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OBJECTIVES: The aim was to develop an easy-to-use risk score based on occupational factors and to validate its performance to identify workers either having (diagnostic setting) or developing (prognostic setting) upper-extremity musculoskeletal disorders (UEMSD).METHODS: This study relied on data from the Cosali prospective cohort conducted in a French working population. Diagnostic status for six UEMSD at inclusion and at follow-up was assessed by a standardized clinical examination. Data on occupational factors were collected through a self-administered questionnaire completed before the clinical examination at inclusion. The risk score was derived from a prediction model developed on data of 2,468 workers included in 2002-2003, and the validation sample is composed of 1,051 workers included later in 2004-2005. The prognostic performance of the risk score was assessed in workers without UEMSD at baseline. RESULTS: A total of 13% and 12% of workers had a UEMSD at inclusion in the development and validation sample. The developed risk score includes physical, organizational and psychosocial factors at work. In the validation sample, this score had acceptable performance for identifying workers having or not UEMSD at baseline (AUC: 0.60 [95% CI 0.57 to 0.63]), in particular the negative predictive value was high (89%-90%). The baseline risk score showed similar performance for predicting incident UEMSD at follow-up examination.CONCLUSION: This score can be useful as a first-line risk assessment tool, especially for excluding the low-risk work situations from further intervention by an ergonomist. Further validation studies are needed to determine its performance among various working populations.

OBJECTIVE: This study aimed to estimate the proportion and number of incident upper-extremity musculoskeletal disorders (UEMSD) cases attributable to occupational risk factors in a working population. METHODS: Between 2002−2005, occupational physicians randomly selected 3710 workers, aged 20–59, from the Pays de la Loire (PdL) region. All participants underwent a standardized clinical examination. Between 2007−2010, 1611 workers were re-examined. This study included 1246 workers who were free of six main clinically diagnosed UEMSD at baseline but were diagnosed with at least one of these UEMSD at follow-up [59% of men, mean age: 38 (standard deviation 8.6) years]. Relative risks and population-attributable fractions (PAF) were calculated using Cox multivariable models with equal follow-up time and robust variance. The total number of incident UEMSD in the PdL region was estimated after adjustment of the sample weights using 2007 census data. The estimated number of potentially avoidable UEMSD was calculated by multiplying PAF by the total number of incident UEMSD in PdL. RESULTS: At follow-up, 139 new cases of UEMSD (11% of the study sample) were diagnosed. This represented an estimated 129 320 incident cases in the PdL in 2007. Following adjustment for personal factors, 26 381 (20.4% of all incident UEMSD) were attributable to high physical exertion, 16 682 (12.9%) to low social support, and 8535 (6.6%) to working with arms above shoulder level. CONCLUSIONS: A large number and important proportion of incident UEMSD may be preventable by reducing work exposures to physical exertion and working with arms above shoulder level as well as improving social support from co-workers/supervisors.

Abstract Background Upper extremity musculoskeletal disorders (UEMSD) are one of the most common and costly occupational health problems. We aimed to assess the population-attributable fraction (PAF) of personal and occupational risk factors associated with incident UEMSD in a working population. Methods From 2002 to 2005, a random sample of 3710 workers from the Pays de la Loire region in France, aged 20–59 were included by occupational physicians (OPs). Between 2007 and 2010, 1611 workers were re-examined by their OPs. Subjects free from UEMSD at baseline were included in this study (1275 workers, mean age: 38.2 years). Cox regression models with equal follow-up time and robust variance estimates were used to estimate age-adjusted and multivariable-adjusted relative risks (RRs) and their 95% confidence intervals (CIs). Based on multivariable models, PAF associated with each factor included in the models was estimated. Results During the follow-up period, 143 (11%) cases of UEMSD were diagnosed. PAFs for factors associated with the incident UEMSD risk were 30% (7 to 51) for high physical exertion (RPE Borg scale ≥12), 12% (− 0.2 to 24) for low social support, 7% (− 3 to 17) for working with arms above shoulder level (≥2 h/day), 20% (12 to 28) for age group ≥45, 13% (3 to 22) for the age group 35–44, and 12% (0.3 to 24) for female gender. Conclusions Our study suggests that an important fraction of UEMSD can be attributed to occupational exposures after the contributions of personal and other work-related factors are considered. In terms of public health, our findings are in agreement with the ergonomic literature postulating that a high proportion of UEMSD are preventable through modifying workplace risk factors. Such information is useful to help public health practitioners and policy makers implement programs of prevention of UEMSD in the working population.

Background: Workers may be exposed to various types of occupational hazards at the same time, potentially increasing the risk of adverse health outcomes. The aim of this review was to analyze the effects of multiple occupational exposures and coexposures to chemical, biomechanical, and physical hazards on adverse health outcomes among agricultural workers. Methods: Articles published in English between 1990 and 2015 were identified using five popular databases and two complementary sources. The quality of the included publications was assessed using the methodology developed by the Effective Public Health Practice Project assessment tool for quantitative studies. Results: Fifteen articles were included in the review. Multiple chemical exposures were significantly associated with an increased risk of respiratory diseases, cancer, and DNA and cytogenetic damage. Multiple physical exposures seemed to increase the risk of hearing loss, whereas coexposures to physical and biomechanical hazards were associated with an increased risk of musculoskeletal disorders among agricultural workers. Conclusion: Few studies have explored the impact of multiple occupational exposures on the health of agricultural workers. A very limited number of studies have investigated the effect of coexposures among biomechanical, physical, and chemical hazards on occupational health, which indicates a need for further research in this area. Keywords: Agricultural workers, Coexposures, Multiple exposures, Occupational hazards

Abstract Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the working-age population. The reduction of CTS incidence in the workforce is a priority for policy makers due to the human, social and economic costs. To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for CTS. Methods Surgical CTS were assessed using regional hospital discharge records for persons aged 20–59 in 2009. Using work-related attributable fractions (AFEs), we estimated the number of work-related CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centered intervention reducing the incidence of WR-CTS arbitrarily by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical CTS by 5% and 10% by targeting personal and work risk factors. Results A limited proportion of CTS were work-related in the region’s population. WR-CTS were concentrated in nine jobs at high risk of CTS, amounting to 1603 [1137–2212] CTS, of which 906 [450–1522] were WR-CTS. The 10%-WI, 5%-GI and 10%-GI hypothetically prevented 90 [46–153], 81 [58–111] and 159 [114–223] CTS, respectively. The 10%-GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5%-GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs). Conclusion The impact of simulated workplace-based interventions suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require integrated strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.

OBJECTIVE: The aim of this study was to describe time trends of incidence/prevalence of carpal tunnel syndrome (CTS), one of the most common musculoskeletal disorders, in a French region over an 8-year period. METHODS: Three independent data sources were analyzed for the population of the Pays de la Loire region aged 20–59 between 2004 and 2011: hospital discharge records for “surgically treated CTS” (SURG-CTS), the social insurance data on “CTS compensated for as an occupational disease” (OD-CTS), and the regional surveillance program of “work-related diseases” (WRD-CTS). Case counts were analyzed using negative binomial regression models and cubic spline curves with year as the main covariate. RESULTS: The annual incidence rates of SURG-CTS decreased from 3.35 to 2.98 per 1000 person-years over the 8-year period, with an overall declining trend [-2.00%, 95% confidence interval (95% CI) -3.07– -0.91%), P

Low-back pain (LBP) stands out as the leading musculoskeletal disorder because it is both highly prevalent and the disability with which people live for the greatest number of years (1, 2). Reaching a peak between the ages of 30–50 years, LBP affects a population at a time of career advancement (3, 4). Back pain is the most expensive disease in terms of indirect costs due to sickness absence and work disability. Indirect (or productivity) costs contribute 93% to total costs, illustrating the importance of the consequences of the disease for work performance (5, 6). On a personal level, low self-motivation and self-confidence make it harder to initiate the return-to-work (RTW) process, especially when problems at work are related to the reason for sick leave (7, 8). At the workplace level, colleagues take over the tasks of the worker on sick leave, work piles up, or another worker is hired to take over the tasks. Timely RTW is thus of great benefit for both injured workers and their employers. The majority of people who experience an episode of back pain recover quickly without residual functional loss, and most of these episodes never reach the consulting room (9). Overall, it is estimated that 60–70% of patients recover within 6 weeks, and 80–90% within 12 weeks. However, recovery after 12 weeks is slow and uncertain, and fewer than half of individuals disabled >12 months return to work. After two years of absence from work, the RTW rate is close to zero (10): the longer a worker is unable to work, the greater is the probability that he/she will not return to work. Chronic LBP is not just “the same as acute back pain lasting longer”, but the result of a complex interplay of physical, psychological, social, and occupational factors. The World Health Organization’s International Classification of Functioning Disability and Health (ICF) has recognized the influence of personal and workplace factors on activity and participation levels (11). If the cause of work disability is associated with workplace factors, then a return to an unchanged workplace (with or without appropriate treatment for the disorder) may be not successful and even lead to recurrent sick leave of longer duration (12, 13). Personal and workplace factors may become RTW barriers. Management of chronic LBP thus has to take into account potential psychological and workplace RTW barriers that might hinder recovery. Key workplace factors include heavy physical demands, the inability to modify work, job stress, an unsupportive workplace, job dissatisfaction, poor expectation of RTW, and fear of re-injury (14). Key psychological factors include depressed mood, social isolation, pain catastrophizing, fear-avoidance beliefs, and low self-efficacy for managing pain (15). The recommendations for management of chronic LBP highlight the multidimensional nature of the problem. For example, the European guidelines for the management of chronic non-specific LBP recommend assessment of domains including work-related factors, psychosocial distress, and depressive mood, and point out that no single intervention is likely to be effective due to the multidimensional nature of chronic LBP (16). International guidelines therefore recommend the use of supervised active exercises, multidisciplinary approaches, cognitive-behavioral therapies, and measures of social and professional order for patients with chronic LBP (16–19). A number of exercise intervention trials for LBP have specifically targeted affected workers with the aim of facilitating a return to usual work or improving work endurance. An extensive literature review of randomized clinical trials for work conditioning programs among injured workers concluded that these types of programs were effective in reducing sick days for workers with chronic LBP compared to usual measures only when they: (i) integrated cognitive-behavioral approaches with intensive physical training (aerobic capacity, muscle strength and endurance, coordination); (ii) were in some way work-related; and (iii) were provided and supervised by either a physiotherapist or a multidisciplinary team (20). Although physical exercise can still be considered a beneficial and also a safe strategy for chronic LBP, the exact mechanisms are not yet clear and may be related to improved aspects of physical fitness, improved mood, fears and behavior, decreased sensitization, or combinations of these different mechanisms. Literature analysis suggests that it may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning program effective (21). According to a French study carried out in 2010 by the epidemiological surveillance network for musculoskeletal disorders in the Pays de la Loire region [3 601 113 inhabitants in 2014], the number of employees with LBP is very high. Using the macro Calmar, developed in SAS (SAS Institute, Cary, NC, USA) by the French National Institute of Statistics and Economic Studies (INSEE), the data from this network were extrapolated to the regional population covered by the occupational medicine (excluding some special social systems not represented in the study) to determine the extent of the phenomenon at the regional level (22). Thus, we can estimate that >268 000 employees reported backache during the preceding seven days and more than half a million (316 552 men and 244 253 women) during the 12 months preceding the survey (ie, 59.3% of men and 55.0% of women). Considering that 2–7% of people with non-specific LBP are at risk of developing chronic pain and disability in due course (23), this would indicate 11 216–39 257 employees at risk of developing severe and durable work disability. Given these statistics – and considering the recommended types of programs for chronic LBP, on the one hand, and the total amount of patient provision by multidisciplinary teams of rehabilitation centres on the other – it is obvious that we cannot meet requirements. These costly and time-consuming intensive multidisciplinary programmes can thus only be offered to a minority of the most heavily affected patients and therefore do not seem likely to respond to public health requirements (16, 18, 24). A lighter program may be one alternative strategy to full-time hospital-based programs at the same stage of treatment, with valuable results in terms of disability and occupational outcome for patients suffering from chronic LBP (24–30). More is not always better (31). It is therefore important to define both what the determining components of management are to overcome activity restriction, including occupational status, and how to include more hospital-independent programs in our healthcare systems in order to treat a larger number of patients more effectively at a lower cost and be able to offer stratified management programs adjusted to the severity of individual situations (32).