Work conditions, musculoskeletal disorders and productivity of dentists in public dental care in Sweden Are dentists working smarter instead of harder?

.................................................................................................................. 7 Introduction............................................................................................................ 7 Aim .......................................................................................................................... 7 Methods................................................................................................................... 7 Results ..................................................................................................................... 8 Conclusions ............................................................................................................. 8 SAMMANFATTNING ................................................................................................. 9 Bakgrund ................................................................................................................ 9 Syfte ......................................................................................................................... 9 Metod ...................................................................................................................... 9 Resultat ................................................................................................................. 10 Slutsatser............................................................................................................... 10 LIST OF PAPERS ...................................................................................................... 11 ABBREVIATIONS ..................................................................................................... 12 INTRODUCTION....................................................................................................... 13 Rationale for the thesis ........................................................................................ 13 Organizational and technological conditions .................................................... 13 Effects of rationalizations on work conditions .................................................. 14 Rationalizations, health and production............................................................ 16 Work environment............................................................................................... 16 Dentists’ physical work environment ............................................................. 16 Physical and psychosocial risk factors........................................................... 17 Health and signs of ill health ......................................................................... 20 Work ability and sick leave ............................................................................. 23 Ergonomic intervention....................................................................................... 23 Organizatory ergonomic intervention ............................................................ 25 Conceptual model under study ........................................................................... 25 Organizational and technical changes in dental care in Jönköping County, Sweden .................................................................................................................. 26 MAIN AIM .................................................................................................................. 29 Specific aims ......................................................................................................... 29 MATERIAL AND METHODS ................................................................................. 31 Flow chart of dental personnel included in I.......................................... 31 Flow chart of dentists participating in II –V ....................................... 33 Paper Paper Study design.......................................................................................................... 34 Cross-sectional and prospective design.............................................................. 34 Measures of exposures ......................................................................................... 34 Questionnaires ................................................................................................ 34 Observation method ........................................................................................ 34 Technical measurement.................................................................................. 35 Self-registration............................................................................................... 37 Measures of outcome ........................................................................................... 37 Questionnaires ................................................................................................ 37 Registration of productivity (T4 system) ........................................................ 37 Measures of mediating variables ........................................................................ 38 Eysenk Personality Questionnaire (EPQ) ..................................................... 38 Marlowe-Crown SD scale (MCSD) ................................................................ 38 Methodological considerations ........................................................................... 38 Research design .............................................................................................. 38 Selection considerations ................................................................................. 39 Ergonomic measurement methods ................................................................. 40 Self-report data................................................................................................ 41 Observation method (PEO) ............................................................................ 42 Technical measurement (sEMG) ................................................................... 42 Productivity Register data ............................................................................ 44 Self-registration............................................................................................... 44 Staff newsletter................................................................................................ 44 Statistics ................................................................................................................ 45 RESULTS .................................................................................................................... 49 DISCUSSION .............................................................................................................. 55 CONCLUSION ........................................................................................................... 61 ISSUES FOR FUTURE WORK................................................................................ 62 ACKNOWLEDGEMENTS ....................................................................................... 63 REFERENCES............................................................................................................ 65 ANNEX ........................................................................................................................ 73