2014-09-01 12:00 - Messages

Exposure–response relationships for the ACGIH threshold limit value for hand-activity level

Results from a pooled data study of carpal tunnel syndrome
Objectives: This paper aimed to quantify exposure–response relationships between the American Conference of Governmental Industrial Hygienists' (ACGIH) threshold limit value (TLV) for hand-activity level (HAL) and incidence of carpal tunnel syndrome (CTS).
Methods: Manufacturing and service workers previously studied by six research institutions had their data combined and re-analyzed. CTS cases were defined by symptoms and abnormal nerve conduction. Hazard ratios (HR) were calculated using proportional hazards regression after adjusting for age, gender, body mass index, and CTS predisposing conditions.
Results: The longitudinal study comprised 2751 incident-eligible workers, followed prospectively for up to 6.4 years and contributing 6243 person-years of data. Associations were found between CTS and TLV for HAL both as a continuous variable [HR 1.32 per unit, 95% confidence interval (95% CI) 1.11–1.57] and when categorized using the ACGIH action limit (AL) and TLV. Those between the AL and TLV and above the TLV had HR of 1.7 (95% CI 1.2–2.5) and 1.5 (95% CI 1.0–2.1), respectively. As independent variables (in the same adjusted model) the HR for peak force (PF) and HAL were 1.14 per unit (95% CI 1.05–1.25), and 1.04 per unit (95% CI 0.93–1.15), respectively.
Conclusion: Those with exposures above the AL were at increased risk of CTS, but there was no further increase in risk for workers above the TLV. This suggests that the current AL may not be sufficiently protective of workers. Combinations of PF and HAL are useful for predicting risk of CTS.

Source: Kapellusch JM, Gerr FE, Malloy EJ, Garg A, Harris-Adamson C, Bao SS, Burt SE, Dale AM, Ellen E, Evanoff BA, Hegmann KT, Silverstein BA, Theise MS, Rempel DR. Scand J Work Environ Health, 2014.

Occupational and Biopsychosocial Risk Factors for Carpal Tunnel Syndrome

Objective: To investigate a biopsychosocial model of risk for carpal tunnel syndrome (CTS). In addition, a host of exploratory psychosocial variables was investigated as potential risk factors for CTS.
Methods: A case–control design was used comparing 87 CTS and 74 sex-matched general orthopedic patients from an outpatient orthopedic clinic. All participants underwent the same diagnostic protocol (ie, physical evaluation and electrodiagnostic testing) and completed a self-report questionnaire assessing a wide range of potential occupational, personological, and psychosocial risk factors.
Results: Multiple logistic regression analyses revealed that occupational repetition, not engaging in vigorous exercise, physical activities with wrist strain, poorer physical health, and lower job satisfaction were significantly related to the presence of CTS. Obesity was borderline significantly related to the presence of CTS.
Conclusions: The biopsychosocial model provides a useful heuristic for conceptualizing CTS risk among injured workers.

Source: Goodson, Jason T.; DeBerard, M. Scott; Wheeler, Anthony J.; Colledge, Alan L. Journal of Occupational & Environmental Medicine: September 2014, Volume 56, Issue 9, p 965–972.

Best evidence for treating back and neck pain

CBRG QuickDecks are now available from the Cochrane Back Review Group (CBRG), housed at the Institute for Work & Health. These slide decks provide a quick summary of the best evidence for treating back and neck pain by type of intervention, including surgical, pharmacological and non-pharmacological (e.g. massage, chiropractic) interventions.

Source: http://www.iwh.on.ca/recent-updates/best-evidence-for-treating-back-and-neck-pain

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