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Image-based deformation estimation is an important tool used in a variety of engineering problems, including crack propagation, fracture, and fatigue failure. These tools have been important in biomechanics research where measuring in vitro and in vivo tissue deformations are important for evaluating tissue health and disease progression. However, accurately measuring tissue deformation in vivo is particularly challenging due to limited image signal-to-noise ratio. Therefore, we created a novel deep-learning approach for measuring deformation from a sequence of images collected in vivo called StrainNet. Utilizing a training dataset that incorporates image artifacts, StrainNet was designed to maximize performance in challenging, in vivo settings. Artificially generated image sequences of human flexor tendons undergoing known deformations were used to compare benchmark StrainNet against two conventional image-based strain measurement techniques. StrainNet outperformed the traditional techniques by nearly 90%. High-frequency ultrasound imaging was then used to acquire images of the flexor tendons engaged during contraction. Only StrainNet was able to track tissue deformations under the in vivo test conditions. Findings revealed strong correlations between tendon deformation and applied forces, highlighting the potential for StrainNet to be a valuable tool for assessing rehabilitation strategies or disease progression. Additionally, by using real-world data to train our model, StrainNet was able to generalize and reveal important relationships between the effort exerted by the participant and tendon mechanics. Overall, StrainNet demonstrated the effectiveness of using deep learning for image-based strain analysis in vivo.

BACKGROUND: Workers reporting of work-related injuries or illnesses is important for treatment and prevention, yet research often focuses on reporting barriers. This study aimed to identify factors related to work-related musculoskeletal disorder (WRMSD) reporting attitudes and their connection to reporting intention and behavior. METHODS: We analyzed data from 377 direct care workers employed in 19 long-term care facilities in South Korea. A self-administered questionnaire collected demographics, job characteristics, physical and psychosocial factors, musculoskeletal symptoms, reporting attitudes, and WRMSD reporting intentions and behavior between May and August 2022. We used a generalized linear mixed model with a random intercept by employers to identify factors influencing reporting attitudes. To explore the relationship between reporting attitude and reporting intention and behavior, simple logistic regression was also conducted. RESULTS: We achieved an 86% response rate. The majority of the study participants were female (87.2%), married (95.9%), and non-immigrant (72.8%). Of the study participants, 48.9% had no intention to report WRMSDs, and 44.3% held negative reporting attitudes. Among 200 workers with WRMSDs, 86.5% did not report them. Attitudes were associated with work duration, safety training, management safety priority, WRMSD experience, and symptom severity and frequency. Management safety priority did not moderate this relationship. Significant links existed between attitudes and reporting intention and behavior. CONCLUSIONS/APPLICATIONS TO PRACTICE: This study highlights the vital influence of workers attitudes on reporting work-related injuries and illnesses. Occupational health providers should employ strategies, such as tailored safety training and management commitment, with a focus on addressing the unique needs of long-tenured and musculoskeletal-exposed workers. Fostering a safety culture that promotes open and timely reporting is crucial, and implementing these strategies can significantly enhance workplace safety and health.

Observer, manual single-frame video, and automated computer vision measures of the Hand Activity Level (HAL) were compared. HAL can be measured three ways: (1) observer rating (HALO), (2) calculated from single-frame multimedia video task analysis for measuring frequency (F) and duty cycle (D) (HALF), or (3) from automated computer vision (HALC). This study analysed videos collected from three prospective cohort studies to ascertain HALO, HALF, and HALC for 419 industrial videos. Although the differences for the three methods were relatively small on average (

BackgroundAlthough recent studies have identified important risk factors associated with incident carpal tunnel syndrome (CTS), risk factors associated with its severity have not been well explored.ObjectiveTo examine the associations between personal, workplace psychosocial and biomechanical factors and incident work disability among workers with CTS.MethodsBetween 2001 and 2010 five research groups conducted coordinated prospective studies of CTS and related work disability among US workers from various industries. Workers with prevalent or incident CTS (N=372) were followed for up to 6.4 years. Incident work disability was measured as: (1) change in work pace or work quality, (2) lost time or (3) job change following the development of CTS. Psychosocial factors were assessed by questionnaire. Biomechanical exposures were assessed by observation and measurements and included force, repetition, duty cycle and posture. HRs were estimated using Cox models.ResultsDisability incidence rates per 100 person-years were 33.2 for changes in work pace or quality, 16.3 for lost time and 20.0 for job change. There was a near doubling of risk for job change among those in the upper tertile of the Hand Activity Level Scale (HR 2.17; 95% CI 1.17 to 4.01), total repetition rate (HR 1.75; 95% CI 1.02 to 3.02), % time spent in all hand exertions (HR 2.20; 95% CI 1.21 to 4.01) and a sixfold increase for high job strain. Sensitivity analyses indicated attenuation due to inclusion of the prevalent CTS cases.ConclusionPersonal, biomechanical and psychosocial job factors predicted CTS-related disability. Results suggest that prevention of severe disability requires a reduction of both biomechanical and organisational work stressors.

Heavy load carrying of water, firewood, and sand/stones is a ubiquitous activity for women living in developing countries. Although the intra-abdominal pressure associated with heavy load carrying is hypothesized to increase the risk of pelvic organ prolapse (POP) among women, relevant epidemiologic data are lacking. We conducted a comparative study involving two exploratory cross-sectional studies among convenience samples of women carrying heavy loads, with different characteristics: (1) as part of their activities for daily living, in Shinyanga region, Tanzania; and (2) working as sand miners in Pokhara, Nepal. Women were categorized has having low or high load-carrying exposures based on the measured weights of the loads being carried at the time of the survey, as well as on self-reported duration and frequency of load carrying. A summary score for lower abdominal discomfort suggestive of POP was generated using questions from the Pelvic Organ Prolapse Distress Inventory (POPDI-6). Women with higher load carrying exposures had on average higher discomfort scores in both Tanzania (adjusted prevalence difference (PDa) = 3.7; 95% CI: -3.8-11.3; p = 0.33) and Nepal (PDa = 9.3; 95% CI: -4.9-23.6; p = 0.18). We identified trends suggestive of an association between increasing heavy load carrying exposures and symptoms of lower abdominal discomfort. Our findings underscore the need for larger epidemiologic studies of the potential adverse reproductive health effects of heavy load carrying activities on women in developing countries.

BackgroundHeavy load carrying has been associated with musculoskeletal discomfort (MSD) and disability. However, there is a lack of research investigating this association in resource-constrained settings where heavy load carrying by women is common.ObjectivesWe assessed the impact of heavy load carrying on musculoskeletal pain and disability among women in Shinyanga Region, Tanzania, in an exploratory cross-sectional study.MethodsEligible participants were a convenience sample of women, at least 18 years of age, who passed a study recruitment site carrying a load. We collected information on load-carrying practices, including frequency and time spent carrying water, wood, agricultural products, coal, sand, or rocks, and measured the weight of the load carried at the time. Outcomes included self-reported MSDs, defined as experiencing pain lasting >3 days in the neck, head, back, knees, feet and/or ankles within the last 1 year, and related disability. Using multivariable logistic regression we assessed for associations between load carrying exposures and MSDs and disability.FindingsResults showed a high prevalence of MSDs across the body regions assessed and evidence to suggest a relationship of back pain and related disability with several measures of load-carrying, including duration, frequency, and weight. Multivariable analyses revealed associations of increased load carrying exposures with low back pain (LBP) and related disability, including statistically significant increases in odds of LBP with increasing weight, total duration of load carrying/week and cumulative loads/week.ConclusionsFindings indicate a substantial burden of MSDs and disability in this population of women who carry heavy loads daily. The extent of discomfort and disability increased with increasing exposure to various load-carrying measures, especially for LBP. Larger epidemiologic studies that definitively assess relationships of load carrying with MSDs and disability are warranted.

Recent studies have shown the 2001 American Conference of Governmental Industrial Hygienists (ACGIH®) Threshold Limit Value (TLV®) for Hand Activity was not sufficiently protective for workers at risk of carpal tunnel syndrome (CTS). These studies led to a revision of the TLV and Action Limit. This study compares the effect of applying the 2018 TLV vs. the 2001 TLV to predict incident CTS within a large occupational pooled cohort study (n = 4,321 workers). Time from study enrollment to first occurrence of CTS was modeled using Cox proportional hazard regression. Adjusted and unadjusted hazard ratios for incident CTS were calculated using three exposure categories: below the Action Limit, between the Action Limit and TLV, and above the TLV. Workers exposed above the 2001 Action Limit demonstrated significant excess risk of carpal tunnel syndrome, while the 2018 TLV demonstrated significant excess risk only above the TLV. Of 186 total cases of CTS, 52 cases occurred among workers exposed above the 2001 TLV vs. 100 among those exposed above the 2018 value. Eliminating exposures above the 2001 TLV might have prevented 11.2% of all cases of CTS seen in our pooled cohort, vs. 25.1% of cases potentially prevented by keeping exposures below the 2018 value. The 2018 revision of the TLV better protects workers from CTS, a recognized occupational health indicator important to public health. A significant number of workers are currently exposed to forceful repetitive hand activity above these guidelines. Public health professionals should promulgate these new guidelines and encourage employers to reduce hand intensive exposures to prevent CTS and other musculoskeletal disorders.

BACKGROUND:There is growing use of a job exposure matrix (JEM) to provide exposure estimates in studies of work-related musculoskeletal disorders; few studies have examined the validity of such estimates, nor did compare associations obtained with a JEM with those obtained using other exposures. OBJECTIVE:This study estimated upper extremity exposures using a JEM derived from a publicly available data set (Occupational Network, O*NET), and compared exposure-disease associations for incident carpal tunnel syndrome (CTS) with those obtained using observed physical exposure measures in a large prospective study. METHODS:2393 workers from several industries were followed for up to 2.8 years (5.5 person-years). Standard Occupational Classification (SOC) codes were assigned to the job at enrolment. SOC codes linked to physical exposures for forceful hand exertion and repetitive activities were extracted from O*NET. We used multivariable Cox proportional hazards regression models to describe exposure-disease associations for incident CTS for individually observed physical exposures and JEM exposures from O*NET. RESULTS:Both exposure methods found associations between incident CTS and exposures of force and repetition, with evidence of dose-response. Observed associations were similar across the two methods, with somewhat wider CIs for HRs calculated using the JEM method. CONCLUSION:Exposures estimated using a JEM provided similar exposure-disease associations for CTS when compared with associations obtained using the 'gold standard' method of individual observation. While JEMs have a number of limitations, in some studies they can provide useful exposure estimates in the absence of individual-level observed exposures.

BackgroundBetween 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.ObjectiveThis analysis examined the presence and magnitude of confounding between biomechanical and workplace psychosocial factors and incidence of dominant-hand CTS.Methods1605 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.ResultsThere 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.ConclusionsAlthough 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.

BackgroundFew large epidemiologic studies have used rigorous case criteria, individual-level exposure measurements, and appropriate control for confounders to examine associations between workplace psychosocial and biomechanical factors and carpal tunnel syndrome (CTS).MethodsPooling data from five independent research studies, we assessed associations between prevalent CTS and personal, work psychosocial, and biomechanical factors while adjusting for confounders using multivariable logistic regression.ResultsPrevalent CTS was associated with personal factors of older age, obesity, female sex, medical conditions, previous distal upper extremity disorders, workplace measures of peak forceful hand activity, a composite measure of force and repetition (ACGIH Threshold Limit Value for Hand Activity Level), and hand vibration.ConclusionsIn this cross-sectional analysis of production and service workers, CTS prevalence was associated with workplace and biomechanical factors. The findings were similar to those from a prospective analysis of the same cohort with differences that may be due to recall bias and other factors.

A job exposure matrix may be useful for the study of biomechanical workplace risk factors when individual-level exposure data are unavailable. We used job title-based exposure data from a public data source to construct a job exposure matrix and test exposure-response relationships with prevalent carpal tunnel syndrome (CTS). Exposures of repetitive motion and force from the Occupational Information Network were assigned to 3,452 active workers from several industries, enrolled between 2001 and 2008 from 6 studies. Repetitive motion and force exposures were combined into high/high, high/low, and low/low exposure groupings in each of 4 multivariable logistic regression models, adjusted for personal factors. Although force measures alone were not independent predictors of CTS in these data, strong associations between combined physical exposures of force and repetition and CTS were observed in all models. Consistent with previous literature, this report shows that workers with high force/high repetition jobs had the highest prevalence of CTS (odds ratio = 2.14-2.95) followed by intermediate values (odds ratio = 1.09-2.27) in mixed exposed jobs relative to the lowest exposed workers. This study supports the use of a general population job exposure matrix to estimate workplace physical exposures in epidemiologic studies of musculoskeletal disorders when measures of individual exposures are unavailable.

BackgroundSix 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.ObjectiveThis paper provides a detailed description of the characteristics of the pooled physical exposure variables and the source data information from the individual research studies.MethodsPhysical 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.ResultsAt 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.ConclusionsThe 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.

ObjectiveEvaluate associations between personal and workplace factors and median nerve conduction latency at the wrist.MethodsBaseline data on workplace psychosocial and physical exposures were pooled from four prospective studies of production and service workers (N = 2396). During the follow-up period, electrophysiologic measures of median nerve function were collected at regular intervals.ResultsSignificant adjusted associations were observed between age, body mass index, sex, peak hand force, duration of forceful hand exertions, Threshold Limit Value for Hand Activity Limit, forceful repetition rate, wrist extension, and decision latitude on median nerve latencies.ConclusionsOccupational and nonoccupational factors have adverse effects on median nerve function. Measuring median nerve function eliminates possible reporting bias that may affect symptom-based carpal tunnel syndrome case definitions. These results suggest that previously observed associations between carpal tunnel syndrome and occupational factors are not the result of such reporting bias.

Background Between 2001 and 2010, five research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries and collected detailed subject-level exposure information with follow-up of

ObjectiveTo analyze differences in carpal tunnel syndrome (CTS) prevalence using a combination of electrodiagnostic studies (EDSs) and symptoms using EDS criteria varied across a range of cutpoints and compared with symptoms in both ≥1 and ≥2 median nerve-served digits.DesignPooled data from 5 prospective cohorts.SettingHand-intensive industrial settings, including manufacturing, assembly, production, service, construction, and health care.ParticipantsEmployed, working-age participants who are able to provide consent and undergo EDS testing (N=3130).InterventionsNone.Main outcome measuresCTS prevalence was estimated while varying the thresholds for median sensory latency, median motor latency, and transcarpal delta latency difference. EDS criteria examined included the following: median sensory latency of 3.3 to 4.1 milliseconds, median motor latency of 4.1 to 4.9 milliseconds, and median-ulnar sensory difference of 0.4 to 1.2 milliseconds. EDS criteria were combined with symptoms in ≥1 or ≥2 median nerve-served digits. EDS criteria from other published studies were applied to allow for comparison.ResultsCTS prevalence ranged from 6.3% to 11.7%. CTS prevalence estimates changed most per millisecond of sensory latency compared with motor latency or transcarpal delta. CTS prevalence decreased by 0.9% to 2.0% if the criteria required symptoms in 2 digits instead of 1.ConclusionsThere are meaningful differences in CTS prevalence when different EDS criteria are applied. The digital sensory latency criteria result in the largest variance in prevalence.

ObjectivesThis 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).MethodsManufacturing 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.ResultsThe 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.ConclusionThose 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.

Work-related musculoskeletal disorders (WMSDs) are a major health concern in the construction industry. Occupational exoskeletons (EXOs) are a promising ergonomic intervention to help reduce WMSD risk. Their adoption, however, has been low in construction. To understand the contributing factors to EXO use-intention and assist in future decision-making, we built decision trees to predict responses to each of three EXO use-intention questions (Try, Voluntary Use, and Behavioural Intention), using online survey responses. Variable selection and hyperparameter tuning were used respectively to reduce the number of potential predictors and improve prediction performance. The importance of variables in each final tree was calculated to understand which variables had a greater influence. The final trees had moderate prediction performance. The root node of each tree included EXOs becoming standard equipment, fatigue reduction, or performance increase. Important variables were found to be quite specific to different decision trees. Practical implications of the findings are discussed. Practitioner summary: This study used decision trees to identify key factors influencing the use-intention of occupational exoskeletons (EXOs) in construction, using online survey data. Key factors identified included EXOs becoming standard equipment, fatigue reduction, and performance improvement. Final trees provide intuitive visual representations of the decision-making process for workers to use EXOs. [ABSTRACT FROM AUTHOR]