Pre-employment examination for low back risk in workers exposed to manual handling of loads: French guidelines

Occupational factors and low back pain: a Mendelian randomization study

Background

Low back pain (LBP) is a common condition and a leading cause of health function loss worldwide. This study assessed the impact of occupational factors on LBP using Mendelian Randomization (MR) method, controlling for confounding variables.

Methods

Based on publicly available genome-wide association studies (GWAS), two-sample univariate and multivariate MR analyses were performed to assess the causal effect of occupational factors on LBP. We used the inverse variance weighted (IVW) method and sensitivity analyses to generate the total results for the univariate MR analysis. Furthermore, we performed multivariate MR analysis to assess the direct causal association between occupational factors and LBP after accounting for potential confounding variables.

Results

The total causal effect of genetically predicted job involves heavy manual or physical work on LBP was found to be significant (IVW OR, 2.117; 95% CI, 1,288-3.479; p = 0.003). Upon adjusting for potential confounding variables, the direct effect of job involves heavy manual or physical work on LBP remained statistically significant. Similarly, the total causal effect of genetically predicted job involves mainly walking or standing on LBP was also found to be significant (IVW OR, 1.429; 95% CI, 1,035-1.975; p = 0.030). However, upon adjusting for potential confounding variables, the direct effect of job involves mainly walking or standing on LBP became insignificant. In contrast, the findings from the MR analysis indicated a lack of association between work/job satisfaction and LBP. Sensitivity analysis consistently supported these trends.

Conclusion

Our results supported a causal link between job involves heavy manual or physical work and increased risk of LBP, while finding no significant associations between prolonged walking/standing at work, job satisfaction, and LBP, providing valuable insights for the development of targeted prevention and intervention strategies for LBP.

Sex and gender considerations in low back pain clinical practice guidelines: a scoping review

Objective

The purpose of this scoping review is to determine if and how sex and gender have been incorporated into low back pain (LBP) clinical practice guidelines (CPG), and if sex and gender terms have been used properly.

Methods

CPGs were searched on MEDLINE, Embase, NICE, TRIP and PEDro from 2010 to 2020. The inclusion criteria were English language, CGPs within physiotherapy scope of practice and for adult population with LBP of any type or duration. Three pairs of independent reviewers screened titles, abstracts and full texts. Guidelines were searched for sex/gender-related terms and recommendations were extracted. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) was used to evaluate the quality of the CPGs.

Results

Thirty-six CPGs were included, of which 15 were test-positive for sex or gender terms. Only 33% (n=5) of CPGs incorporated sex or gender into diagnostic or management recommendations. Sixty percent of guidelines (n=9) only referenced sex or gender in relation to epidemiology, risk factors or prognostic data, and made no specific recommendations. Overall, there was no observable relationship between guideline quality and likeliness of integrating sex or gender terms. The majority of guidelines used sex and gender terms interchangeably, and no guidelines defined sex or gender.

Conclusion

CPGs did not consistently consider sex and gender differences in assessment, diagnosis or treatment of LBP. When it was considered, sex and gender terms were used interchangeably, and considerations were primarily regarding pregnancy. Researchers should consider the importance of including sex-based and/or gender-based recommendations into future LBP CPGs.

Remote screening of retinal and optic disc diseases using handheld nonmydriatic cameras in programmed routine occupational health checkups onsite at work centers

Purpose

To evaluate the first year outcomes of a remote screening program for detection of retinal diseases using handheld nonmydriatic cameras in occupational routine checkups performed onsite at work centers.

Methods

Cross-sectional, first year screening program outcomes audit. Participants were volunteers recruited from staff within work centers. Retinal fundus images were captured by technicians, and images and data were anonymized and sent securely to a remote server. A team of ophthalmologists, all retinal specialists, remotely read the images using a custom-made software and sent telematic reports of findings within 24–48 h. The main items evaluated were the detection of retinal abnormalities and the relationship between retinal findings and demographic data such as age and sex.

Results

A total of 19,881 workers were evaluated in 52 centers. Mean age was 41.1 years old, 43.9% men and 56.1% women. Mean duration of the test was around 2 min. Of the workers, 7.8% presented abnormalities in retinal fundus images, being the main findings choroidal nevus (2.4%), macular pigment abnormalities (1.5%), glaucomatous optic disc (1.2%), and macular signs of high myopia (1.1%). The presence of abnormalities was associated with greater age, being 5%, 7.9%, 12.6%, and 19.7% in workers less than 40 years, from 40 to 49, 50–59, and ≥ 60 years (p < 0.05), respectively. Men had more abnormalities in retinal fundus images than women (8.6 vs. 7.2; p < 0.05 RR: 1.2; CI 1092–1322).

Conclusions

Mass screening of retinal and optic disc abnormalities during occupational health routine checkups is a feasible, quick, and efficient tool for early detection of potential vision-threatening disease markers.