Work-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to analyze the cost-benefit results of organizational-level ergonomic workplace-based interventions aimed at preventing WMSD, (2) to explore factors related to the implementation process of these interventions (obstacles and facilitating factors) in order to identify whether economic results may be due to a successful or unsuccessful implementation. Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design. Out of 189 records, nine studies met selection criteria and were included in our review. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions given the quality and the limited number of studies identified. Our review shows that among the nine included studies, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors in training sessions or a lack of financial resources and when adequacy of intervention to workers’ needs was low. In studies where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation. Studies investigating the determinants of financial outcomes of prevention related to implementation process are very seldom. We recommend that in future research economic evaluation should include information on the implementation process in order to permit the interpretation of economic results and enhance the generalizability of results. This is also necessary for knowledge transfer and utilization of research results for prevention-oriented decision-making in occupational health and safety.

It is unclear how to effectively protect healthcare workers’ mental health during infectious disease epidemics. Targeting the occupational determinants of stress may hold more promise than individual stress management, which has received more focus. Through a systematic review of the 2000–2021 English- and French-language scientific literature, we evaluated the effectiveness of organizational and psychosocial work environment interventions to protect healthcare workers’ mental health in an epidemic/pandemic context. Evidence from medium- and high-quality studies was synthesized using GRADE. Among 1604 unique search results, 41 studies were deemed relevant, yielding 34 low-quality and seven medium-quality studies. The latter reported on promising multi-component prevention programs that combined staffing adjustments, work shift arrangements, enhanced infection prevention and control, recognition of workers’ efforts, psychological and/or logistic support during lockdowns (e.g., accommodation). Our confidence in the effectiveness of reviewed interventions is low to very low, however, owing to methodological limitations. We highlight gaps in the reporting of intervention process and context elements and discuss theory and implementation failure as possible explanations for results. We conclude by urging authors of future studies to include and document detailed risk assessments of the work environment, involve workers in solution design and implementation and consider how this process can be adapted during an emergency.

During the COVID-19 pandemic, healthcare workers (HCWs) were at high risk of exposure to the SARS-CoV-2 virus and to work-related psychosocial risks, such as high psychological demands, low social support at work and low recognition. Because these factors are known to be detrimental to health, their detection and mitigation was essential to protect the healthcare workforce during the pandemic, when this study was initiated. Therefore, using Facebook monitoring, this study aims to identify the psychosocial risk factors to which HCWs in Quebec, Canada reported being exposed at work during the first and second pandemic waves. In this study, HCWs mainly refer to nurses, respiratory therapists, beneficiary attendants and technicians (doctors, managers and heads of healthcare establishments were deemed to be less likely to have expressed work-related concerns on the social media platforms explored). A qualitative exploratory research based on passive analysis of Facebook pages from three different unions was conducted. For each Facebook page, automatic data extraction was followed by and completed through manual extraction. Posts and comments were submitted to undergo thematic content analysis allowing main coded themes to emerge based on known theoretical frameworks of the psychosocial work environment. In total, 3796 Facebook posts and comments were analyzed. HCWs reported a variety of psychosocial work exposures, the most recurrent of which were high workload (including high emotional demands), lack of recognition and perceived injustice, followed by low workplace social support and work–life conflicts. Social media monitoring was a useful approach for documenting the psychosocial work environment during the COVID-19 crisis and could be a useful means of identifying potential targets for preventive interventions in future sanitary crises or in a context of major reforms or restructuring.

Importance: Long COVID, a chronic condition following SARS-CoV-2 infection, affects millions of people worldwide and can lead to significant functional impairment. Estimates of long COVID risk after a first COVID-19 infection vary, and data on risk following reinfections remain lacking. Objective: To estimate and compare long COVID risk and severity with first COVID-19 infection versus reinfections among healthcare workers (HCWs). Design: Retrospective cohort study based on an electronic survey among Quebec HCWs conducted between May 16 and June 15, 2023. A short telephone survey among randomly selected non-respondents further assessed potential response bias. Setting: Population-based study in Quebec, Canada. Participants: 397 222 HCWs were invited to participate in the electronic survey and 10 500 in the telephone survey. Main outcomes and measures: We defined long COVID cases as HCWs self-reporting COVID-19-attributed symptoms lasting ≥12 weeks, classified as mild, moderate, or severe based on perceived symptom intensity. We compared self-reported symptoms and functional limitations of cases to COVID controls (infected participants without long COVID) and non-COVID controls (uninfected participants). Risk and prevalence were estimated by number of infections, likely infecting variant and perceived acute COVID-19 severity. We conducted symptom clustering analyses using unsupervised learning techniques. Results: Estimated long COVID risk following any COVID-19 infection was similar among 22 496 online survey participants (17.0% [95%CI, 16.3%–17.6%] and 3 978 telephone survey participants (15.9% [14.6%–17.2%]. The cumulative risk increased with the number of infections, but reinfections were associated with three times lower risk of long COVID than first infections. Pre-Omicron infections and severe acute COVID-19 episodes correlated with higher long COVID risk and severity. Among prevalent long COVID cases, 43% were moderate and 33% severe. Compared to controls, dyspnea, neurocognitive symptoms, post-exertional malaise and smell/taste disturbances were most strongly associated with long COVID. Cluster analysis identified seven symptom groups with systemic, neurocognitive, pulmonary, and mood-related clusters being the most prevalent. Severe long COVID cases exhibited multiple symptom clusters and greater functional limitations. Conclusions: Long COVID is a common and disabling condition among HCWs. Societal and healthcare burden remains important and will continue to accrue given ongoing SARS-CoV-2 transmission and long COVID risk with reinfections. KEY POINTS: Question: Does the risk and severity of long COVID differ for first COVID-19 infections versus reinfections among healthcare workers in Quebec, Canada? Findings: The risk of long COVID was ∼15% with first COVID-19 infection, but three-fold lower with reinfections. Risk was higher with COVID-19 infections due to ancestral strains and with more severe acute episodes. Long COVID risk and severity compromised self-rated health, physical capacity and cognitive function. Meaning: Long COVID is a common and disabling condition among workers. Societal and healthcare burden remains important and will continue to accrue given ongoing SARS-CoV-2 transmission and long COVID risk with reinfections.

Background/Objectives: Musculoskeletal disorders (MSDs) contribute to work disability arising from personal and work-related physical, organizational and psychosocial factors that often differentially affect men and women. We aimed to identify determinants of the sex/gender difference in duration of MSD work absence through a mixed-studies systematic review. Methods: We synthesized evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach adapted to prognostic studies and meta-ethnography for qualitative studies, followed by a mixed synthesis. Results: Twenty-six quantitative and four qualitative studies contributed to the evidence synthesis. Only two of the twenty-six quantitative studies addressed the sex/gender gap directly, compared to three of the four qualitative studies. Most other quantitative studies provided evidence from sex/gender-stratified analyses of determinants of MSD disability. The synthesis of qualitative studies suggested that domestic strain, less access to modified work/retraining, and gender-biased attitudes of health and insurance system gatekeepers hindered women’s return to work. Prognostic factors in women supporting this conclusion from quantitative studies included the combination “working ≥ 40 h/week and having dependents” and low supervisor support. The mixed synthesis yielded a conceptual model of hypothesized determinants of the sex/gender difference in MSD work disability that integrates factors from personal, workplace, healthcare and insurance–disability management spheres, influenced by the larger sociopolitical, cultural and macroeconomic context. Conclusions: Studies directly addressing the sex/gender gap in MSD disability are needed. These can be informed by the proposed model. Practitioners and policymakers can build upon the model to develop and implement MSD prevention and rehabilitation interventions tailored to the needs of men and women to reduce sex/gender disparities.

: Healthcare workers are affected by mental health issues, burnout and turnover, and this burden is even greater during epidemics and pandemics, such as COVID-19. The purpose of this research is to provide an overview of the measures introduced or supported in the institutions of Quebec’s health and social services network during the COVID-19 pandemic with the aim of protecting healthcare workers’ mental health. An online questionnaire survey was administered in 2021 among human resources department personnel in health and social services network institutions involved in workplace mental health in Quebec. A total of 223 key informants representing 31 of the 34 public health and social services institutions in the province of Quebec in Canada responded to the questionnaire. Measures that focus on the needs of staff, involve all levels of authority and the ones that provide flexibility, support and recognition at work were more successful, according to the advisors surveyed. Future research into whether the same measures are considered effective or ineffective outside of a pandemic context is needed.