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  • 1
    Publication Date: 2016-10-15
    Description: Background Between 2001 and 2010, six research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries to estimate exposure–response relationships. Objective This analysis examined the presence and magnitude of confounding between biomechanical and workplace psychosocial factors and incidence of dominant-hand CTS. Methods 1605 participants, without CTS at enrolment, were followed for up to 3.5 years (2471 person-years). Demographic information, medical history and workplace psychosocial stress measures were collected at baseline. Individual workplace biomechanical exposures were collected for each task and combined across the workweek using time-weighted averaging (TWA). CTS case criteria were based on symptoms and results of electrophysiological testing. HRs were estimated with Cox proportional hazard models. Confounding was assessed using causal diagrams and an empirical criterion of 10% or greater change in effect estimate magnitude. Results There were 109 incident CTS cases (IR=4.41/100 person-years; 6.7% cumulative incidence). The relationships between CTS and forceful repetition rate, % time forceful hand exertion and the Threshold Limit Value for Hand Activity Level (TLV-HAL) were slightly confounded by decision latitude with effect estimates being attenuated towards the null (10–14% change) after adjustment. The risk of CTS among participants reporting high job strain was attenuated towards the null by 14% after adjusting for the HAL Scale or the % time forceful hand exertions. Conclusions Although attenuation of the relationships between CTS and some biomechanical and work psychosocial exposures was observed after adjusting for confounding, the magnitudes were small and confirmed biomechanical and work psychosocial exposures as independent risk factors for incident CTS.
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 2
    Publication Date: 2016-05-18
    Description: Objectives To investigate exposure–response relationships between measured movements and postures of the wrist and the incidence of carpal tunnel syndrome (CTS), and any modifications by sex. Methods In 2011, we established a historical cohort of 9364 members of the Painters’ Union in Denmark. Self-reported task distributions were obtained by questionnaire (53% responded) and combined with sex-specific task exposure matrices to get individual estimates of exposure intensity, that is, velocity of wrist flexion/extension, mean power frequency (MPF) and non-neutral wrist postures. Exposure duration was assessed from yearly working proportions. Registered first-time hospital discharge CTS diagnoses and CTS surgery were collected as outcomes. The cohort was followed from 1994 to 2010. Log-linear Poisson regression was used. Results For CTS diagnoses, the adjusted incidence rate ratios (IRRs) increased with increasing wrist velocity (IRR=1.37 (95% CI 1.10 to 1.71) per °/s) and MPF (IRR=1.53 (95% CI 1.21 to 1.91) per 0.01 Hz). For CTS surgery, the results were similar. The outcomes were not related to non-neutral postures or exposure duration. The adjusted IRRs for women were higher than those for men. There were no multiplicative interaction effects between exposure intensity, exposure duration and sex. However, the absolute incidence rates (IRs) increased at a steeper rate for women than for men, indicating an additive interaction. Conclusions The incidence of CTS increased with increasing velocity of wrist flexion/extension and MPF of wrist movements. The relative increase in incidence rates was the same for women and men, but the absolute incidence rates increased at a steeper rate for women than for men.
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 3
    Publication Date: 2015-03-17
    Description: Objectives Perceived time pressure at work has increased in most European countries during recent decades. Time pressure may be harmful for employees’ health and well-being. The aim of this register-based follow-up study is to investigate whether the effects of time pressure on long sickness absence vary by the level of working time control. Methods The data are taken from the Finnish Quality of Work Life Survey 2003 (n=3400), a representative sample of Finnish employees, combined with a register-based follow-up from Statistics Finland covering the years 2002–2006. In the 2003 survey, employees were asked about their perceived time pressure and to what extent they had control over working time. The register data included information on long-term (more than 10 days) sickness absence. A negative binomial model was used in the analysis of long-term sickness absence days during 2004–2006. The results are adjusted for several background and work-related factors and controlled for baseline absenteeism in 2002. Results High working time control decreased and high time pressure increased long-term sickness absence. The highest incidence of long-term sickness absence was found in time strain situations (high time pressure, low time control). However, there was no statistical interaction between working time control and time pressure. Conclusions Establishments that use working time control as a human resource instrument may benefit from reduced absenteeism. However, following the ‘strain’ hypothesis it is insufficient to focus solely on working time control as high time pressure maintains its detrimental effect on employees’ health.
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 4
    Publication Date: 2015-01-10
    Description: Background Six research groups independently conducted prospective studies of carpal tunnel syndrome (CTS) incidence in 54 US workplaces in 10 US States. Physical exposure variables were collected by all research groups at the individual worker level. Data from these research groups were pooled to increase the exposure spectrum and statistical power. Objective This paper provides a detailed description of the characteristics of the pooled physical exposure variables and the source data information from the individual research studies. Methods Physical exposure data were inspected and prepared by each of the individual research studies according to detailed instructions provided by an exposure subcommittee of the research consortium. Descriptive analyses were performed on the pooled physical exposure data set. Correlation analyses were performed among exposure variables estimating similar exposure aspects. Results At baseline, there were a total of 3010 participants in the pooled physical exposure data set. Overall, the pooled data meaningfully increased the spectra of most exposure variables. The increased spectra were due to the wider range in exposure data of different jobs provided by the research studies. The correlations between variables estimating similar exposure aspects showed different patterns among data provided by the research studies. Conclusions The increased spectra of the physical exposure variables among the data pooled likely improved the possibility of detecting potential associations between these physical exposure variables and CTS incidence. It is also recognised that methods need to be developed for general use by all researchers for standardisation of physical exposure variable definition, data collection, processing and reduction.
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 5
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    BMJ Publishing Group
    Publication Date: 2014-12-17
    Description: In this first edition of Occupational and Environmental Medicine for 2015 we have introduced a new front cover. We have decided to retire the ‘word cloud’, which has adorned the front cover since May 2012. This word cloud was based on the frequency of words contained in articles published in OEM prior to that date and after more than two and a half years it was becoming increasingly out of date. Our new front cover retains the blue colour scheme and continues the tradition of OEM being known as the ‘blue journal‘ amongst occupational health journals. The central feature of the new cover is a globe which signifies the wide reach of OEM around the world. For this first edition, we have selected a group of pictures which illustrate a range of hazardous working environments, as well as motor vehicle exhausts, an increasingly recognised contributor to a wide...
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 6
    Publication Date: 2013-07-11
    Description: Background Privatisations of public sector organisations are not uncommon, and some studies suggest that such organisational changes may adversely affect employee health. In this study, we examined whether transfer of work from public sector hospital units to commercial enterprises, without major staff reductions, was associated with an increased risk of long-term sickness absence among employees. Methods A cohort study of 962 employees from four public hospital laboratory and radiology units in three hospitals which were privatised during the follow-up and 1832 employees from similar units without such organisational changes. Records of new long-term sick leaves (〉90 days) were obtained from national health registers and were linked to the data. Mean follow-up was 9.2 years. Results Age- and sex-adjusted HR for long-term sickness absence after privatisation was 0.83 (95% CI 0.68 to 1.00) among employees whose work unit underwent a change from a public organisation to a commercial enterprise compared with employees in unchanged work units. Further adjustments for occupation, socioeconomic status, type of job contract, size of residence and sick leaves before privatisation had little impact on the observed association. A sensitivity analysis with harmonised occupations across the two groups replicated the finding (multivariable adjusted HR 0.92 (0.70–1.20)). Conclusions In this study, transfer of work from public organisation to commercial enterprise did not increase the risk of long-term sickness absence among employees.
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 7
    Publication Date: 2013-07-11
    Description: Objectives To quantify the risk for carpal tunnel syndrome (CTS) from workplace physical factors, particularly hand activity level and forceful exertion, while taking into account individual factors including age, gender, body mass index (BMI), and pre-existing medical conditions. Methods Three healthcare and manufacturing workplaces were selected for inclusion on the basis of range of exposure to hand activity level and forceful exertion represented by their jobs. Each study participant's job tasks were observed and evaluated onsite and videotaped for further analysis, including frequency and duration of exertion and postural deviation. Individual health assessment entailed electrodiagnostic testing of median and ulnar nerves, physical examination and questionnaires at baseline with annual follow-up for 2 years. Results The incidence of dominant hand CTS during the study was 5.11 per 100 person-years (29 cases). Adjusted HRs for dominant hand CTS were as follows: working with forceful exertion ≥20% but 〈60% of the time: 2.83 (1.18, 6.79) and ≥60% of the time vs 〈20%: 19.57 (5.96, 64.24), BMI ≥30 kg/m 2 (obesity): 3.19 (1.28, 7.98). The American Conference for Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) for hand activity level also predicted CTS, HR=1.40 (1.11, 1.78) for each unit increase in the TLV ratio, controlling for obesity and job strain. Conclusions Workplace and individual risk factors both contribute to the risk for CTS. Time spent in forceful exertion can be a greater risk for CTS than obesity if the job exposure is high. Preventive workplace efforts should target forceful exertions.
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 8
    Publication Date: 2013-07-11
    Description: Background Between 2001 and 2010, six research groups conducted coordinated multiyear, prospective studies of carpal tunnel syndrome (CTS) incidence in US workers from various industries and collected detailed subject-level exposure information with follow-up symptom, physical examination, electrophysiological measures and job changes. Objective This analysis of the pooled cohort examined the incidence of dominant-hand CTS in relation to demographic characteristics and estimated associations with occupational psychosocial factors and years worked, adjusting for confounding by personal risk factors. Methods 3515 participants, without baseline CTS, were followed-up to 7 years. Case criteria included symptoms and an electrodiagnostic study consistent with CTS. Adjusted HRs were estimated in Cox proportional hazard models. Workplace biomechanical factors were collected but not evaluated in this analysis. Results Women were at elevated risk for CTS (HR=1.30; 95% CI 0.98 to 1.72), and the incidence of CTS increased linearly with both age and body mass index (BMI) over most of the observed range. High job strain increased risk (HR=1.86; 95% CI 1.11 to 3.14), and social support was protective (HR=0.54; 95% CI 0.31 to 0.95). There was an inverse relationship with years worked among recent hires with the highest incidence in the first 3.5 years of work (HR=3.08; 95% CI 1.55 to 6.12). Conclusions Personal factors associated with an increased risk of developing CTS were BMI, age and being a woman. Workplace risk factors were high job strain, while social support was protective. The inverse relationship between CTS incidence and years worked among recent hires suggests the presence of a healthy worker survivor effect in the cohort.
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 9
    Publication Date: 2013-02-10
    Description: Objectives To study the employment and occupational outcomes of workers who were diagnosed with upper limb musculoskeletal disorders (UL-MSDs) or had complained of upper limb musculoskeletal pain a few years before compared with workers who had no upper limb pain. Methods In 2002–2005, an epidemiological surveillance system was set up. Occupational physicians examined 3710 randomly selected workers. It focused on six UL-MSDs: rotator cuff syndrome, lateral epicondylitis, flexor-extensor peritendinitis of the hands and fingers, de Quervain's disease, carpal tunnel syndrome and ulnar tunnel syndrome. Three groups were constituted: a ‘UL-MSD’ group (workers with a clinically diagnosed UL-MSD at baseline, 13% of the cohort); a ‘PAIN’ group (workers with pain in the previous 7 days at baseline and without any clinically diagnosed form, 38%); and a ‘HEALTHY’ group (workers with no disorder or upper limb pain in the previous 7 days, 49%). They completed a questionnaire between 2007 and 2009. Results A total of 2332 responded. Fewer subjects were still in work in the ‘UL-MSD’ group (79.3%) than in the ‘PAIN’ (85.9%) and ‘HEALTHY’ (90.4%) groups, the difference remaining significant after adjusting for gender, age, occupational category, type of company and comorbidities. Of the subjects still in work, 24% had changed their work station in the same company in the ‘PAIN’ group compared with 19% in the ‘HEALTHY’ group and 21% in the ‘UL-MSD’ group. Conclusions This study showed the impact of musculoskeletal pain on employment outcome and the difficulty of keeping workers with musculoskeletal problems at work.
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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