A gender sensitive approach to Occupational Medicine: focus on working populations exposed to manual handling occupational risk

Introduction: nowadays work-related musculoskeletal disorders represent a major public health issue which contribute significantly to the global disease burden and disability. Their incidence is particularly high amongst healthcare workers worldwide. Nursing homes, retirement homes and long-term care facilities can be considered high risk workplaces, for the constant assistance required by not self-sufficient patients recovered in this kind of facility and the relevant exposure to manual handling risk. This huge workload is shared by a prevalence of female workers, that can be up to 95% of the whole staff in these work settings. Aims: The overall aim of this thesis is to study the phenomenon of musculoskeletal diseases and their impact on occupational health in healthcare workers of eldercare facilities, given the horizontal segregation of female workers in this work setting. Scoping review: In the first phase of the project, a scoping review was carried out to contextualize the phenomenon of musculoskeletal disorders in this category of workers: in all 22 studies included the great majority of participants (over 90%) were female; the most involved region of the body for musculoskeletal disorders was the back and the main risk factors for musculoskeletal disorders were identified into physical, demographic and psychosocial issues. Retrospective observational study: In the second phase of the project, a retrospective study on workers of eldercare facilities was conducted based on occupational health records collected by the Competent Doctor – an Occupational Medicine Specialist - from 2009 to 2024 during the Health Surveillance. The main objective of the study was to explore incidence and associated factors for limitations in manual handling activities within the suitability to work released by the Competent Doctor. 200 workers (80% women) were enrolled in a preventive visit (Time 0 - T0) and followed with periodic medical examinations up to a maximum of five subsequent observations (from T1 to T5). The use of pain medications, the diagnosis of osteoarticular pathologies and the presence of specific clinical signs in the physical examination of the musculoskeletal system at a certain time were associated with suitability to work with limitations in manual handling at the same time, from T1 to T5, while physical activity was a protective factor. A clinical Score was constructed, based on eight clinical-anamnestic data collected at a time T with the aim of predicting the presence of limitations in manual handling in subsequent times. Each Score calculated at a Time T was tested with ROC curves showing good accuracy for the suitability with limitations in manual handing, from time T2 to time T5, and a critical cut-off for the Score was set up. To analyze the incidence rate of suitability to work with limitations for manual handling during the various observation periods, Kaplan-Meier curves were constructed for all intervals, from T0 to T5. In the construction of the curves, the population was divided according to key variables (musculoskeletal symptoms, clinical signs of musculoskeletal disorder and physical activity) and to the cut-off value of the Score, with significative statistical differences for almost all the variables tested except for the curves at T1. Finally, the Scores were further tested with univariate Cox logistic regression from T1 to T5 and with multivariate Cox logistic regression at T4 and T5: the Scores calculated at a time T were significantly associated with suitability with manual handling limitations at the following times, except for the T0 Score for time T1.