Piotr Garlicki

Workers who experience downsizing and job insecurity are more at risk o MSD (Ki-vimaki et al., 2001; Mohren et al., 2003; Smith, 1997; Strazdins et al., 2004). However,ear o unemployment was shown to aect the health o more highly educated em-ployees more than less educated ones (Domenighetti, DAvanzo & Bisig, 2001). Never-theless, low job security does not increase signicantly sickness absence due to neckpain (Ariens et al., 2002).

Harassment, violence and bullying at work are also psychosocial risk actors whichpredict the incidence o MSDs (Gunnarsdottir, Ransdottir, Helgadottir & Tomasson,2003).

Workers highly exposed to the combination o occupational physical and psychoso-

cial risk actors are more likely to report MSDs than workers highly exposed to the oneor the other type o exposure; besides, the eects o exposure to psychosocial risk


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Combined exposure to

MSD and psychosocial

risks aect workers

health to a greater extent

than single exposure.


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actors at work are more important when the simultaneous occupational exposure to

physical risk actors is high (Devereux, Vlachonokolis & Buckle, 2002). Whereas physical

and ergonomic variables play a more important role than psychological actors with

regards to the development o upper extremity disorders and visual discomort, psy-

chological actors are the major contributors to back and lower extremity pain (Hsu &Wang, 2003). While occupational physical and psychological risk actors are associa-

ted with the occurrence o low-back pain and upper-extremity complaints, individual

actors predominantly determine whether the persons aected will go on sick leave

(Jzelenberg, Molenaar & Burdor, 2004).

Change in the work organisation and better ergonomic planning o workplaces could

reduce the prevalence o MSDs (Fracassi, 2001; Stubbs, 2000; Yu & Wong, 1996). Flexi-

ble organisation o the workplace helps reducing the incidence o work-related health

disabilities, as the length o work disabilities related to MSDs in the neck and shoulders

in traditionally organised workplaces is about two years higher (Shannon, Robson &

Sale, 2001). In any case, the organisational context is an important actor or the suc-cess o ergonomic interventions (Westgaard, 2000). Last but not least, with a view to

the central role psychosocial actors play in the incidence o work-related MSDs, psy-

chology is seen as one o the emerging disciplines that should be systematically taken

into consideration in the eld o occupational health (Sauter et al., 1999).

MULTI-FACTORIAL RIS KS

Most research and intervention papers dealing with multi-actorial risks are ocused

on call centres. One explanation might be that call centres are in expansion.

In spite o their younger age and shorter exposure to computer work, call centre ope-

rators suer more rom MSDs than VDU workers in other occupations, and especially

rom muscle tension and nerve aections in the neck and shoulder region (Toomingas

et al., 2003). The use o VDUs in general generates musculoskeletal problems especially

in the neck and shoulder regions (Yu & Wong, 1996). In computertelephone interac-

tive tasks, a low level o satisaction with the physical arrangement o the workstation,

but also psychosocial actors and job duration, predict the occurrence o MSDs in the

neck, shoulders, hands and wrists, and o MSD-related absenteeism (Ferreira, Paulo

& Saldiva, 2001). A urther important MSD risk actor is work organisation (Fracassi,

2001; Malchaire, Roquelaure,Cock & Piette, 2001; Yu & Wong, 1996). For instance, lack

o resting periods, tight work schedules and time pressure lead to upper extremity

MSDs among workers involved in computertelephone interactive tasks (Ferreira Ju-

nior, Conceicao & Saldiva, 1997; Halord & Cohen, 2003).

Call centre agents are ound to work in sitting positions over longer periods tha

Physical Safety

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