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Background: Several methods with which to assess the risk of biomechanical overload of the upper limb are described in the literature. Methods: We retrospectively analysed the results of the risk assessment of the biomechanical overload of the upper limb in multiple settings by comparing the application of the Washington State Standard, the threshold limit values (TLV) proposed by the American Conference of Governmental Industrial Hygienists (ACGIH), based on hand-activity levels (HAL) and normalised peak force (PF), the Occupational Repetitive Actions (OCRA) checklist, the Rapid Upper-Limb Assessment (RULA), and the Strain Index and Outil de Repérage et d'Evaluation des Gestes of INRS (Institut National de Recherche et de Sécurité). Results: Overall, 771 workstations were analysed for a total of 2509 risk assessments. The absence of risk demonstrated for the Washington CZCL, used as the screening method, was in good agreement with the other methods, with the sole exception of the OCRA CL, which showed at-risk conditions in a higher percentage of workstations. Differences in the assessment of the frequency of actions were observed among the methods, while their assessments of strength appeared to be more uniform. However, the greatest discrepancies were observed in the assessment of posture. Conclusions: The use of multiple assessment methods ensures a more adequate analysis of biomechanical risk, allowing researchers to investigate the factors and segments in which different methods show different specificities. [ABSTRACT FROM AUTHOR]

Biomechanical overload is considered a significant occupational risk in manufacturing and a potential cause of musculoskeletal disorders. This research aims to introduce new methodologies for the quantitative risk evaluation of biomechanical risk by combining surface electromyography with a motion acquisition system based on inertial measurement units. Due to the lack of experimental data in the literature acquired in a real industrial environment during the working shift, an on-the-field study regarding an automotive assembly line workstation has been carried out in collaboration with Fiat Chrysler Automobiles Italy S.p.A. Data related to the trunk flexion forward and the erector spinae muscle activity have been acquired for several consecutive working cycles by considering three different workers. Data analyses indicated kinematic and muscular activity patterns consistent with those expected and that the proposed wearable technologies can be integrated and used simultaneously during work activities. Furthermore, the results demonstrated data repeatability, strengthening the feasibility and usefulness of the combined use of kinematic and electromyography technologies to assess biomechanical overload in production lines. This study could lay the bases for the future definition of a method for assessing biomechanical overload due to awkward postures. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the arboriculture sector, some activities are still manually performed by forestry workers, which result consequently exposed to a high risk of developing muscle skeletal disorders. The Italian Compensation Authority reported an increase of work-related tendinopathies and carpal tunnel syndrome in loggers, but screening protocols are not available yet. OBJECTIVES: The objectives were: a) to evaluate the prevalence of tendinopathies and carpal tunnel syndrome in a sample of loggers and b) identify a sound screening approach. METHODS: 41 loggers and 41 paired control workers were recruited for a total of 164 hands. The protocol included 1) demographic data; 2) medical history; 3) identification of CTS symptoms through a questionnaire and a hand-chart; 4) upper limbs clinical examination; 5) Raynaud's diseases questionnaire; 6) wrists ultrasound; 7) NCS of the distal median nerve. RESULTS: The prevalence of tendinopathies was statistically significant only in the non-dominant hand (75, 5% in the exposed group and 53, 6% in the non-exposed group). The prevalence of CTS was 32, 2% in the exposed group and 15, 5% in the non-exposed group. The questionnaire had a sensitivity of 56, 7% and a specificity of 75%. The hand-chart had a sensitivity of 30% and a specificity of 92%. The clinical examination had sensitivity of 30% and specificity of 80%. The ultrasound had a sensitivity of 70% and a specificity of 56%. CONCLUSIONS: Loggers are a population at risk of occupational hand and wrist disorders. The hand-chart could be considered, together with the questionnaire, as the best secondary prevention tool to diagnose CTS. [ABSTRACT FROM AUTHOR]

Background: Several methods with which to assess the risk of biomechanical overload of the upper limb are described in the literature. Methods: We retrospectively analysed the results of the risk assessment of the biomechanical overload of the upper limb in multiple settings by comparing the application of the Washington State Standard, the threshold limit values (TLV) proposed by the American Conference of Governmental Industrial Hygienists (ACGIH), based on hand-activity levels (HAL) and normalised peak force (PF), the Occupational Repetitive Actions (OCRA) checklist, the Rapid Upper-Limb Assessment (RULA), and the Strain Index and Outil de Repérage et d’Evaluation des Gestes of INRS (Institut National de Recherche et de Sécurité). Results: Overall, 771 workstations were analysed for a total of 2509 risk assessments. The absence of risk demonstrated for the Washington CZCL, used as the screening method, was in good agreement with the other methods, with the sole exception of the OCRA CL, which showed at-risk conditions in a higher percentage of workstations. Differences in the assessment of the frequency of actions were observed among the methods, while their assessments of strength appeared to be more uniform. However, the greatest discrepancies were observed in the assessment of posture. Conclusions: The use of multiple assessment methods ensures a more adequate analysis of biomechanical risk, allowing researchers to investigate the factors and segments in which different methods show different specificities.

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Biomechanical overload is considered a significant occupational risk in manufacturing and a potential cause of musculoskeletal disorders. This research aims to introduce new methodologies for the quantitative risk evaluation of biomechanical risk by combining surface electromyography with a motion acquisition system based on inertial measurement units. Due to the lack of experimental data in the literature acquired in a real industrial environment during the working shift, an on-the-field study regarding an automotive assembly line workstation has been carried out in collaboration with Fiat Chrysler Automobiles Italy S.p.A. Data related to the trunk flexion forward and the erector spinae muscle activity have been acquired for several consecutive working cycles by considering three different workers. Data analyses indicated kinematic and muscular activity patterns consistent with those expected and that the proposed wearable technologies can be integrated and used simultaneously during work activities. Furthermore, the results demonstrated data repeatability, strengthening the feasibility and usefulness of the combined use of kinematic and electromyography technologies to assess biomechanical overload in production lines. This study could lay the bases for the future definition of a method for assessing biomechanical overload due to awkward postures.

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.

Objective: This study aimed to analyse the role of several environmental and time variables, as well as individual and psychosocial factors, on the perception of exertion, expressed by using the Borg scale, on logistics workers performing heavy manual tasks.Materials and Methods: We enrolled 56 subjects working in logistics sector that were interviewed on the perceived exertion required to execute a task of manual lifting of heavy loads, by using the Borg scale. The interviews were carried out during different shifts, at different times during the shifts and during several different months of the year. We also assessed the workers' anthropometric characteristics, length of service, any musculoskeletal diseases, and physical activity outside work. Workers were also interviewed using the structured OREGE questionnaire, in order to evaluate the main symptoms of stress and work-related psychosocial risk factors.Results: Overall, the subjective perception of the strength exerted by the workers exposed to a high risk of manual handling of loads was moderate. The rating attributed using the Borg scale showed no correlation with any of the investigated variables. 100% of the workers denied to suffer from symptoms of stress, whereas in terms of psychosocial factors, the workload was globally perceived as positive.Conclusion: The study results support the hypothesis that optimal work conditions—from a psychosocial point of view—reduce the subjective perception of exertion by workers even if exposed to a high risk of biomechanical overload.

The current study aims at testing whether skin temperatures (Tskin) changes are sensitive to work conditions during lifting tasks. The second goal of this work is to analyse possible differences in Tskin changes across individuals with different obesity levels. By applying IRT imaging this study considered 29 participants with different obesity levels, for a repetitive lifting task between floor and shoulders height with a periodicity of 7 seconds up to 2 minutes. Thermal images were registered across 16 Regions Of Interest (ROI) (divided into body anterior and posterior views). Data analysis was performed from the temperatures differential, calculated as the algebraic difference between Tskin measured before and after the task. This Tskin difference presented statistical evidence (p < 0.05 for all ROI), with a decrease after the task. The average Tskin decrease of the 8 ROI for anterior view was 0.33(±0.08)ºC and for posterior view was 0.51(±0.08)ºC, being an indicator of muscular overload increased. Results show a relation between the obese participants and the presence of higher cooling in the ROI studied. These outcomes corroborate that obesity is a WRMSD risk factor and also provides evidence that IRT can be a useful tool to assess the participants' biomechanics performance. [ABSTRACT FROM AUTHOR]

We are writing in regards to Armstrong et al`s recent discussion paper (1), which addresses the scientific basis of ISO standards on biomechanical risk factors and more specifically the OCRA methodology. The paper comments on the ISO’s working methods, but it will be up to the ISO to respond if it sees fit to do so. As the authors of the OCRA method, we wish to respond in a individual capacity. For several years, we have belonged to an ISO working group (ISO TC 159/SC3/WG4) advocating methods for the assessment of biomechanical overload risk; the members of the working group come from various countries and represent public authorities, social partners and researchers with particular expertise in this field. Our decision to send this letter to the editor was motivated by the following position put forth in Armstrong et al`s paper concerning the rigor of development of the ISO ergonomics standards: “The production of the ISO ergonomics standards differed substantially from the writing of evidence-based practical guidelines. According to the limited information provided in the published documents, the ISO ergonomics standards were not based on a systematic search and appraisal of available literature. It is not clear why the ISO subcommittee preferred one method of risk assessment over others. For instance, the ISO 11228-3 identified three detailed risk assessment methods for repetitive hand exertions at high frequency: OCRA (a concise index for the assessment of exposure to repetitive movements of the upper limbs) (20), ACGIH hand activity level (HAL) (21), and the Strain Index (22), but preferred the OCRA methods without providing a scientific basis or comparison (eg, intra- and inter-observer reliability, strength of association with musculoskeletal disorders (MSD), etc.) even though such comparisons are available in the literature (13, 23). As a result, some statements in ISO 11228-3 appear to be based on personal opinions and are in contrast with scientific evidence from the literature. For instance, the ISO standard includes a statement “in many epidemiological surveys it (OCRA) has shown itself to be well related with health effects (such as the occurrence of UL-WMSD [upper limb–work related MSD)]” (13). This statement was not supported by a well-designed epidemiological study in 2007 when the ISO standard was published (19). Indeed, in 2010, Takala and colleagues noted the absence of longitudinal studies on the association between the OCRA index and the risk of MSD. They also pointed out the absence of studies on the repeatability of the OCRA method (13)”. (Note: the references in italic relate to the original paper). We would like to point out that the ISO standards in question (2) were actually developed by the working group, as mandated by ISO, over the period 2000‒2004.The years leading up to the publication of the standard (2005‒2007) were dedicated to the challenging task of democratically seeking the endorsement of the ISO member countries. During this time, no significant changes could be made to the basic text other than those arising from specific observations or comments from the countries. This needs to be taken into account, especially when debating the references underpinning the standard. More specifically, the standard in question (ISO 11228-3) (2) in Annex A, clearly states that the general reference model for assessing “repetitive, high frequency, low load movements of the upper limbs” is a Consensus Document, drafted and published in 2001 by the IEA-Technical Committee on Musculoskeletal Disorders, with the endorsement of the International Commission on Occupational Health (ICOH) (3). The study considered at least 14 different methods that have over time been suggested in the literature as briefly summarized in the same ISO standard (2). The recommendations set forth in this vital Consensus Document went on to become the basis for choosing the most appropriate methods to suggest to future users through the standard (OCRA; ACGIH Hand Activity Level (HAL); Strain Index), each with their respective merits and limits in compliance with the criteria set out in the Consensus Document and taking into account their applicability in the field and ability to interpret the results of the risk assessment. It is against this background, and in light of the rationale described in Annex A, that the entire group agreed that the OCRA method was to be considered as the “preferred” method, insofar as it was deemed to best match the recommendations laid out in the aforementioned Consensus Document. Furthermore the OCRA method was, at the time, the only risk assessment method supported by the results of several epidemiological, albeit cross-sectional studies, uniquely available in literature. The study was based on a very large number of cases (>5000 cases) with results both of risk evaluation of upper-limb biomechanical overload (using the OCRA method) and of musculo­skeletal clinical examination (assessing the corresponding diseases). Such studies were reported in a special issue of Ergonomics (4), in an updated paper ‒ first published in Italian (5) ‒ also in Ergonomics (6), in the books edited by Elsevier (7), and CRC Taylor & Francis (8). This risk/damage database enabled an estimation (within defined limits) of the risk of upper-limb work-related musculoskeletal disorders at a given OCRA index level. Starting from the established relation among risk indexes and percent of pathological subjects, it was possible to determine the risk limit values provided by the ISO standard (2). With reference to the alleged absence of studies on the repeatability of the OCRA method, we prefer to mention the most recent results obtained by other researchers, rather than our findings, acknowledging the good “inter-rater reliability” of the OCRA Checklist, and stating that “the OCRA Checklist inter-rater reliability scores were among the highest reported in the literature for semi-quantitative physical exposure assessment tools of the upper extremity” (9) As for the scientific base, we suggest Armstrong et al (1) could get more valuable information about the OCRA methodology looking not only to the 1996 special issue in Italian language (10) ‒ the only publication they mention dealing specifically with OCRA ‒ but to the many updated publications. Some of the most relevant publications in English (as suggested by the publisher) are mentioned in the references here below. Many other publications and manuals in English, Italian, Spanish and Portuguese are available but not reported here due to limitation of space. A complete list of our publications can be found on our website: www.epmresearch.org, where some of the articles are available for download. Simple tools (Excel spreadsheets) for carrying out risk assessments by OCRA can also be freely downloaded from the same website. The validity and usability of OCRA methodology can also be indirectly confirmed by its extensive use around the world. For example, a recent search on ScienceDirect (www.sciencedirect.com/science/journals/all/full-text-access) has recently shown that more than 477 works dealing with OCRA hae been published by different authors in indexed journals to date. In conclusion, we recommend the authors of the discussion paper (1) deepen their analysis of the OCRA methodology [beyond the only cited old 1996 paper (10)] before expressing definite conclusions about the scientific value of the OCRA methodology and about the entire ISO standard-setting system. Our team is always happy to engage with the scientific community and end users of studies on biomechanical overload, as we have also done within the ISO for many years now. ISO working groups arguably offer valuable opportunities to come together at the international level and table discussions between researchers and users. We are researchers who have devoted our life’s work to prevention, and intend to continue striving towards that goal, with everyone’s help and without bickering, bias, vested interests, or professional rivalry. The health and well-being of workers is all we have ever cared about. We have always been ready to cooperate with those who share this vital objective. References 1. Armstrong T J, Burdorf I A, Descatha A, Farioli A, Graf M, Horie S, Marras W S, Potvin J R, Rempel D, Spatari G, Takala E P, Verbeek J, Violante FS. Scientific basis of ISO standards on biomechanical risk factors. Scand J Work Environ Health ‒ online first. https://doi.org/10.5271/sjweh.3718 2. ISO. ISO 11228-3. Ergonomics - Manual handling - Handling of low loads at high frequency. ISO, 2007. Geneva, Switzerland. 3. Colombini D, Occhipinti E, Delleman D, Fallentin N, Kilbom A, Grieco A. Exposure assessment of upper limb repetitive movements: a consensus document in W. Karwowski International Encyclopaedia of Ergonomics and Human Factors, New York: Taylor & Francis, 2001. 4. Colombini D, Grieco A, Occhipinti E. Occupational musculoskeletal disorders of the upper limbs due to mechanical overload. Ergonomics. Special issue;1998:41(9). 5. Occhipinti, E., Colombini, D. Metodo OCRA: aggiornamento dei valori di riferimento e dei modelli di previsione dell’occorrenza di UL-WMSDs nelle popolazioni lavorative esposte a movimenti e sforzi ripetuti degli arti superiori. [The OCRA method: update of UL-WMSDs reference values and prediction models of occurrence in working populations exposed to repetitive movements and strains of the upper limbs]. La Medicina del Lavoro, 2004. 95;4:305–319 6. Occhipinti E, Colombini D. Updating reference values and predictive models of the OCRA method in the risk assessment of work-related musculoskeletal disorders of the upper limbs. Ergonomics; 2007,50(11):1727-1739. https://doi.org/10.1080/00140130701674331 7. Colombini D, Occhipinti E, Grieco A. Risk assessment and management of repetitive movements and exertions of upper limbs. Amsterdam: Elsevier Science, 2002. 8. Colombini D, Occhipinti E. Risk analysis and management of repetitive actions: a guide for applying the OCRA system (occupational repetitive actions). New York: CRC press, 2016. 9. Paulsen R, Gallu T, Gilkey D, Reiser R, Murgia L, Rosecrance J. The inter-rater reliability of Strain Index and OCRA Checklist task assessments in cheese processing. Applied Ergonomics. 2015;51,199-204. https://doi.org/10.1016/j.apergo.2015.04.019 10. Occhipinti E, Colombini D. Proposal of a concise index for the evaluation of the exposure to repetitive movements of the upper extremity (OCRA index)]. Med Lav. Special issue, 1996 Nov-Dec; 87(6): 526–548

OBJECTIVE: To estimate the three-year cumulative risk of work-related upper limb disorders (WRULDs) in a cohort of automotive industry workers and to provide a first test of the ability of the European Assembly Worksheet (EAWS) methodology to predict WRULDs. METHODS: 292 workers were investigated by reviewing workers' medical records during the period from 2012–2015 to determine their exposure to biomechanical overload according to EAWS risk scores (0–25, low risk, Green zone; 26–50, medium risk, Yellow zone; >50, High risk; Red zone). RESULTS: The risks were 0.83%, 5.71%, and 11.88% for the Control (unexposed), Green and Yellow Groups, respectively. Only the comparison between the Yellow/Control Groups was significant (p = 0.0014). In total, we observed 17 cases of musculoskeletal disorders (MSDs) (14 symptomatic and 3 cases detected by physical examination). CONCLUSIONS: The EAWS is a useful tool for the preliminary risk assessments of biomechanical overload among automotive industry workers. The finding of mainly non-specific disorders highly suggests that health surveillance should aim to identify not only full-blown diseases but also symptomatic cases. [ABSTRACT FROM AUTHOR]

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Introduction Several studies have dealt with the issue of professional risk factors and onset of knee osteoarthritis (OA). In particular, occupational epidemiological studies have provided evidence that activities resulting in biomechanical overload may be linked with an increased risk of knee OA – also among farmers. To our knowledge, no cases of knee OA among chestnut farmers have been reported in the literature. Case report We report the case of a 70-year-old Caucasian male who has worked for more than 50 years on a chestnut farm. In 2007, an X-ray and a MRI, performed after a workplace accident to his left knee, showed the presence of knee OA. His job required a range of repetitive tasks, such as squatting, kneeling, climbing, walking on sloping terrain, assuming uncomfortable postures, and lifting and carrying heavy loads for the great majority of the working day. All the aforementioned tasks are known occupational risk factors for knee OA. Regarding individual risk factors, at the time of the first diagnosis of knee OA, the worker was 64-years-old with a body mass index of 26.5 kg/m2. He reported no cases of arthritis among his relatives and no sports playing on his part. In addition, his medical history revealed the presence of two minor lumbar disc herniations and tendinitis of the long head of the biceps. Conclusions Considering the lack of major individual risk factors for knee OA, it is reasonable to suppose that five decades of exposure to biomechanical overload as a chestnut farmer was a relevant risk factor for the onset of the disease.

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: We aimed at assessing whether differences among males and females in carpal tunnel syndrome (CTS) epidemiology might be attributable to segregation with respect to occupational biomechanical exposures or differential access to care by sex. Methods: We analysed surgically treated cases of CTS occurring among non-manual workers in Tuscany between 1997 and 2000. We conducted a Monte Carlo simulation to estimate the difference in occupational biomechanical exposures between males and females necessary to explain the observed incidence rate ratios. We also accounted for the sex-specific probability of receiving surgery after the diagnosis of CTS, as women were reported to be more likely to undergo surgery in a subset of our study population. We quantified the hypothetical biomechanical overload through the hand activity level (HAL) metric proposed by the American Conference of Governmental Industrial Hygienists. To quantify the effect of HAL on CTS risk, we assumed a prior distribution based on findings from two large cohort studies of industrial workers. Results: After adjustment for the probability of receiving surgery, women showed a 4-fold incidence of CTS as compared with men. To explain this association among non-manual workers, women should have an average value of HAL at least 5 points higher. Conclusions: Our analysis does not support the hypothesis that the difference in CTS incidence between males and females is entirely attributable to occupational risk factors or to differential access to surgery. The causal pathway between sex and CTS might include more determinants such as hormonal factors, anthropometric characteristics, and non-occupational exposure to biomechanical overload (e.g. household tasks). [ABSTRACT FROM AUTHOR]

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

Data on biomechanical overload of the upper limb in animal facility operators are currently scanty. We decided to study this risk in a university animal facility. Eleven different tasks performed by operators were identified. For each of them, the biomechanical overload of the upper limb was evaluated by applying 4 different methods frequently used, hypothesising a task duration of 4 and 8 h. Then two ‘typical’ real working days of the examined facility were reconstructed, and the risk for operators was calculated using the OCRA Index, Checklist and Mini-Checklist. Considering the specific tasks, the results show some difference among methods, but the overall results show an acceptable/slight risk of biomechanical overload of the upper limb in animal facility operators during typical working days. Practitioner Summary:Upper limb biomechanical overload (UL-BO) is a neglected risk in animal facilities. In a university facility, 11 different tasks were identified, and 2 typical working days were analysed. Even if some task at increased risk may exist, during typical working days,  the overall results show that the risk of UL-BO in operators can be considered usually acceptable or, at worst, slight. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: This study aimed to evaluate the risk of musculoskeletal disorders to the hand-wrist system. The American Conference of Governmental Industrial Hygienists (ACGIH) proposed threshold limit values (TLV©) based on hand activity level (HAL) and normalized peak force (PF). We validated ACGIH TLV© in OCTOPUS, a large cohort study on carpal tunnel syndrome (CTS). METHODS: Industrial and service workers were followed from 2000–2003. We classified subjects with respect to action limit (AL) and TLV. Case definitions were: (i) self-reported symptoms; and (ii) combination of symptoms and positive nerve conduction studies. Poisson regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate incidence rate ratios (IRR) of CTS. RESULTS: There were 4097 eligible workers. Of these, 236 (5.8%) were non-responders, 2194 (53.6%) had a complete follow-up, 728 (17.8%) were lost after intermediate assessment, and 939 (22.9%) were lost after baseline. Among the 3860 subjects with complete information at baseline, 2599 (67.3%) were women [mean age 38.1 [standard deviation (SD) 9.5] years; mean body mass index (BMI) 23.8 (SD 3.9) kg/m2]. ACGIH TLV© classification predicted both CTS symptoms [IRR between AL and TLV 2.43 [95% confidence interval (95% CI) 1.77–3.33]; above TLV 3.32 (95% CI 2.34–4.72)] and CTS confirmed by nerve conduction studies [IRR between AL and TLV 1.95 (95% CI 1.21–3.16); above TLV 2.70 (95% CI 1.48–4.91)]. CONCLUSIONS: We found a dose–response relationship between ACGIH TLV© classification and risk of CTS. The increased risk observed for workers exposed between AL and TLV suggests that the current AL and TLV might not be sufficiently protective.

The risk to run into a Work-Related Musculoskeletal Disorder (WMSD) is very high when operating in the primary sector. As a matter of fact the professional illnesses related to the WMSD in Italy are increasing. Nowadays the assessment of the WMSD in the primary sector is performed mainly in the agricultural sector, considering different agronomical activities; for the forestry sector, only few documents reported an ergonomic evaluation. The lack of available information on this topic in the forestry sector, as well as the similarity with the agricultural sector, drives the interest to the assessment of the conditions that expose workers to WMSD risks in forestry operations. Four different assessment approaches were applied in this study. These tools permitted to classify which are the exposures and if there is the presence of WMSD risk for forest operators. The approaches are respectively the OCRA checklist and the RNLE equation, both recognized as ISO standards, as well as OWAS and REBA, recommended by ISO standards. The first approach focusses on the risk due to repetitive and stressed movements, while the second evaluates the risk of injures due to the manual movement of loads. Meanwhile OWAS and REBA detect the possibility of injures due to wrong postures during the work. These approaches were applied for the cutting operations with chainsaw. Since the evaluation requires high levels of attention and also because it was necessary to gain a good level of safety for the surveyor, a digital camera was used to film the operative activities. Then, the movies were analysed in office. Aim of the research is to analyse if it is possible to apply the approaches suggested by ISO standards in order to assess the most dangerous activities that, when not properly carried out, could be the cause of WMSD in forestry operations. The study showed that during the use of the chainsaw the index of risk of professional injures was overpassed several times, compromising the operator’s safety.

Introduction. Several studies have dealt with the issue of professional risk factors and onset of knee osteoarthritis (OA). In particular, occupational epidemiological studies have provided evidence that activities resulting in biomechanical overload may be linked with an increased risk of knee OA – also among farmers. To our knowledge, no cases of knee OA among chestnut farmers have been reported in the literature. Case report. We report the case of a 70-year-old Caucasian male who has worked for more than 50 years on a chestnut farm. In 2007, an X-ray and a MRI, performed after a workplace accident to his left knee, showed the presence of knee OA. His job required a range of repetitive tasks, such as squatting, kneeling, climbing, walking on sloping terrain, assuming uncomfortable postures, and lifting and carrying heavy loads for the great majority of the working day. All the aforementioned tasks are known occupational risk factors for knee OA. Regarding individual risk factors, at the time of the first diagnosis of knee OA, the worker was 64-years-old with a body mass index of 26.5 kg/m2. He reported no cases of arthritis among his relatives and no sports playing on his part. In addition, his medical history revealed the presence of two minor lumbar disc herniations and tendinitis of the long head of the biceps. Conclusion. Considering the lack of major individual risk factors for knee OA, it is reasonable to suppose that five decades of exposure to biomechanical overload as a chestnut farmer was a relevant risk factor for the onset of the disease. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to evaluate the risk of musculoskeletal disorders to the hand-wrist system. The American Conference of Governmental Industrial Hygienists (ACGIH) proposed threshold limit values (TLV©) based on hand activity level (HAL) and normalized peak force (PF). We validated ACGIH TLV© in OCTOPUS, a large cohort study on carpal tunnel syndrome (CTS). Methods Industrial and service workers were followed from 2000-2003. We classified subjects with respect to action limit (AL) and TLV. Case definitions were: (i) self-reported symptoms; and (ii) combination of symptoms and positive nerve conduction studies. Poisson regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate incidence rate ratios (IRR) of CTS. Results There were 4097 eligible workers. Of these, 236 (5.8%) were non-responders, 2194 (53.6%) had a complete follow-up, 728 (17.8%) were lost after intermediate assessment, and 939 (22.9%) were lost after base-line. Among the 3860 subjects with complete information at baseline, 2599 (67.3%) were women [mean age 38.1 [standard deviation (SD) 9.5] years; mean body mass index (BMI) 23.8 (SD 3.9) kg/m²]. ACGIH TLV© classification predicted both CTS symptoms [IRR between AL and TLV 2.43 [95% confidence interval (95% CI) 1.77-3.33]; above TLV 3.32 (95% CI 2.34-4.72)] and CTS confirmed by nerve conduction studies [IRR between AL and TLV 1.95 (95% CI 1.21-3.16); above TLV 2.70 (95% CI 1.48-4.91)]. Conclusions We found a dose-response relationship between ACGIH TLV© classification and risk of CTS. The increased risk observed for workers exposed between AL and TLV suggests that the current AL and TLV might not be sufficiently protective. [ABSTRACT FROM AUTHOR]

Purpose: To study job stress and upper limb biomechanical overload due to repetitive and forceful manual activities in a factory producing high fashion clothing. Methods: A total of 518 workers (433 women and 85 men) were investigated to determine anxiety, occupational stress (using the Italian version of the Karasek Job Content Questionnaire) and perception of symptoms (using the Italian version of the Somatization scale of Symptom Checklist SCL-90). Biomechanical overload was analyzed using the OCRA Check list. Results: Biomechanical assessment did not reveal high-risk jobs, except for cutting. Although the perception of anxiety and job insecurity was within the normal range, all the workers showed a high level of job strain (correlated with the perception of symptoms) due to very low decision latitude. Conclusion: Occupational stress resulted partially in line with biomechanical risk factors; however, the perception of low decision latitude seems to play a major role in determining job strain. Interactions between physical and psychological factors cannot be demonstrated. Anyway, simultaneous long-term monitoring of occupational stress features and biomechanical overload could guide workplace interventions aimed at reducing the risk of adverse health effects. [ABSTRACT FROM AUTHOR]

Aim of this work is to describe results obtained by risk assessment of biomechanical overload for workers involved in grana padano cheese production: from breeding to obtain milk to the finished product in dairy. To analyze operation tasks authors used video recordings, interviewed operators and visited workplaces in order to proceed with evaluation instruments, using internationally recognized technical standards ISO 11228, such as OCRA, NIOSH and Snook and Ciriello's studies. The results show significant risk of biomechanical overload for spine and upper limbs both in breeding and in dairy. [ABSTRACT FROM AUTHOR]

The authors analyse 493 hospital cases in 356 workers from the construction industry, came to observation for musculoskeletal disorders (average age 48,2 years, SD 9; work seniority 32,2 years, SD 9,7; work seniority in construction industry 27,3 years, SD 12,4). The evaluation was required in 305 subjects (85.7% of the sample) to investigate one or more suspected WMDS; in 51 subjects (14.3% of the sample) to express an opinion on fitness to work or residual work capacity. Investigations led to diagnosis of 479 musculoskeletal disorders; the districts most affected are spine and upper limb. 64.7% of the musculoskeletal disorders was evaluated to be work-related, the percentage rises to 68% when considering only cases sent for evaluation of suspected WMDS. The most frequent reasons to exclude relation between the musculoskeletal disorders and work were an high age at diagnosis, presence of comorbidity or outcome of trauma, a disease mismatch exposure. [ABSTRACT FROM AUTHOR]

In August 2009, an international group was founded with the task of developing a 'toolkit for MSD prevention' under the IEA and in collaboration with the World Health Organization. According to the ISO standard 11228 series and the new Draft ISO TR 12259 'Application document guides for the potential user', our group developed a preliminary 'mapping' methodology of occupational hazards in the craft industry, supported by software (Excel®, free download on: www.epmresearch.org). The possible users of toolkits are: members of health and safety committees; health and safety representatives; line supervisors; foremen; workers; government representatives; health workers providing basic occupational health services; occupational health and safety specialists. The proposed methodology, using specific key enters and quick assessment criteria, allows a simple ergonomics hazards identification and risk estimation to be made. It is thus possible to decide for which occupational hazards a more exhaustive risk assessment will be necessary and which occupational consultant should be involved (occupational physician, safety engineer, industrial hygienist, etc.). The methodology has been applied in different situations of small and medium craftsmanship Italian enterprises: leather goods, food, technical dental work, production of artistic ceramics and stained glass, beekeeping activities. The results are synthetically reported and discussed in this paper. [ABSTRACT FROM AUTHOR]

During the last Congress of the International Ergonomics Association (IEA), Beijing, August 2009, an international group was founded aimed at developing a 'toolkit for MSD prevention' within IEA and in collaboration with World Health Organization (WHO). Possible users of toolkits are: members of health and safety committees, health and safety representatives, line supervisors; labor inspectors; health workers implementing basic occupational health services; occupational health and safety specialists. According to ISO standard 11228 series and the new Draft CD ISO 12259-2009: Application document guides for the potential user, a computer software ( in Excel®) was create dealing with hazard 'mapping' in handicraft The proposed methodology, using specific key enters and quick assessment criteria, allows a simple ergonomics hazard identification and risk estimation. Thus it makes possible to decide for which professional hazards a more exhaustive risk assessment will be necessary and which professional consultant should be involved (occupational physician, safety engineer, industrial hygienist, etc.). [ABSTRACT FROM AUTHOR]

This work analyzes the activities carried out by a plaster construction worker, describing the data obtained from the assessment of risk for upper limb biomechanical overload, through the application of checklist and the OCRA method, and the operator's energy expenditure, measured using portable calorimeter. By analyzing the pattern of energy expenditure in relation to the actions performed we observe a direct correlation between posture, force employed, and metabolic rate. The activity of plastering involves biomechanical overload of upper extremity and high energy expenditure. [ABSTRACT FROM AUTHOR]

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Occupational logging activities expose workers to a wide range of risk factors, such as lifting heavy loads, prolonged, awkward positioning of the lower back, repetitive movements, and insufficient work pauses. Body posture has an important impact on the level of physiological load. The present study involved a group of 40 loggers in the province of Enna (Sicily, Italy) with the aim of defining the impact of logging activities on the workers' physiological strain during the three primary work tasks of felling, delimbing, and bucking. The Zephyr Bioharness measurement system was used to record trunk posture and heart rate data during work tasks. The NASA TLX questionnaire was used to explore workers' effort perception of the work tasks. Based on our results, the most demanding work task was tree felling, which requires a higher level of cardiac cost and longer periods spent in awkward trunk postures. The perceived physiological workload was consistently underestimated, especially by the more experienced loggers. Lastly, as the weight of the chainsaw increased, the cardiac load increased.

Summary: Patient manual handling (MHP) and an increase in the average age of the healthcare workforce increase the risk of musculoskeletal disorders and diseases, leading to sickness absence. Targeted interventions, supported by management, have been proven effective for workplace safety and can lead to improved quality of care., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by GIMLE.)

Permucosal osseointegrated dental implants are a highly effective and predictable treatment modality for edentulism. This review discusses some controversial aspects of the definitions for success and failure of root-form dental implants. The discussion will focus on the underlying pathologies that, if untreated, may lead to loss of the implanted device. Few clinical syndromes are described based on human pathological material and clinical presentation. The theoretical chronological relationship between implant loss and the incidence of pathology of the soft- and hard-tissue seal around implants is also discussed. The review also examines the finding that implant failures are not randomly distributed in the treated populations and that implant loss clusters in specific high-risk groups and individuals. Known risk indicators, and possible risk factors, are discussed, taking into account the patient, the reconstruction, the implant, and implant site-specific factors. Particular emphasis is placed on the need for better determination of whether periodontal patients are at higher risk for implant failures as a consequence of their increased susceptibility to infectious, inflammatory-response-driven tissue breakdown. [ABSTRACT FROM AUTHOR]