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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.

Introduction: With recent higher awareness of the necessity of improving healthcare workers’ well-being, we aimed to overview systematic reviews dealing with interventions on well-being, occupational health, and aging of healthcare workers. Methods: From three databases (PubMed, Embase, and Web of Science), a scoping review of systematic reviews was carried out to determine current knowledge on interventions focused on the well-being or aging of healthcare workers. Only systematic reviews were considered, with appropriate extraction and quality evaluation. Results: Of the total of 445 references identified, 10 systematic reviews were included, mostly published since 2019. Nurses were the most frequent targets of interventions, and mental health was the main outcome described. The overall level of quality was also heterogenous, with high to low-quality reviews. Conclusions: Workers' mental health well-being was the major outcome targeted by intervention, with varying level of evidence. Further studies are needed with integrative approaches on global health and life course perspectives, with a focus on the plurality of settings, worker types, and women.

Abstract Background Breast cancer (BC) treatments and related symptoms may affect return to work (RTW). The objective of this study was to investigate the impact of BC care pathways (timing and sequence of treatments) and related symptoms on RTW. Methods The study population included working-age women with BC who were enrolled in the French CONSTANCES cohort from 2012 to 2018. BC treatments, antidepressant/anxiolytic and antalgic drug deliveries (used as proxies of depression and pain, respectively) and statutory sick pay (used to estimate RTW and time to RTW) were assessed monthly using data from the French national healthcare system database. BC care pathways were identified with the sequence analysis method. Cox models with time-dependent covariates were used to investigate the impact of BC care pathways and related symptoms on RTW and time to RTW, after adjusting for age and socioeconomic characteristics. Results 73.2% (231/303) of women returned to work within 2 years after BC diagnosis. Five BC care pathway patterns were identified: (i) BC surgery only, (ii) BC surgery and radiotherapy, (iii) BC surgery and chemotherapy, (iv) BC surgery and chemotherapy and radiotherapy, and (v) BC surgery and long-term alternative chemotherapy/radiotherapy. The hazards ratios of non-RTW were significantly higher for women who received BC surgery and long-term alternative chemotherapy/radiotherapy and for > 55-year-old women. Time to RTW was significantly longer in women who received chemotherapy (patterns iii to v) and in women with antidepressant/anxiolytic and antalgic drug deliveries. Conclusion This study highlights the value of considering the dynamic, cumulative and temporal features of BC care pathways and related symptoms to facilitate the RTW of women with BC.

Abstract Background This study examined prospective associations between atypical working hours with subsequent tobacco, cannabis and alcohol use as well as sugar and fat consumption. Methods In the French population-based CONSTANCES cohort, 47,288 men and 53,324 women currently employed included between 2012 and 2017 were annually followed for tobacco and cannabis use. Among them, 35,647 men and 39,767 women included between 2012 and 2016 were also followed for alcohol and sugar and fat consumption. Three indicators of atypical working hours were self-reported at baseline: working at night, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to atypical working hours at baseline while adjusting for sociodemographic factors, depression and baseline substance use when appropriate. Results Working at night was associated with decreased smoking cessation and increased relapse in women [odds ratios (ORs) of 0.81 and 1.25], increased cannabis use in men [ORs from 1.46 to 1.54] and increased alcohol use [ORs from 1.12 to 1.14] in both men and women. Weekend work was associated with decreased smoking cessation in women [ORs from 0.89 to 0.90] and increased alcohol use in both men and women [ORs from 1.09 to 1.14]. Non-fixed hours were associated with decreased smoking cessation in women and increased relapse in men [ORs of 0.89 and 1.13] and increased alcohol use in both men and women [ORs from 1.12 to 1.19]. Overall, atypical working hours were associated with decreased sugar and fat consumption. Conclusions The potential role of atypical working hours on substance use should be considered by public health policy makers and clinicians in information and prevention strategies.

This article aims to examine how the organisational work of owner-managers in microenterprises might include prevention features, as part of their operational strategies when regulating customer and production variability. The notion of an owner-manager’s organisational work allows us... to investigate the notion of informal prevention, integrated into their work organisation, while considering performance, restaurant cost effectiveness and employee health. The methodology is based on a descriptive qualitative analysis, with an ergonomic perspective. We analysed ten operating strategies implemented by two owner-managers during work situations encountered at lunchtime in their establishments. Data collection mainly consisted of individual self-confrontations based on videos made during observation phases. The results show that their operating strategies provide a favourable environment for managing work situations that involve a high variability linked to customer demands. However, the owner-managers’ health may be harmed by these operational strategies, which expose them to constraints and raise the question of the resources needed for them to be able to protect themselves.

OBJECTIVES: Musculoskeletal disorders (MSD) represent a major public health issue, affecting more then 40 million European workers in 2017. The overall aging of the working population is expected to increase the burden of disease, but temporal changes in exposures or diagnosis may also drive the global trends in MSD. We therefore conducted a systematic review to summarize the evidence on the role of demographic and temporal changes in the occurrence of MSD. METHODS: We conducted a systematic review of articles reporting temporal trends in MSD in the general working-age population. Only articles controlling for age in the analysis were included. The risk of bias was assessed. The main indicators extracted were age-controlled time trends in MSD incidence or prevalence. RESULTS: Among 966 articles, 16 fulfilled the inclusion criteria, representing 23 results according to the indicators extracted. No study was found with a high risk of bias. Results presenting time trends in prevalence were found in 12 studies and incidence in 11. After controlling for age, the reported temporal trends varied, mostly between non-monotonic changes (N=12/23) and increases (N=10/23). One article also highlighted an increase among women and non-monotonic changes among men (N=1/23). Several factors other than aging were suggested to explain temporal trends in MSD, mainly trends in obesity, changing occupational exposures, and cultural factors regarding pain tolerance. CONCLUSION: This review shows that different kind of factors in addition to aging may contribute to varying or increasing trends in MSD. This review also highlighted the scarcity of evidence regarding time trends in the burden of MSD and their underlying causes.

Abstract We examined the prospective association of physical exertion at work with subsequent tobacco, cannabis, alcohol use, and sugar and fat consumption. Volunteers of the French population-based CONSTANCES cohort currently employed were included from 2012 to 2017 for tobacco and cannabis outcomes (n = 100,612), and from 2012 to 2016 for alcohol and sugar and fat outcomes (n = 75,414). High level of physical exertion at work was defined as a score ≥ 12 at the Rating Perceived Exertion Borg scale. Substance use was self-reported and diet rich in sugar and fat was obtained from principal component analysis and analyzed as quartiles. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to baseline physical exertion at work, while adjusting for sociodemographic factors, depressive symptoms and baseline level of consumption. High physical exertion was associated with tobacco use with dose-dependent relationships. It was also associated with increased odds of cannabis use at least once per month compared to no use in the past and with increased odds of diet rich in sugar and fat. Hence, the role of physical exertion at work on tobacco and cannabis use and diet rich in sugar and fat should be tackled for information and prevention strategies.

Abstract Background International consensus is needed on case definitions of work-related musculoskeletal disorders and diseases (MSDs) for use in epidemiological research. We aim to: 1) study what information is needed for the case definition of work-related low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral and medial elbow tendinopathy, and knee and hip osteoarthritis, and to 2) seek consensus among occupational health professionals/researchers regarding the case definitions of these work-related MSDs. Methods A two-round Delphi study was conducted with occupational health professionals/researchers from 24 countries. Definition of work-related MSDs were composed of a case definition with work exposures. Round 1 included 32 case definitions and round 2, 60 case definitions. After two rounds, consensus required 75% of the panellists to rate a case definition including work exposures ≥7 points on a 9-point rating scale (completely disagree/completely agree). Results Fifty-eight panellists completed both rounds (response rate 90%). Forty-five (70%) panellists thought that for LBP a case definition can be based on symptoms only. Consensus was only reached for work-related medial elbow tendinopathy, while the lowest agreement was found for knee osteoarthritis. Where consensus was not reached, this was – except for LBP - related to physical examination and imaging rather than disagreement on key symptoms. Conclusion Consensus on case definitions was reached only for work-related medial elbow tendinopathy. Epidemiological research would benefit from harmonized case definitions for all MSDs including imaging and physical examination for LRS, SAPS, CTS, lateral elbow tendinopathy and hip and knee osteoarthritis.

Objective Cold environments are a potential risk factor for stroke. The aim of this study was to investigate the association between performing work tasks in cold environments and the occurrence of a first stroke event.Methods From the French population-based cohort CONSTANCES (‘Cohorte des consultants des Centres d'examens de santé’ in French), we collected data from baseline questionnaires along with medical interviews on cardiovascular risk factors and reported exposure to cold temperatures (

AimsTo examine the longitudinal associations between cannabis use and risks of short (28 days) sickness absences at one-year follow-up.Methods87,273 participants aged 18-65 years from the French CONSTANCES cohort reported their frequency of cannabis use at inclusion between 2012 and 2018. Sickness absences occurring during one year of follow-up were collected from national medico-administrative registries. Multivariable generalized linear regressions were used to compute the Odds Ratios (OR) with their 95% Confidence Intervals (CI) of having at least one sickness absence at follow-up compared to no sickness absence, while controlling for sociodemographic factors, chronic conditions and occupational factors.ResultsCannabis use more than once a month was associated with an increased risk of short (OR, [95% CI]: 1.56 [1.32–1.83]) and medium (1.29 [1.07–1.54]) sickness absences at one-year follow-up, with dose-dependent relationships for short sickness absences (1.13 [1.08–1.18], p-for-trend

Abstract Background The aim of this study was to identify case definitions of diagnostic criteria for specific musculoskeletal disorders (MSDs) for use in occupational healthcare, surveillance or research. Methods A scoping review was performed in Medline and Web of Science from 2000 to 2020 by an international team of researchers and clinicians, using the Arksey and O’Malley framework to identify case definitions based on expert consensus or a synthesis of the literature. Seven MSDs were considered: non-specific low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral or medial elbow tendinopathy, and knee and hip osteoarthritis (OA). Case definitions for occupational healthcare or research were charted according to symptoms, signs and instrumental assessment of signs, and if reported, on work-related exposure criteria. Results In total, 2404 studies were identified of which 39 were included. Fifteen studies (38%) reported on non-specific LBP, followed by knee OA (n = 8;21%) and CTS (n = 8;21%). For non-specific LBP, studies agreed in general on which symptoms (i.e., pain in lower back) and signs (i.e., absence of red flags) constituted a case definition while for the other MSDs considerable heterogeneity was found. Only two studies (5%), describing case definitions for LBP, CTS, and SAPS and lateral and medial elbow tendinopathy respectively, included work-related exposure criteria in their clinical assessment. Conclusion We found that studies on non-specific LBP agreed in general on which symptoms and signs constitute a case definition, while considerable heterogeneity was found for the other MSDs. For prevention of work-related MSDs, these MSD case definitions should preferably include work-related exposure criteria.

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.

OBJECTIVES: A job exposure matrix (JEM) is a tool to estimate workers’ exposure to occupational physical risk factors. We evaluated the performance of two general population JEM (CONSTANCES and O*NET) to detect known exposure–disease relationships in an American prospective cohort study. We compared exposure estimates from three data sources and explored whether combining exposures from these two JEM, or combining exposure from each JEM with individual-level measures, improved prediction of carpal tunnel syndrome (CTS). METHODS: Using Cox proportional hazard models, we evaluated relationships between physical work exposure and incident CTS of 2393 workers using JEM-assigned and individual-level measure exposure information. We compared exposure estimates using Spearman’s rank correlation and Cohen’s kappa. We compared combined exposure models to single source exposure models by using binomial logistic regression and examined differences based on model fit and performance. RESULTS: The O*NET JEM [hazard ratio (HR) range 1.3–2.01] demonstrated generally similar exposure–disease associations as individual-level measures (HR range 1.00–1.42); we found fewer associations with the CONSTANCES JEM (HR range 1.08–2.05). Comparisons between the three sources showed stronger correlations and agreement at the job versus worker level. Combined models improved goodness-of-fit and had lower Akaike information criterion (AIC) values compared to single-source models. CONCLUSIONS: JEM can be applied cross nationally and there is potential to combine complementary exposure methods to improve estimation of workplace physical exposures in the prediction of CTS. More investigations are needed to explore exposure-disease associations in other samples and combinations of exposure data from different methods.

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: Exploratory study to investigate whether co-exposure to physical wrist stressors and chemicals is associated with carpal tunnel syndrome (CTS) in French male farmers and agricultural workers. Methods: Cross-sectional study of 711 men aged 30–65 years and working as either farmers or agricultural workers in 2009–2010 within a cohort covered by the French Agricultural Workers' and Farmers' Mutual Benefit Fund. CTS and exposure to physical wrist stressors and chemicals were assessed using a self-administered questionnaire. Associations between CTS and personal/medical factors, exposure to physical wrist stressors, exposure to chemicals, and co-exposure to physical wrist stressors and chemicals were studied using multivariate logistic regression models. Results: Forty-four men {5.6% [95% confidence interval (CI) 4.0–7.7]} reported that they had suffered from unilateral/bilateral CTS during the last 12 months. CTS was associated with age, current smoking [odds ratio (OR) = 2.1 (1.0–4.5)], and exposure to physical wrist stressors [OR = 2.6 (1.1–5.9)]. An association was found between CTS and co-exposure to physical wrist stressors and chemicals [OR = 3.3 (0.8–14.3), p = 0.044] in comparison with the no-exposure group. Conclusions: This exploratory study shows an association of CTS with exposure to biomechanical wrist stressors in male farmers and agricultural workers and suggests an association of CTS with co-exposure to physical wrist stressors and chemicals. Owing to the limitations of the study, this result must be confirmed by a prospective study with objective assessments of the outcome and exposure before drawing conclusions on the possible synergistic effects of mechanical stressors and chemicals on the impairment of the median nerve. Keywords: Carpal tunnel syndrome, Chemicals, Co-exposure, Multiple exposure, Physical risk factors

Abstract Background Data are lacking regarding the prevalence of benzodiazepine long-term use in the general population. Our aim was to examine the prevalence of prescribed benzodiazepine long-term use (BLTU) according to sociodemographic and clinical factors in the French general population. Methods Data came from 4686 men and 4849 women included in 2015 in the French population-based CONSTANCES cohort. BLTU was examined using drug reimbursement administrative registries from 2009 to 2015. Analyses were weighted to provide results representative of the French general population covered by the general health insurance scheme. Weighted prevalence of BTLU and weighted Odds Ratios (OR) of having BTLU were computed with their 95% Confidence Interval (95% CI) according to age, education level, occupational status, occupational grade, household income, marital status, alcohol use disorder risk and depressive symptoms. All the analyses were stratified for gender. Results Weighted prevalence of BLTU were 2.8%(95% CI:2.3–3.4) and 3.8%(95% CI: 3.3–4.5) in men and women, respectively. Compared to men, women had an increased risk of having benzodiazepine long-term use with OR = 1.34(95% CI = 1.02–1.76). Aging, low education, not being at-work, low occupational grade, low income, being alone and depressive state were associated with increased risks of having BTLU. Conclusions BLTU is widespread in the French general population, however this issue may particularly concern vulnerable subgroups. These findings may help in raising attention on this public health burden as well as targeting specific at-risk subgroups in preventive intervention.

We have read with great interest the two editorials by Burdorf et al: “The COVID-19 pandemic: one year later – an occupational perspective” (1) and “The COVID-19 (Coronavirus) pandemic: consequences for occupational health” (2). The authors highlight the importance of the societal consequences of the outbreak and changes in the world of work to manage occupational health. The key points identified – such as individual socio­economic factors, psychological effects and occupations with highest risk of contamination – modify return-to-work approaches. It is estimated that around 800 million people of working age worldwide were living with disabilities before the SARS-CoV-2 pandemic. In early January 2021, the cumulative COVID-19 hospitalisation rate reached 207.4/100 000 (18–49-year-olds) and 505.7/100 000 (50–64-year-olds), respectively, in the United States (3). In France, the hospitalisation rate was 411.5/100 000 across all ages (4). A recent cohort study of working-age men who were hospitalised for COVID-19 highlighted the long-term health consequences of such a disease (5). The SARS-CoV-2 pandemic creates new challenges for occupational health, shifting attention away from return-to-work after health problems to resuming work during an outbreak, dealing with lockdown, and taking special account of workers with vulnerabilities (6, 7). We recommend considering three different aspects of occupational medicine during a pandemic. Firstly, for most workers at high-risk of severe COVID-19, the issues of work disability and resuming work had never occurred before the epidemic. Recommendations such as physical and social distancing and wearing a facemask are highly advisable to protect against infection but may not be enough to enable some individuals to resume work. Therefore, decision-making requires individual comprehensive assessments of the underlying medical condition, the SARS-CoV-2 contamination risk associated with either regular work or teleworking, and vaccination opportunities. The second situation concerns workers who have suffered from COVID-19. Preliminary studies suggest that long recovery duration is related to high severity (7), but this is still a matter of debate for patients suffering from “long COVID-19” (5, 8, 9), a condition for which the long-term effects remain unknown. Any long-running recovery must be considered to be a potential sign of long COVID-19. These long-lasting syndromes occur among patients with severe symptoms but have also been reported independently of acute phase severity, hospitalisation and receiving medical oxygen (8, 9). Researchers worldwide are currently investigating such syndromes. Strategies promoting return to work for these workers will need to be implemented and could be similar to programmes developed for other chronic conditions. Moreover, numerous more serious sequelae following critical illness suggest the need for enhanced support by rehabilitation and occupational health specialists. Finally, the consequences of the epidemic must be evaluated over time for people who suffered from functional limitations before COVID-19 as their physical and mental condition may be modified by the epidemic and, specifically, the consequences of lockdown (10). In all of these situations, medical, social, financial and working contexts are key elements. In addition to a medical assessment, the use of scales such as the Work Ability Index (WAI) (11) or the Work Productivity and Activity Impairment (WPAI) (12) can help perform long-term follow-up and provide information about work capacity and workload. It also gives a “back to basics” perspective, urging politicians to move towards a `decent-work-for-all` policy, as advocated by the United Nation`s Sustainable Development Goal (SDG) 8, which the WHO has endorsed (13). References 1. Burdorf A, Porru F, Rugulies R. The COVID-19 pandemic: one year later – an occupational perspective. Scand J Work Environ Health – online first. https://doi.org/10.5271/sjweh.3956 2. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020;46(3):229–230. https://doi:org/10.5271/sjweh.3893. 3. COVID-19 Hospitalizations [Internet]. Available from: https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html 4. COVID-19 in France, vaccine and allergy management in occupational setting. Descatha A et al. Arch Mal Prof Environ 2021. Accepted for publication. 5. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397(10270):220-32 https://doi.org/10.1016/S0140-6736(20)32656-8 6. Shaw WS, Main CJ, Findley PA, Collie A, Kristman VL, Gross DP. Opening the Workplace After COVID-19: What Lessons Can be Learned from Return-to-Work Research? J Occup Rehabil. 2020;30(3):299–302. https://doi.org/10.1007/s10926-020-09908-9 7. Taylor T, Das R, Mueller K, Pransky G, Christian J, Orford R, et al. Safely Returning America to Work: Part I: General Guidance for Employers. J Occup Environ Med. 2020;62(9):771–9. https://doi.org/10.1097/JOM.0000000000001984 8. Carfì A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603–5. https://doi.org/10.1001/jama.2020.12603 9. Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI, Files DC, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network - United States, March-June 2020. MMWR Morb Mortal Wkly. 2020;69(30):993–8. https://doi.org/10.15585/mmwr.mm6930e1 10. Chudasama YV, Gillies CL, Zaccardi F, Coles B, Davies MJ, Seidu S, et al. Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr. 2020;14(5):965–7. https://doi.org/10.1016/j.dsx.2020.06.042 11. Tuomi K. Eleven-year follow-up of aging workers. Scand J Work Environ Health. 1997;23(1):1–71. 12. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics. 1993;4(5):353–65. https://doi.org/10.2165/00019053-199304050-00006 13. Organization WH. Health in the 2030 agenda for sustainable development. Sixty-Ninth World Health Assembly. Document A. 2016, p69.

The study aimed to assess the proportion mediated by the duration of exposure to ergonomic factors at work on the relationship between socioeconomic position (SEP) and low walking speed. This cross-sectional study was performed on data collected at baseline on 19,704 men and 20,273 women 45–70 years old, currently or previously employed, enrolled in the Constances cohort. SEP was assigned through current or last occupation, categorized in three classes, based on the European Socioeconomic Classification. Walking speed was assessed through one measurement of normal walking for 3 m and dichotomized at the lowest quintile of the sex- and age- (5-year) specific distribution. Self-reported workplace exposure throughout working life to repetitive work, intense physical work, and lifting/carrying heavy loads was used to assess the duration of exposure to each factor, categorized in four classes. Through Poisson regression models, adjusted for BMI, smoking, alcohol intake, hypertension, physical activity, diabetes, cardiovascular diseases, and a cognitive score, the attenuation in the prevalence ratio (PR) of low walking speed by SEP produced by the inclusion of duration of exposure to each factor was evaluated. The mediating effect of work ergonomic exposures on the relationship between SEP and low walking speed was assessed using the weighted method by Vanderweele. In the fully adjusted model without ergonomic exposures, both men and women in the middle and the lowest SEP had a significantly increased risk of low walking speed compared with those in the highest SEP (men: PR = 1.30 and PR = 1.46, respectively; women: PR = 1.24 and PR = 1.45, respectively). The inclusion in separate regression models of exposure duration to repetitive work, intense physical work, and handling of heavy loads produced modest risk attenuations in both men and women, all smaller or around 10%. Mediation analysis revealed in both sexes significant mediation effects for most ergonomic exposures considered, although also with low mediation effects. Significant differences in walking speed by SEP were observed in this large sample, but the proportion of such differences explained by the duration of exposure to ergonomic factors at work was low using either the risk attenuation or the mediation analysis methods.

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of individual experts. Evidence from mechanistic data and prior studies suggests that exposure to long working hours may cause stroke. In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from stroke that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates. Objectives: We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41–48, 49–54 and ≥55 h/week), compared with exposure to standard working hours (35–40 h/week), on stroke (three outcomes: prevalence, incidence, and mortality). Data sources: A protocol was developed and published, applying the Navigation Guide to systematic reviews as an organizing framework where feasible. We searched electronic databases for potentially relevant records from published and unpublished studies, including Ovid MEDLINE, PubMed, EMBASE, Scopus, Web of Science, CISDOC, PsycINFO, and WHO ICTRP. We also searched grey literature databases, Internet search engines, and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. Study eligibility and criteria: We included working-age (≥15 years) individuals in the formal and informal economy in any WHO and/or ILO Member State but excluded children (aged

Background Long‐working hours (LWH) are a probable risk factor for ischemic heart diseases (IHD); however, no previous study has considered duration of exposure to LWH when addressing this topic. We aimed to determine the association between cumulative exposure to LWH and IHD while accounting for relevant confounders. Methods and Results In this retrospective study, we included all baseline participants from the French population‐based cohort CONSTANCES. Part‐time employees and those who reported a cardiac event in the 5 years before LWH exposure were excluded. From self‐administered questionnaires and clinical examinations, we obtained participants’ age, sex, body mass index, occupational status, smoking habits, high blood pressure, diabetes mellitus, familial history of cardiovascular disease, dyslipidemia, exposure to LWH, and its duration. We defined LWH as working for >10 hours daily for at least 50 days per year. The main outcome was reported history of IHD, ie, myocardial infarction or angina pectoris, during a clinical examination. Of 137 854 included participants, 69 774 were men. There were 1875 cases (1.36%) of IHD, and exposure to LWH was reported by 42 462 subjects (30.8%) among whom 14 474 (10.50%) reported exposure for at least 10 years. Overall, exposure to LWH for ≥10 years was associated with an increased risk of IHD, adjusted odds ratio (aOR) 1.24 (1.08–1.43), P=0.0021. In stratified analyses, this effect was not observed in women, but was significant amongst men, aOR 1.28 (1.11–1.48), P=0.0008. Conclusions This large population‐based study supports an association between cumulative exposure to LWH and IHD in men. Future research should consider relevant strategies for reducing LWH exposure and duration.

ObjectiveTo investigate the effects of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS in a large cohort of French workers.MethodsProspective study using the data collected at baseline and at the first 12 month-follow-up for the 18,018 participants included in the population-based Constances cohort between 2012 and 2015. CTS at follow-up and exposure to biomechanical wrist stressors and chemicals at baseline were assessed using a self-administered questionnaire. Associations between CTS and co-exposure to biomechanical wrist stressors and chemicals were studied using multivariate logistic regression models, adjusted for personal/medical factors.Results184 men (2.1%, 95%CI 1.8-2.4) and 331 women (3.6%, 3.2-3.9) free from chronic hand symptoms at baseline declared suffering from unilateral/bilateral CTS at follow-up. A potentiating effect of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS was found for both genders, with higher OR in the co-exposure group (OR = 3.38 [2.29-5.01] in men and OR = 4.12 [2.73-6.21] in women) than in the biomechanical exposure group (OR = 2.14 [1.51-3.03] in men and OR = 2.19 [1.72-2.78] in women) compared to no exposure group.ConclusionsThe study showed an association between CTS and co-exposure to biomechanical wrist stressors and chemicals, after adjustment for the main personal and medical factors. This finding should be confirmed using more objective case definition of CTS and assessment of the chemical exposure before drawing conclusions on the possible synergistic effects of mechanical stressors and chemical on the median nerve.

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

Background: Chronic silica exposure can lead to silicosis, complicated or not by autoimmune diseases (AID). The pathophysiology of silica-induced AID remains not fully understood, especially immune mechanisms that may develop in patients without yet established silicosis. We conducted a prospective clinical study to analyze the impact of crystalline silica (CS) on T cell phenotype and regulatory T cells (Tregs) frequency, as well as on auto-antibodies development in non-silicotic workers exposed to CS.Methods: Workers with moderate to high exposure level to CS and aged between 30 and 60 years-old were considered for inclusion. Peripheral blood mononuclear cells were analyzed by flow cytometry. Auto-antibodies were screened in serum by immunofluorescence. Blood from 42 and 45 healthy subjects (HC) was used as control for T cell phenotype and serum analyses, respectively.Results: Among the 63 included workers exposed to CS, 55 had full data available and were analyzed. Ten were exposed to CS for

The Musculoskeletal Disorder (MSD) risk assessment tools currently used in industries to identify critical situations have shown biases related to the variability of results. The validity and reliability of targeting risk situations with these simple tools are questionable, which might bias the orientation given to the prevention of MSD. This study explores known indicators regarding MSD risk assessment together with notions of regulation and situational operational leeway (SOL). In a sample of selected work situations in the metallurgy industry, we therefore compared the SOL indicators using two semi-quantitative and qualitative methods to determine the level of SOL sufficiency for each situation. The results of these two methods show differences in judgment. These methods nevertheless provide additional information that complement simple MSD risk assessment tools. We propose ways to improve semi-quantitative methods to target critical situations as from the MSD risk assessment phase.

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

BACKGROUND:Substance use is more prevalent among unemployed subjects compared to employed ones. However, quantifying the risk subsequent of job loss at short-term according to substance use remains underexplored as well as examining if this association persist across various sociodemographic and occupational positions previously linked to job loss. We examined this issue prospectively for alcohol, tobacco, cannabis use and their combination, among a large population-based sample of men and women, while taking into account age, gender, overall health status and depressive symptoms. METHODS:From the French population-based CONSTANCES cohort, 18,879 working participants were included between 2012 and 2016. At baseline, alcohol use disorder risk according to the Alcohol Use Disorders Identification Test (mild, dangerous, problematic or dependence), tobacco (non-smoker, former smoker, 1-9, 10-19, >19 cigarettes/day) and cannabis use (never, not in past year, less than once a month, once a month or more) were assessed. Employment status at one-year (working versus not working) was the dependent variable. Logistic regressions provided Odds Ratios(OR(95%CI)) of job loss at one-year, adjusting for age, gender, self-reported health and depressive state (measured with the Center of Epidemiologic Studies Depression scale). Stratified analyses were performed for education, occupational grade, household income, job stress (measured with the Effort-Reward Imbalance), type of job contract, type of work time and history of unemployment. In sensitivity analyses, employment status over a three-year follow-up was used as dependent variable. RESULTS:Alcohol, tobacco and cannabis use were associated with job loss, from the second to the highest category: 1.46(95%CI:1.23-1.73) to 1.92(95%CI:1.34-2.75), 1.26(95%CI:1.09-1.46) to 1.78(95%CI:1.26-2.54) and 1.45(95%CI:1.27-1.66) to 2.68(95%CI:2.10-3.42), respectively, and with dose-dependent relationships (all p for trend

Effective and sustainable prevention of work-related musculoskeletal disorders (WR-MSDs) remains a challenge for preventers and policy makers. Coordination of stakeholders involved in the prevention of WR-MSDs is a key factor that requires greater reflection on common knowledge and shared representation of workers' activities among stakeholders. Information on workers' strategies and operational leeway should be the core of common representations, because it places workers at the center of the “work situation system” considered by the intervention models. Participatory ergonomics permitting debates among stakeholders about workers' activity and strategies to cope with the work constraints in practice could help them to share representations of the “work situation system” and cooperate. Sharing representation therefore represents a useful tool for prevention, and preventers should provide sufficient space and time for dialogue and discussion of workers' activities among stakeholders during the conception, implementation, and management of integrated prevention programs.

To examine the associations between job exposure to the public (e.g., customers, guests, users of a public service, patients) and alcohol, tobacco and cannabis use.From the French population-based CONSTANCES cohort, 16,566 men and 17,426 women currently working were included between 2012 and 2016. They reported their exposure to the public (daily versus no daily), and among the daily exposed participants (10,323 men and 13,318 women), the frequency of stressful exposure (often versus rarely). Dependent variables were: chronic alcohol consumption (42(28) drinks per week in men(women)), heavy episodic drinking (never, at most once a month, more than once a month), alcohol use risk with Alcohol Use Disorders Identification Test (mild, dangerous, problematic or dependence), tobacco use (non-smoker, former smoker, 1-9, 10-19, >19 cigarettes per day) and cannabis use (never, not in past year, less than once a month, once a month or more). Logistic regressions provided odds ratios of substance use, stratifying for gender and adjusting for sociodemographic confounders, depression, effort-reward imbalance and perceived health status.Exposed men had higher risks of alcohol (chronic alcohol consumption, heavy episodic drinking and alcohol use risk), tobacco and cannabis use. Exposed women had higher risks of tobacco and cannabis use. In men, stressful exposure was associated with increased risks of heavy episodic drinking, tobacco and cannabis use. In women, stressful exposure was associated with increased risks of chronic alcohol consumption, alcohol use risk, tobacco and cannabis use. All these findings remained significant in multivariable analyses, taking into account sociodemographic variables, depressive symptoms, perceived health status and effort-reward imbalance.Interventions to reduce emotional job demand should systematically integrate assessment and prevention measures of addictive behaviors. Vulnerable workers may be offered more specific interventions to reduce the impact of exposure to the public on their substance use.

OBJECTIVES: Return-to-work interventions associated with the workplace environment are often more effective than conventional care. The Sherbrooke model is an integrated intervention that has proved successful in preventing work disability due to low-back pain. Implementation, however, runs up against many obstacles, and failure has been reported in many countries. The present study sought to identify barriers to and facilitators of the implementation of the Sherbrooke model within the French health system. METHODS: A multiple case study with nested levels of analysis was performed in two regions of France. A conceptual framework was designed and refined to identify barriers and facilitators at the individual, organizational and contextual levels. Qualitative data were collected via semi-structured interview (N=22), focus groups (N=7), and observation and from the gray literature. Participants (N=61) belonged to three fields: healthcare, social insurance, and the workplace. RESULTS: Numerous barriers and facilitators were identified in each field and at each level, some specific and others common to workers in all fields. Individual and organizational barriers comprised lack of time and resources, discordant professional values, and perceived risk. Legal barriers comprised medical confidentiality, legal complexity, and priority given to primary prevention. Individual-level facilitators comprised needs and perceived benefits. Some organizations had concordant values and practices. Legal facilitators comprised possibilities of collaboration and gradual return to work. CONCLUSION: The present feasibility analysis of implementing the Sherbrooke model revealed numerous barriers and facilitators suggesting a new implementation strategy be drawn up if failure is to be avoided.

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).

OBJECTIVES: This study aims to estimate the association between repeated measures of occupational risk factors and the incidence of lateral epicondylitis in a large working population. METHODS: A total of 3710 workers in a French region were included in 2002–2005, and among them 1046 had a complete follow-up in 2007–2010. At both stages, occupational health physicians assessed the presence of lateral epicondylitis and workers self-reported their occupational exposures. Poisson models were performed to assess the incidence rate ratios (IRR) separately by sex using multiple imputed data. RESULTS: The annual incidence rate of lateral epicondylitis was estimated as 1.0 [95% confidence interval (95% CI) 0.7–1.3] per 100 workers among men and 0.9 (95% CI 0.6–1.3) among women. Workers aged >45 years had higher incidence than those aged 2 hours/day) was a risk factor, with an age-adjusted IRR of 3.2 (95% CI 1.5–6.4) for workers exposed at both questionnaires [3.3 (95% CI 1.4–7.6) among women]. CONCLUSIONS: This study highlights the importance of temporal dimensions for occupational risk factors on the incidence of lateral epicondylitis. Further research should evaluate the risk associated with the duration and repetition of occupational exposure on the incidence of lateral epicondylitis.

OBJECTIVE: We aimed to assess whether the risk factors for severe shoulder pain, especially exposure to arm elevation, were still relevant after a 12-year follow-up, even following retirement. METHODS: All men participating in the ARPEGE ancillary study of the GAZEL cohort (followed-up since 1989) and who answered the 1994 or 1995 general GAZEL self-administered questionnaire were included. Weight and self-reported exposure (arm elevation >90° with and without carrying loads) over the entire working life were collected at baseline (1994–1995). Shoulder pain and its intensity were recorded in 1994–1995 and again in 2006. Shoulder pain was measured on an intensity or discomfort 6-point scale in 1994–1995 and on an 8-point scale in 2006. Severe shoulder pain was defined as point-rated higher than the mid-points (>3/6 in 1994–1995 and >4/8 in 2006) while moderate pain was lower or equal to these thresholds. RESULTS: At baseline, 1786 47–51-year-old men were included. In 1994–1995, moderate pain was observed among 8.5% (N=151) of men and severe shoulder pain among 14.6% (N=261). Exposure to arm elevation >90° while carrying loads was significantly associated with severe shoulder pain with >25 years of exposure [adjusted odds ratio (OR_adj) 4.2, 95% confidence interval (95% CI) 1.7–10.5], taking into account age, sports, smoking habits, history of shoulder trauma, and body mass index. In 2006, when most of the subjects had retired, 1482 men (83.0%) answered the questionnaire, 17.3% of them with severe shoulder pain; the association between exposure to arm elevation >90° while carrying loads and severe shoulder pain was still significant (ORadj 3.3, 95% CI 1.3–8.0), and remained so when subjects with shoulder pain at baseline were excluded. CONCLUSIONS: Among men, the effect of high shoulder exposure (arm elevation >90° while carrying loads) during working life on severe shoulder pain remains even after retirement. Extended surveillance and prevention should be offered to these workers.

OBJECTIVES: The aim of this study was to assess the effects of personal and work-related factors on the incidence of rotator cuff syndrome (RCS) in a large working population. METHODS: A total of 3710 French workers were included in a cross-sectional study in 2002–2005. All completed a self-administered questionnaire about personal factors and work exposure. Using a standardized physical examination, occupational physicians established a diagnosis of RCS. Between 2007–2010, 1611 workers were re-examined. Associations between RCS and risk factors at baseline were analyzed by logistic regression. RESULTS: A total of 839 men and 617 women without RCS at baseline were eligible for analysis. RCS was diagnosed in 51 men (6.1%) and 45 women (7.3%). The risk of RCS increased with age for both genders [odds ratio (OR) 4.7 (95% confidence interval [95% CI] 2.2–10.0) for men aged 45–49 years and 5.4 (95% CI 2.3–13.2) for women aged 50–59 years; reference

OBJECTIVE: Rotator cuff syndrome (RCS) is a major health problem among workers. The aim of the study was to examine the risk factors for RCS among workers exposed to various levels of shoulder constraints. METHODS: From 3710 workers, representative of a French region`s working population, trained occupational physicians diagnosed a total of 142 cases of RCS among men and 132 among women between 2002–2005. Diagnoses were established by standardized physical examination while personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between RCS and personal and work-related factors were analyzed for each gender using logistic regression modeling. RESULTS: The personal risk factors for RCS were age [odds ratio (OR) for 1-year increment 1.07, 95% confidence interval (95% CI) 1.05–1.09, among men and 1.08, 95% CI 1.06–1.10, among women] and diabetes mellitus (OR 2.9, 95% CI 1.0–8.6, among women). The work-related risk factors were (i) sustained or repeated arm abduction (≥2 hours/day) >90 degrees among men (OR 2.3, 95% CI 1.3–3.9) and >60 degrees among women (OR 1.8, 95% CI 1.0–3.2) or both conditions among men (OR 2.0, 95% CI 1.1–3.7) and women (OR 3.6, 95% CI 1.8–7.3); (ii) high repetitiveness of the task (≥4 hours/day) among men (OR 1.6, 95% CI 1.0–2.4) and women (OR 1.7, 95% CI 1.1–2.5); (iii) high perceived physical demand among men (OR 2.0, 95% CI 1.3–3.1); (iv) high psychological demand among men (OR 1.7, 95% CI 1.2–2.5); and (v) low decision authority among women (OR 1.5, 95% CI 1.0–2.3). CONCLUSION: Personal (ie, age) and work-related physical (ie, arm abduction) and psychosocial factors were associated with RCS for both genders in this working population.

OBJECTIVE: De Quervain’s disease (DQD) is a significant cause of musculoskeletal pain among workers. The aim of this study was to assess the relative importance of personal and occupational risk factors for DQD in a working population. METHODS: A total of 3710 workers from a French region were randomly included in the cross-sectional study between 2002–2005. There were 45 subjects with DQD (of these, 5 subjects had a bilateral condition), diagnosed by 83 trained occupational physicians performing a standardized physical examination. Individual factors and work exposure were assessed by a standardized physical and a self-administered questionnaire. Statistical associations between DQD and individual and occupational factors were analyzed using logistic regression modeling in the whole sample and among women. RESULTS: The prevalence rates of uni- or bilateral DQD for the whole, male and female working populations were 1.2% [95% confidence interval (95% CI) 0.9–1.6], 0.6% (95% CI 0.3–0.9) and 2.1% (95% CI 1.4–2.8), respectively. Personal risk factors for DQD were mainly age (1.1 for 1-year increase in age) and female gender [odds ratio (OR) 4.9, 95% CI 2.4–10.1]. Work-related factors were workpace dependent on (i) technical organization (OR 2.0, 95% CI 1.0–4.0), (ii) repeated or sustained wrist bending in extreme posture (OR 2.6, 95% CI 1.3–5.3) and (iii) repeated movements associated with the twisting or driving of screws (OR 3.4, 95% CI 1.7–7.1). No association was found with psychosocial factors. CONCLUSIONS: Personal and work-related factors were associated with DQD in the working population; wrist bending and movements associated with the twisting or driving of screws were the most significant of the work-related factors.

OBJECTIVE: Little is known about the long-term effect of occupational determinants on knee pain. We aimed to assess whether the risk factors for severe knee pain, observed with a cross-sectional approach, were still relevant after retirement, 12 years later. METHODS: All men participating in the ARPEGE side study of the GAZEL cohort (employees of the French national utility for energy production and distribution, recruited in 1989) and who answered the 1994 or 1995 general GAZEL self-administered questionnaire, were included. Weight and self-reported exposures over the entire working life were collected at baseline. Knee pain and its intensity were recorded in 1994–1995 and again in 2006. Moderate and severe knee pain, defined from an intensity or discomfort scale (threshold 3 on a 6-level scale in 1994–1995, and 4 on an 8-level scale in 2006), were the main outcomes. RESULTS: At baseline, 1786 men were included. In 1994–1995, moderate knee pain was observed among 10.3% and severe pain in 12.8% of men. In 2006, 1482 men (83%) answered the questionnaire. Moderate and severe knee pain were observed in 18.6% and 16.3% of respondents, respectively. Working in a kneeling or squatting position was significantly associated with severe knee pain at baseline, taking into account age, sports, smoking habits, and body mass index [adjusted odds ratio (OR_adj) 1.4, 95% confidence interval (95% CI) 1.1–1.9 for “ever exposed” and OR_adj 2.0, 95% CI 1.3–3.1 for >25 years of exposure]. In 2006, when most subjects were retired, the association between working in a kneeling or squatting position and severe pain was weaker but still significant (OR_adj 1.4, 95% CI 1.04–1.85). CONCLUSIONS: The effect of high knee exposure in the working life on severe knee pain remains even after retirement, although decreased. An extended surveillance and prevention program for these workers could be proposed.

Subjective health measurements are increasingly used in clinical research, particularly for patient groups comparisons. Two main types of analytical strategies can be used for such data: so-called classical test theory (CTT), relying on observed scores and models coming from Item Response Theory (IRT) relying on a response model relating the items responses to a latent parameter, often called latent trait. Whether IRT or CTT would be the most appropriate method to compare two independent groups of patients on a patient reported outcomes measurement remains unknown and was investigated using simulations. For CTT-based analyses, groups comparison was performed using t-test on the scores. For IRT-based analyses, several methods were compared, according to whether the Rasch model was considered with random effects or with fixed effects, and the group effect was included as a covariate or not. Individual latent traits values were estimated using either a deterministic method or by stochastic approaches. Latent traits were then compared with a t-test. Finally, a two-steps method was performed to compare the latent trait distributions, and a Wald test was performed to test the group effect in the Rasch model including group covariates. The only unbiased IRT-based method was the group covariate Wald's test, performed on the random effects Rasch model. This model displayed the highest observed power, which was similar to the power using the score t-test. These results need to be extended to the case frequently encountered in practice where data are missing and possibly informative.

The aim of this article is twofold: 1) to understand the consequences of using patient handling tools on the risk factors for Upper Extremity Musculoskeletal Disorders (UEMSDs) and low back pain; and 2) to make recommendations to health professionals about how to improve their relationship with the tools as well as about the utilization criteria and methods on which designers can base their work. The reasons for studying this aspect was the low use of patient handling tools in real practice, the high number of low back injuries during patient handling, and the concerns of UHC management about the purchase of equipment. The chosen methodology was based on an ergonomic diagnosis of patient handling activities, from observations accompanied by measurements comparing three patient handling tools (quilted pads, mobile equipment, rail on the ceiling), data resulting from testing new material, and epidemiological data on the relationships between handling constraints and health impacts.

The improvement of intervention practices is today an undeniable issue in the field of work-related musculoskeletal disorder (MSD) prevention. The development of knowledge about workplace interventions is therefore a research issue, which deals with the theme of intervention evaluation. International research in the MSD field focuses its work and recommendations mainly on the evaluation of the effects of interventions through the evolution in the state of the symptoms of the workers involved and/or the evolution in the exposures.In this article, we show first that this orientation assumes that a certain number of important conditions are associated, which are often difficult to associate and generally underestimated. We suggest that indicators relating to the work activity be considered, as well as employees’ margins of maneuver, as additional criteria in the evaluation, while emphasizing the necessity that work be carried out to make them operational.Second, we reiterate that the evaluation of the intervention’s effects is insufficient for developing knowledge about the intervention: this necessarily assumes the precise description of the intervention process and the consideration of its execution context.Finally, the discussion underlines the fact that, from our perspective, intervention evaluation is a project in itself, contributing directly to the transformation of the work.