Clinical trials among worker populations: the value and significance of anamnestic findings and clinical and instrumental tests for diagnosing work-related musculoskeletal disorders of the upper limbs (WMSDs)

Fuzzy-Based Bioengineering System for Predicting and Diagnosing Diseases of the Nervous System Triggered by the Interaction of Industrial Frequency Electromagnetic Fields

The study aims to enhance the standard of medical care for individuals working in the electric power industry who are exposed to industrial frequency electromagnetic fields and other relevant risk factors. This enhancement is sought through the integration of fuzzy mathematical models with contemporary information and intellectual technologies. The study addresses the challenges of forecasting and diagnosing illnesses within a specific demographic characterized by a combination of poorly formalized issues with interconnected conditions. To tackle this complexity, a methodological framework was developed for synthesizing hybrid fuzzy decision rules. This approach combines clinical expertise with artificial intelligence methodologies to promote innovative problem-solving strategies. Additionally, the researchers devised an original method to evaluate the body's protective capacity, which was integrated into these decision rules to enhance the precision and efficacy of medical decision-making processes. The research findings indicate that industrial frequency electromagnetic fields contribute to illnesses of societal significance. Additionally, it highlights that these effects are worsened by other risk factors such as adverse microclimates, noise, vibration, chemical exposure, and psychological stress. Diseases of the neurological, immunological, cardiovascular, genitourinary, respiratory, and digestive systems are caused by these variables in conjunction with unique physical traits. The development of mathematical models in this study makes it possible to detect and diagnose disorders in workers exposed to electromagnetic fields early on, especially those pertaining to the autonomic nervous system and heart rhythm regulation. The results can be used in clinical practice to treat personnel in the electric power industry since expert evaluation and modeling showed high confidence levels in decision-making accuracy.

Prevalence of musculoskeletal disorders in subjects not exposed to biomechanical overload

BACKGROUND

Data on the prevalence of work-related musculoskeletal disorders (WMSDs) in groups of unexposed subjects may serve for comparison in studies on risk/damage in groups of exposed subjects and for the planning of preventive interventions.

OBJECTIVES

To assess the musculoskeletal health status in a group of working subjects not exposed to biomechanical overload.

METHODS

Medical histories were collected by occupational health physicians as part of an active health surveillance program. An ad hoc questionnaire was administered to the subjects to detect musculoskeletal disorders.

RESULTS

The sample consisted of 1023 subjects (605 females and 418 males) with a mean age of 40 years. The prevalence of acute low back pain and disc hernia was 4% and 5.6% respectively; 4.3% of subjects were affected by at least one disorder of the upper limbs while the prevalence of knee disorders was 1.7%. Standardized data proved to be in line with previous studies with the exception of a greater prevalence of shoulder disorders and disc hernia.

CONCLUSIONS

WMSDs occur ubiquitously across the general working population unexposed to biomechanical overload. Such findings represent a valid reference for groups of exposed working subjects, in that any excess of such disorders/pathology may be due to specific work conditions.

Interaction of biomechanical and morphological factors on shoulder workload in industrial paint work

BACKGROUND

It is known that work-related musculoskeletal disorders are caused by multifactor operations of various risk factors. Among these, the association of these risk factors with pain symptoms and work-related musculoskeletal disorders have been reported in many studies in all typical manufacturing settings (Bernard, 1997). This study focuses on the automobile industry.

METHODS

Twenty-nine paint area production workers of an automobile industry plant took part (age 37.7+/-8.2 years; seniority 6.9+/-6.2 years). Musculoskeletal morbidity was assessed through a questionnaire-administered interview and a clinical exam. Each workplace exposure was assessed by the observational rapid upper limb assessment method. The quantification of the workload on shoulders and wrists during the actual work task accomplishment was obtained through surface EMG.

FINDINGS

Biomechanical exposure varied significantly between pain symptomatic and asymptomatic workers. It was the only estimator that could predict the risk of occurrence of musculoskeletal symptoms. Multifactor linear analysis showed that some linear and combined anthropometric characteristics could be associated to a higher workload on the shoulders and upper limbs.

INTERPRETATION

The rigid external working conditions for employees with different morphologic characteristics, combined with demanding force application associated with the adoption of awkward postures for long and continuous periods of work time, impose constraints in accomplishment of the paint tasks. Additionally our results suggest that the same work task could present different musculoskeletal mechanical load for people with different anthropometrics.

Classification systems for upper-limb musculoskeletal disorders in workers:

OBJECTIVE

The purpose of this study was to provide a review of the available classification systems and to describe the similarities and differences in the structure of these systems.

METHODS

Classification systems of upper limb musculoskeletal disorders (MSDs) were located via electronic database searches and researchers' files. The classification systems were compared on the disorders they described and on the criteria presented for each disorder.

RESULTS

Twenty-seven classification systems were found after title, abstract, or full article review of 1671 articles. The systems differed in the disorders they included, the labels used to identify the disorders, and the criteria used to describe the disorders.

CONCLUSION

Twenty-seven classification systems were found that described disorders of the muscle, tendon, or nerve that may be caused or aggravated by work. No two systems were the same.

Active epidemiological surveillance of musculoskeletal disorders in a shoe factory

AIMS

(1) To evaluate an active method of surveillance of musculoskeletal disorders (MSDs). (2) To compare different criteria for deciding whether or not a work situation could be considered at high risk of MSDs in a large, modern shoe factory.

METHODS

A total of 253 blue collar workers were interviewed and examined by the same physician in 1996; 191 of them were re-examined in 1997. Risk factors of MSDs were assessed for each worker by standardised job site work analysis. Prevalence and incidence rates of carpal tunnel syndrome, rotator cuff syndrome, and tension neck syndrome were calculated for each of the nine main types of work situation. Different criteria used to assess situations with high risk of MSDs were compared.

RESULTS

On the basis of prevalence data, three types of work situation were detected to be at high risk of MSDs: cutting, sewing, and assembly preparation. The three types of work situations identified on the basis of incidence data (sewing preparation, mechanised assembling, and finishing) were different from those identified by prevalence data. At least one recognised risk factor for MSDs was identified for all groups of work situations. The ergonomic risk could be considered as serious for the four types of work situation having the highest ergonomic scores (sewing, assembly preparation, pasting, and cutting).

CONCLUSION

The results of the health surveillance method depend largely on the definition of the criteria used to define the risk of MSDs. The criteria based on incidence data are more valid than those based on prevalence data. Health and risk factor surveillance must be combined to predict the risk of MSDs in the company. However, exposure assessment plays a greater role in determining the priorities for ergonomic intervention.

Transient hand paresthesias in Champagne vineyard workers

BACKGROUND

The aim of the study was to assess the prevalence of hand paresthesias (HP) and their relationship with pruning activities.

METHODS

A cross-sectional study was conducted among 537 workers pruning grapevines in the region of Champagne. All workers completed a questionnaire about nocturnal HP and musculoskeletal pain during the preceding 12-month period.

RESULTS

The 12-month prevalence of nocturnal HP and hand-wrist pain were 37 and 12%, respectively. HP, predominantly affecting the dominant hand, only began during the pruning period and ended after the pruning season in 90% of cases. HP were transient in most cases, with a mean duration of symptoms of 3.3 +/- 3.2 months. Risk factors associated with HP were: female gender (OR = 2.3 [1.3-3.0]), being overweight (OR = 1.6 [1.1-2.5]), payment on a piecework basis (OR = 2.0 [1.2-2.3]) and traditional blade sharpening method (OR = 1.7 [1.1-2.7]). HP were less frequent in employees who used electric pruning shears (OR = 0.5 [0.2-1.6], P = 0.09).

CONCLUSIONS

The development of HP, which affected a third of employees, was different from HP observed in industrial workers since most vineyard workers recovered without medical treatment after the pruning season.

Chronic lateral epicondylitis of the elbow: A prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine

OBJECTIVE

To compare the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine in treating chronic tennis elbow.

DESIGN

Prospective, matched single-blind control trial.

SETTING

University hospital clinic.

PATIENTS

Thirty patients with unilateral chronic tennis elbow, an unsuccessful conservative therapy during the 6 months before referral, and clinical signs of cervical dysfunction (eg, pressure pain at the C4-5 and/or C5-6 level, protraction of the head).

INTERVENTIONS

Three times at weekly intervals all patients received 1000 shockwave impulses of an energy flux density of.16mJ/mm(2) at the lateral elbow. Additionally, they underwent manual therapy of the cervical spine and the cervicothoracic junction 10 times (group I). For each patient, a control matched by age (3-yr range) and gender at first conservative treatment was drawn at random from 127 patients who had undergone low-energy shockwave therapy in the same unit in the past 3 years (group II). Follow-up examinations took place at 12 weeks and at 12 months.

MAIN OUTCOME MEASURES

The Roles and Maudsley outcome score at 12 months, defining an excellent or good result with no or only occasional discomfort without limitation of activity and range of motion.

RESULTS

Neither group differed statistically before the study, with a poor rating for all patients (p >.05). At 12 months, there was still no significant difference, with the outcome being excellent or good in 56% in group I, and in 60% in group II (p >.05). Each group showed significant improvement compared with the respective prestudy evaluation (p <.0001).

CONCLUSION

ESWT may be an effective conservative treatment method for unilateral chronic tennis elbow. The efficacy of additional cervical manual therapy for lateral epicondylitis remains questionable.