Managing musculoskeletal disorders — Cyprus

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This article is Cyprus’s contribution to the comparative analytical report of the European Working Conditions Observatory on the existing situation regarding the impact of work changes on the resurgence of work-related musculoskeletal diseases

The questionnaire

1. Definitions

The various terms listed above in describing MSDs all put the accent on repetitive and cumulative motions.

The Eurostat description of EODS methodology provides some useful comparative insight about disease statistics and the general functioning of national work-insurance systems, e.g. who compensate occupational diseases, in particular MSDs included and at what degree of seriousness are listed: only some of the MSDs are recognized as such by National Insurance Agencies (NIAs) and other agencies entitled by government and/or social partners in playing such a role. There are two main obstacles to their recognition: certain activities outside work expose people to similar risks, especially women (see question 3 below); and the nature of the contract does not help to point to the occupational origin of the disease.

1.1 Please, report the official definition of WR-MSDs, if any, or the most widespread one. Please specify whether it includes backaches.

In Cyprus there is no official definition of musculoskeletal disorders, laid down either by law or collective labour agreement, or for the purposes of statistical records and analysis. However, according to the Ministry of Labour and Social Insurance, Department of Labour Inspection, the term used today in Europe and therefore also in Cyprus is “work-related musculoskeletal disorders.” In the context of the abovementioned definition, backaches are not regarded as musculoskeletal disorders but as symptoms of such disorders, musculoskeletal disorders are described as follows:

Musculoskeletal disorders cover a broad range of illnesses, including disorders of the bones, joints, tendons, muscles and nerves controlling the muscular system. It is now widely known that risks capable of causing musculoskeletal disorders cause physical strain and put workers’ musculoskeletal systems in danger of injury or disorder. These are known as ergonomic risks, and they include repetitive and violent movements, strained or forced body positions due to unsuitable equipment or workplaces, manual handling of heavy cargos, manual jobs requiring force, vibrations, unsuitable temperature conditions, etc. Ergonomic risks also include work organisation factors, such as work at a rapid pace within tight deadlines, insufficient breaks or rest periods, monotonous work, etc. Various psychosocial factors also appear to increase the risk musculoskeletal disorders, such as the type of tasks workers perform, the manner in which they are monitored, social relations among workers, feelings of job dissatisfaction, etc. Backaches are regarded as a symptom of a musculoskeletal disorder caused by repeated vertical vibrations of the whole body.

Occupational Health and Safety in Small and Medium Enterprises, EL.IN.Y.A.E, 1995, Athens.

1.2 Please check whether criteria illustrated in the above EODS paper have been updated in the meantime. Are recognition criteria by NIAs taking into account gender differences? Have there been any changes in last years both in general and wrt to gender issues in particular?

Despite the lack of an official definition of musculoskeletal disorders on the national level, the criteria illustrated in the EODS methodology have been updated as to be also used by the Ministry of Labour and Social Insurance, Department of Labour Inspection, for the encoding of the occupational illnesses.

More specifically, on the basis of the Accidents and Occupational Diseases (Notification) Law of 1953 (Chapter 176) all diseases included in Annex 1 of this law are regarded as occupational diseases. In this context, since no reference is made in the relevant annex to musculoskeletal disorders, it is not possible to investigate the matter with regard to the gender dimension due to lack of statistical data.

Given the absence of legislative protection for a wide range of illnesses, the Ministry of Labour and Social Insurance, Department of Labour Inspection, has prepared in November 2006, a Draft on notification of occupational diseases. According to the Ministry’s Draft, occupational disease means a disease caused by exposure to risks in the work environment, and according to Annex I occupational diseases involving musculoskeletal disorders are the following:

• Illness due to atmospheric compression or decompression.

• Osteoarticular diseases of the hands and wrists caused by mechanical vibration.

• Angioneurotic diseases caused by mechanical vibration.

• Diseases of the periarticular sacs due to pressure.

• Pre-patellar and sub-patellar bursitis.

• Olecranon bursitis.

• Shoulder bursitis

• Diseases due to overstraining of the tendon sheaths.

• Diseases due to overstraining of the peritendineum.

• Diseases due to overstraining of the muscular and tendonous insertions.

• Meniscus lesions following extended periods of work in a kneeling or squatting position.

• Paralysis of the nerves due to pressure.

• Carpal tunnel syndrome.

The aforesaid Draft also includes in Annex II a list of possible occupational diseases; for these diseases be recognised their origin and occupational nature must first be demonstrated to the competent medical officer. According to Annex II, one possible occupational disease involving musculoskeletal disorders is the following:

• Disc-related diseases of the thoracic and lumbar vertebral column caused by repeated vertical vibration of the whole body.

Seen as important is the unanimous approval in principle of the Draft by technical committee of the Labour Consultative Body, on the part of the employer organisations by the Cyprus Chamber of Commerce and Industry (KEBE) and the Employers and Industrialists Federation (OEB), and on the part of the unions by the Democratic Labour Federation of Cyprus (DEOK), the Pancyprian Federation of Labour (PEO) and the Cyprus Workers' Confederation (SEK). The Draft has been forwarded to the parliamentary chamber and it is expected to be approved.

It is notable, however, that the Ministry of Labour and Social Insurance, Department of Social Insurance provides a list of Occupational illnesses in order to supply disability allowances. The recognised occupational illnesses related to musculoskeletal disorders as defined on the basis of Article 73 of the 1980 Social Insurance (Diseases) Regulations, include the following:

Occupational Illnesses Recognised by Social Insurance

Description of Disease or Disorder	Nature of occupation
Cramp of the Hand or forearm due to repetitive movements	Prolonged periods of handwriting, typing or other repetitive movements of the fingers, hand or arm.
Bursitis or subcutaneous (under the skin) cellulitis arising at or about the knee due to severe or prolonged external friction or pressure at or about the knee.	Manual work causing severe or prolonged external friction or pressure at or about the knee
Bursitis or subcutaneous (under the skin) cellulites arising at or about the elbow due to severe or prolonged external friction or pressure at or about the elbow	Manual work causing severe or prolonged external friction or pressure at or about the elbow.
Traumatic inflammation of the tendons of the hand or forearm or the tendons coming into contact with them.	Manual work or frequent or repeated movements of the hand or forearm.

Source: Regulatory Administrative Act (KDP) 242/80, the 1980 Social Insurance Law, regulations under Article 73.

2. Reporting

Reporting is another key preliminary issue. Two orders of problems can be identified.

Clinical reporting, statistical sources (mainly based on self-reporting), working conditions surveys and administrative sources from NIAs and Health Systems tend to differ. The latter heavily depend on the institutional definitions (both legal and administrative settings) both about their causes and their nature. Figures are often collected and classified according non-homogeneous criteria, and at different analytical level in terms of part of the body affected and causes. For instance, the LFS 1999 additional module reported MSDs in an aggregated way (Q217), while the 2007 LFS ad hoc module questionnaire distinguish (Q215/216) MSDs according three regions affected: neck, shoulder, arms and hands (WR-ULD); hips, legs, feet; back.

According to Eurostat, this make difficulties to collect comprehensive European level data on recognized MSDs. Also in the EU-15, it is not granted that the European standards (EODS in our case) are employed. This causes a further problem of comparability.

Working conditions survey are probably the least dependent on institutional (legal) framework, but cultural/social habits could can affect reporting work related MSDs. However, an UK study shows significant consistencies amongst self-reported and clinical results (see the Foundation report “Quality of work and employment in Europe. Issues and challenges”.)

This very short overview, far from being complete, outlines some of the main questions related to reporting

2.1 Please list the main sources of information about WR-MSDs (NIAs and other insurance agencies empowered by government and/or social partners, WCS, public health, statistical bureaux). Please describe the way WR-MSDs are categorized by public authorities and NIAs according to the part of the body affected (upper/lower limb, bone, joint or muscle problem, hips, legs, feet, knees, back, neck, shoulders, arms, etc. ..), causes (repetitive work, vibrations, heavy loads, postures, PCs, etc…..) and occupational and demographic characteristics (labour contracts, occupation, age, gender).

The main sources of information about work-related musculoskeletal disorders are the following:

• The Department of Social Insurance of the Ministry of Labour and Social Insurance.

• The Department of Labour Inspection of the Ministry of Labour and Social Insurance.

• The trade union organisations DEOK, PEO, SEK and the Cyprus Union of Bank Employees (ETYK).

• The employer organisations KEBE and OEB.

• Medical officers who treat patients with musculoskeletal disorders.

• The international bibliography.

According to the Ministry of Labour and Social Insurance, Department of Labour Inspection, no public authority, including the national insurance funds, has categorised musculoskeletal disorders either according to the part of the body affected or according to occupational and demographic characteristics. However, some of the causes of musculoskeletal disorders are cited both in the list of occupational diseases of the Department of Social Insurance and also in the list included in the Draft Regulations on Notification of Occupational Diseases. Specifically the causes listed are the following:

• Atmospheric compression or decompression.

• Prolonged periods of handwriting, typing or other repetitive movements of the fingers, hand or arm.

• Manual work or frequent or repeated movements of the hand or forearm.

• Manual work causing severe or prolonged external friction or pressure at or about the knee.

• Manual work causing severe or prolonged external friction or pressure at or about the elbow.

• Mechanical vibration.

• Prolonged periods of work in a kneeling or squatting position.

• Repeated vertical vibrations of the whole body.

2.2 Please describe the number, type and variety of questions advanced in MSDs. Please report the exact formulation of questions advanced in working conditions surveys. What is the evolution over time of question formulation?

In Cyprus, the causes of musculoskeletal disorders lie both in physical factors and also in work organisation-related factors.

The physical causes of musculoskeletal disorders include the following:

• Manual handling of cargos.

• Lifting of cargos.

• Poor position and awkward movements.

• Repetitive movements.

• Manual work requiring force.

• Direct mechanical pressure on body tissues.

• Vibration.

• Cold work environments.

The causes associated with work organisation include:

• Pace of work.

• Repetitive work.

• Working time organisation.

• Monotonous work.

• Psychosocial factors.

www.osha.gov

In this context it is important to note that there is no bibliography on musculoskeletal disorders on the national level. Specifically, following a relevant search, no national bibliography was found in any of the national, municipal, university, medical or other libraries of Cyprus. However, we still have a few reservations, since relevant articles may exist in scientific journals with medical content.

Likewise, no research has been conducted on musculoskeletal disorders on the national level. However, in the context of a relevant study carried out in 2001 by the European Foundation for the Improvement of Living and Working Conditions with regard to the acceding and candidate countries, Cyprus among them, data were gathered on musculoskeletal disorders and work-related stress.

More specifically, the European Foundation study was completed in 2001 on the basis of a questionnaire on working conditions in 10 countries acceding to the EU and two candidate countries, Romania and Bulgaria.

According to the findings of the study, the percentages of Cypriot workers suffering from work-related musculoskeletal disorders were as shown in the following table:

Working Conditions in the acceding and cadidate countries 2001.

Health affected by work	Cyprus
Backache	-	63.1%
	+	36.9%
Muscular Pains in shoulders and neck	-	72.8%
	+	27.2%
Muscular Pains in Upper limbs	-	74.7%
	+	25.3%
Muscular Pains in Lower limbs	-	77.3%
	+	22.7%

Source: European Foundation for the Improving of Living and Working Conditions 2001

2.3 Is there any research of analyse of causes available?

Due to the proportions assumed in Cyprus of the question of safety and health at work, and due to the absence of official data on the nature and frequency of musculoskeletal disorders on the national level, the Department of Labour Inspection of the Ministry of Labour and Social Insurance decided to announce an official competition for the carrying out of a relevant study.

In the Ministry’s opinion, a specialised study would assist in an evaluation of the situation with regard to physical and mental disorders of workers in Cyprus on the one hand, and the introduction of positive measures aimed at reducing the number of workers affected by such diseases on the other. In particular, the study has two specific objectives:

a. Collection and statistical analysis of all data necessary for an assessment and evaluation of the existing situation in Cyprus, partly for purposes of comparison with the 2001 data.

b. Formation of a strategy and introduction of positive measures aimed at reducing the number of workers suffering from these diseases.

Some initiatives on the level of information have been noted, however. More specifically, in October 2000, in the context of the Campaign to Prevent Accidents at Work and Occupational Diseases, a Week of Health and Safety at Work 2000 was organised on the subject of musculoskeletal disorders, whose central message was “Address work-related musculoskeletal disorders.” Officers and Inspectors from the Department of Labour Inspection prepared and implemented a special programme which included visits to workplaces, attendance at Safety Committee meetings, discussion with workers and distribution of information material. Officers of the Department of Labour Inspection also took part in a series of informative radio and television broadcasts; radio and television messages were also broadcast and short films were shown on TV channels. In collaboration with the employer and trade union organisations and other bodies, a series of seminars was held aimed at providing information on the provisions of the law in this area.

In the context of planned events, the Pan-Cyprian Conference on Health and Safety at Work was held, with the participation of experts who presented various aspects of the problem.

3. Trends of MSDs and their social impact

MSDs complaints show a growth across the editions of the EWCS, supporting the argument of “work densification” and that actual prevention instruments are not fully adequate in order to cope with them. As discussed above, organizational changes, which reflect both changes in competition and HRM practices (see for all Oesterman, 2000), play a key role in such a trend. Such trends can differ significantly across sectors, occupations, firm size and gender.

The increasing participation of women to labour market make the need of engendered prevention policies for the following reasons:

a. According to Pèze (2002), “women are massively hit by MSD not only because of their morphology and hormonal factors, but because work organisation keep them out massively from conception and decision-making”: therefore, workplace design is based on the prevailing occupational group, i.e. men;

b. Horizontal and vertical segregation literature show that some industries are significantly engendered (for all Hakim, 1992)

c.Women still cope with more domestic tasks than men, facing thus larger risk exposure outside work.

The report “Work organisation and health at work in the European Union” investigates the relationship between health according three broad classes of organizational factors, an engendered approach from the 3^rd EWCS:

• temporal framework, according to the two sub-dimensions of internal flexibility (shifts, long hours, night work, sundays working, no fixed times) and industrial type of the pace of work (depending on the automatic speed of the machine, depending on quantitative standards)

• scope of manoevre, according to the two sub-dimensions of autonomy (no possibility to choose or modify the pace of work; no possibility to choose or modify the methods of work, no possibility to choose or modify the sequence of tasks, not allowed to take a break) and of control (respect of precise quality standards, personal evaluation of the quality of their work);

• social relationships, according to the three sub-dimensions of the commercial constraints (the pace depends on the current demands from customers etc.) discussions (no possibility of discussing work organization when changes occur, no possibility of discussing your working conditions in general) and continuing training.

3.1 Please report figures on absence days caused by MSDs (from NIAs and other Agencies, or WCS where the former are not available) according to parts of the body affected and causal agent, and their trends over last 10 years, disaggregated by labour contracts, occupation, age, if it were possible in a engendered way, accordingly to the sources available described in Q2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communication.

3.2 Please report figures from WCSs on MSDs suffered according to parts of the body affected and causal agent, and their trends over last 10 years, disaggregated by labour contracts, occupation, and age in an engendered way by gender, accordingly to the sources available described in Q2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communication.

3.3 Please provide some crosstables of MSDs according to part of the body affected and, if possible, causal agent, with the following organizational factors in an engendered way, showing trends from the 90s and taking into account the questions included in WCS for each country:

• pace of work (speed or repetitiveness, tight deadlines)

• autonomy (in general and wher possible breaks opportunities , scope on pace of work, scope on methods);

• use of PCs and other ICTs devices;

• scope of discussion over work organization and/or organizational changes;

With regard to questions 3.1, 3.2 and 3.3, unfortunately there are no available data. Very few incidents related to occupational diseases in general have been reported to the social insurance services. However, it cannot be determined whether they include cases of musculoskeletal disorders. This lack of data comes from the fact that the existing legislation Accidents and Occupational Diseases (Notification) Law of 1953 is very old and does not provide an inventory system for the reporting of work related diseases.

4. Trends of MSDs and their economic impact

MSD has consequences both on health and work efficiency. This latter can be accounted in lower productivity of both the affected worker and his/her substitute.

Lower work efficiency is just part of the costs. They are both direct (compensation, treatment, medical care) and indirect (production lost, loss of quality in production, errors/mistakes in production, absenteism, replacement). As we have seen in the introduction, estimates produced by some countries differ in included costs.

Just from these few cases, their amount is undoubtedly huge and calls for prevention policies and a careful evaluation of their impact in terms of costs and benefits.

4.1 Are there estimates of MSDs costs? If any, which direct and indirect costs are included? Who carry them? If not, what indicators are monitored by policy makers and Agencies in order to propose/draw new policies, esp. in prevention?

There are no data or estimates in Cyprus of the financial costs of musculoskeletal disorders. The only available data refer to calculation of costs of accidents at work, according to research carried out by the University of Cyprus in 1998. More specifically, according to the findings of that research, the cost of accidents at work during 1997 was estimated at around CYP30 million, without taking into account the cost of occupational diseases.

4.2 Are there “return to work policies” (by whom/ on what level/ whose initiative/ involvement of the actors) developed and implemented (in general and specifically for MSDs)?

Such information are collected just in order to have a flavour of the shared awareness of their social and economic impact, and as such we deal with them. Please do not devote more than 300 words.

The Department of Labour at the Ministry of Labour and Social Insurance is also responsible for the vocational rehabilitation of people with disabilities, as one of the basic parameters for their integration and reintegration in society. Attention began to be paid to the vocational rehabilitation of people with disabilities when the Ministry of Labour and Social Insurance set up the Centre for the Vocational Rehabilitation of the Disabled (KEAA) in 1969. The focus of KEAA’s activities is vocational training for the disabled, where in conjunction with provision of vocational guidance services, evaluation of their abilities and their placement in the labour market, it completes the set of services necessary for an integrated intervention aimed at their vocational and social integration on an equal standing.

However, there are no policies for reintegration in the labour market of people suffering from musculoskeletal problems or other occupational diseases.

5. Prevention policies and room to manoeuvre

The figures/data so far available seem to suggest that we are not sure the EU is already the downward part of the slope of the reported graph form Brenner et al. (2002). The 2002 Scoreboard on implementing the Social Policy Agenda statement about the “insufficiency of current occupational health and safety practices and hence the cost of non-social policy to businesses and workers” could be applied to MSDs. As the Community strategy on health and safety at work (2002 – 06) points out, “the preventive approach set out in Community directives has not yet been fully understood”.

According to various studies, such as those summarized in Bourgeois et al. (2000) both MSDs and stress-related disorders arises out of work situations which limit workers’ discretion. Along these lines Coutarel (2003) suggests preventive strategies based on the notion of room to manoeuvre (“marge de manoeuvre”). i.e. the means and opportunities of action an employee has in a given production situation to influence and correct the work process. This gives the possibility for the individual to have control over the work situation and to use personal capacities.

According to Douillet, Schweitzer, 2002, “expanding workers’ discretion (…) becomes a key prevention priority: not just to reduce the physical and psychological stressors, but also as a way of recognizing the individual’s creativity at work”. The organizational changes in order to prevent MSDs must therefore include all the concerned stakeholders (Daniellou, 2005).

Therefore, the room to manoeuvre approach calls for prevention strategies based on interventions at an early stage at the design of the workplace according a participative method, which can be different labelled and stylized across countries. This calls for the opportunity in developing some quality indictors in order to set benchmarking policies, such as:

• Good quality working conditions;

• Possibilities of cooperation;

• Mobility;

• Rotation;

• Organisation of work which allows to make maximum of benefit out of the workforce

• Training

• Stability in the workforce/low staff turnover

Limits of such a prevention approach are economic constraints (productivity/overall performance maintainance, further investments) and social constraints (population characteristics, level of experience, training, levels of exposure).

5.1 In general, plant-level prevention policies are “risk elimination oriented” or centered around “risk information”? What the role of social partners?

In accordance with the provisions of Article 13 of the Safety and Health at Work Laws, as amended between 1996 and 2003, all employers are obliged to ensure, as far as possible, the safety, health and well-being of all their employees at work. According to the answers given by a senior officer of the Department of Labour Inspection, Ministry of Labour and Social Insurance, the effective prevention of musculoskeletal disorders can be achieved through the appropriate interventions in workplaces, aimed mainly at reducing ergonomic risks and adapting work to human needs. More particularly, these interventions are aimed at the following:

1. Redesigning or adapting of workstations, as well as choosing the suitable equipment and tools so as to reduce uncomfortable and unnatural positions and the mechanical loading of musculoskeletal system.

2. Altering work methods and workers’ tasks, in order to avoid repetitive and monotonous work. The use of mechanical aids, the automatisation of specific tasks and the broadening of tasks through the addition of more varied activities are some examples in this direction.

3. Taking various organisational measures such as short-time working, longer breaks, uniform distribution of work on each shift, etc.

4. Using individual means of protection, where considered necessary.

5. Performing checkups of workers’ health, aimed at detecting musculoskeletal disorders early and taking measures to protect them.

6. Providing staff with information and training in order to address these problems.

7. However, there are no signs of improvement as results of the implementation of these measures due to the small time of period passed from the year 2003. In addition, according to the Department of Labour Inspection, the are not enough labour inspectors working in the department and this is another reason why it is very difficult to estimate whether there is any improvement or not.

In the context of every employer’s obligations regarding risk assessment and implementation of a risk management system, the provisions of the Management of Safety and Health Issues at Work Regulations of 2002 (KDP 173/2002) apply. According to the provisions of these regulations, the employer must establish and operate suitable protection and prevention services and implement fire safety measures and measures to evacuate workplaces. One important obligation of the employer is to inform employees of risks arising at work as well as of the prevention and protection measures they must take. The Regulations also lay down obligations for employees in matters of safety and health, as well as provisions on monitoring of their health.

The basic role of the social partners is to inform employees, by means of regular seminars, of the risks arising from work, and to monitor the extent to which employees’ rights are ensured on the basis of the relevant laws and regulations.

5.2 Please illustrate some plant-level good practices (at least one in manufacturing and one in services) following (or showing significant similarities with) the “room to manoeuvre” approach above skecthed, showing in particular the adopted approaches and the impact both in working conditions and firm performance. Is there any specific strategy of the kind towards small and medium enterprises?

As regards examples of good practices, in the area both of preventing and of evaluating and combating occupational risk, initiatives on the enterprise level are extremely few. The two most recent examples involve two small enterprises, during the 2004-2005 period.

The first case involves a woodworking industry, which purchased the appropriate equipment when increased risk for musculoskeletal disorders was noted. Specifically, in the production department it was ascertained that some work included repetitive tasks involved in lifting or moving products and also in delivering orders. As a result the people performing these tasks were exposed to high risk for disorders of the musculoskeletal system (lumbago, tendonitis, etc.). When the problem was identified by the staff and the factory safety committee, the existence of alternative solutions to the problem was investigated, and following a relevant study it was decided to purchase and install on the production line lifting platforms and a manual lifting apparatus. When the equipment was purchased, apart from reduced risk for musculoskeletal disorders among employees, there was also an immediate improvement in labour productivity. In fact, it is expected that the cost of the mechanical equipment will be offset in a very short time thanks to higher productivity.

The second case involves the installation of a movable metal ladder in a furniture factory. Removing lumber from the shelves in the storage area using unsuitable portable ladders created, apart from the risk of falls, serious ergonomic problems for employees. With the construction of a permanent moveable metal ladder that moves on metal tracks, the risk of accident has been reduced to a minimum, and the total cost-benefit ratio of the structure was seen as particularly favourable.

5.3 Have been developed any quality indicators measuring “room to manoeuvre” preventive strategies?

In Cyprus there are not any quality indicators for the above issue.

References

Brenner, Fairis and Ruser, 2004, “”Flexible” work practices and occupational safety and health: exploring the relationship between cumulative trauma disorders and workplace transformations”, Industrial relations 43.

Bourgeois F. (ed.), 2000, TMS et travail: quand la santé interroge l’organisation. ANACT.

Clot Y., 2005, “Les TMS: hypersollicitation ou hyposollicitation”, communication presented at the “1.er congrés francophone sur les TMS du membre supèrieur”, Nancy, 30-21 may 2005.

Coutarel F., 2004, La prevention des troubles musculo-squelettiques en conception: quelles marges de manoeuvre pour le dèploiment de l’activitè?, Coll. Thèses et Mèmoires, Universitè Victor Segalen Bordeaux 2 – ISPED, Laboratoire d’Ergonomie des Systèmes Complexes.

Daniellou F., 2005, “TMS et modèles d’organisation du travail et de la produciont”, communication presented at the “1.er congrés francophone sur les TMS du membre supèrieur”, Nancy, 30-21 may 2005.

Hakim C. (1993), “Segregated and Integrated Occupations: A New Approach to Analysing Social Change”, European Sociological Review 4.

Oesterman P., 2002, “Organizing the US Labor Market: National Problems, Community Strategies”, in Trubek D., Zeitlin J. (eds.) Reconfiguring work and welfare in the New Economy, Oxford, Oxford University Press, 2002

Pèze M. (2002), Approche psychosomatique et psychodynamiques des TMS. Mimeo.

Putz-Anderson V. (2002), Cumulative trauma disorders – A manual for musculoskeletal diseases of the upper limbs. Taylor&Francis, London.

Polina Stavrou, INEK/PEO

• ID: CY0611019Q
• Author: Polina Stavrou
• Institution: INEK/PEO
• Country: Cyprus
• Language: EN
• Publication date: 2007-10-09
• Sector: Health and Social Work
• Subject: Workplace health promotion