Machinery-Related Perceived Risks and Safety Attitudes in Senior Swedish Farmers

OBJECTIVES

To perform an ergonomic analysis of work and machinery-related risks in a group of Swedish older farmers, investigating farmers' attitudes and perceptions about: 1) health status and work motivation, 2) physical and cognitive workload and difficulties in the interaction with machinery and technological innovations, and 3) risks and safety practices.

METHODS

Nine Swedish male farmers aged 65+ were administered a semi-structured interview and a questionnaire.

RESULTS

Participants perceived themselves as being in good health and considered farming as a good proxy of their health status. They reported an increased physical workload but did not describe any cognitive workload. Technology was reported to have low usability, and thus its benefits cannot be fully exploited. Older farmers acknowledged the existence of "new risks" related to the aging process and mainly referred to the common sense and previous experience as the best safety practices.

CONCLUSION

Multilevel interventions focused on the capabilities and limits of the older farmers should be developed, involving both training activities and design solutions for the machinery that can support older farmers' health and safety.

Ergonomic conditions in manual harvesting in Swedish outdoor cultivation

INTRODUCTION AND OBJECTIVE

Ergonomic problems in manual labour in agriculture are well known worldwide. This study investigates the ergonomic conditions during manual work in Swedish outdoor vegetable/berry cultivation.

MATERIAL AND METHODS

A questionnaire on work and health conditions was sent to all growers of vegetables and strawberries in Sweden. Workplace studies with video recordings and observations of work operations and positions at harvest were performed. Calculations of back compression and risk assessment for harmful impact of work were made. Employers and employees were interviewed.

RESULTS

Working standing/walking instead of kneeling when harvesting vegetables was shown to decrease lumbar compression. Using a conveyor belt instead of carrying a plastic box into the field for the harvested vegetables reduced harmful forward bends and the risk of musculoskeletal disorders (MSD). When strawberries were grown in pots, the work position was a straight back and neck, with lowered arms. When grown on raised beds, the work position was either kneeling or bending forward with straight legs. When kneeling, the back was often bent or rotated, frequently with the arms far from the body. Bending forward with straight legs caused a harmful level of lumbar compression.

CONCLUSIONS

Harmful work postures arise during manual harvesting in Swedish outdoor cultivation. The risk can be reduced using mechanized work tools and optimal cultivation methods. Adequate work training, including instructions about optimal working postures and movements, may reduce the risk of MSD, but will most likely not eliminate it completely.

Occupational Injuries in Swedish Agriculture: Development and Preventive Actions

Abstract. A comprehensive survey of injuries in Swedish agriculture was completed in 2013. The aim was to update the statistics on injuries and to compare them with data for 2004. The results were intended to provide a basis for evaluating the effect of Swedish initiatives to reduce occupational injuries in agriculture. In 2013, there were about 63,000 active farms in Sweden, and questionnaires with 21 questions were sent out to a sample of 6000 of these farms. The most important question was whether any injuries had occurred during 2013. Farms that reported injuries were contacted by telephone with additional questions about the injuries. A total of 3375 farms (56%) responded to the questionnaire. After population-level extrapolation, there were approximately 4400 injuries in Swedish agriculture during 2013 (66% in farming, 18% in mixed farming-forestry, and 14% in other related business activities). According to official statistics, there were only about 344 registered occupational injuries, which means that only 7% of the injuries reported in the questionnaire responses were listed in official statistics. In all, at least one injury occurred on about 7% of all enterprises with farming or combined farming-forestry. About 70% of the affected farms had animals, and 17% of all dairy farms had one or more injuries during 2013. According to this study, the overall number of injuries on farms had fallen by about 12% in 2013 compared with the corresponding study in 2004. Taking into account the reduced labor demand in agriculture and the decline in the number of farms since 2004, the rate of injury has not been reduced. To reduce occupational injuries in agriculture, in recent years the industry and government have been working intensively on work environment advice and training for farmers. Our study showed that farmers who received work environment advice and training introduced more measures to prevent injuries than those without any advisory input. It is alarming that despite all efforts to reduce injuries in agriculture, the level is still very high compared with other industries. Safety campaigns and more permanent safety initiatives in agriculture are needed to raise awareness of occupational risk factors and encourage safe behaviors. Keywords: Agriculture, Extension, Farming, Injury prevention, Injury statistics, Occupational injuries.

Comparison of Working Conditions and Prevalence of Musculoskeletal Symptoms among Dairy Farmers in Southern Sweden over a 25-Year Period

Working conditions and the prevalence of perceived musculoskeletal symptoms (MSSs) among dairy farmers in 2013 were monitored by repeating a mail survey of dairy workers in Scania, southern Sweden, using the same method for collecting data on MSSs and working conditions employed in previous surveys conducted in 1988 and 2002. All dairy enterprises in Scania (total 419) were sent two copies of a questionnaire. One or more responses were received from 232 enterprises (55.4%), of which those from 247 dairy farmers (75% men and 25% women) in 199 enterprises are included in this study. The farmers had increased their weekly working hours in 2013 compared with 2002 (males x¯= 43.9, 40.7; females x¯= 37.9, 33.9). Each male milked on average 30 cows in 1988, 44 cows in 2002, and 86 cows in 2013. The corresponding numbers milked by female farmers were 29, 60, and 102, respectively. In 1988, almost all farmers used tethered systems, while in 2013, 54.4% of male and 66.1% of female farmers instead worked with loose-housing systems. Of the farmers who used loose-housing systems, 50.7% had a robotic milking system. In 2013, 79.0% of male and 88.5% of female farmers reported MSSs on some occasion, especially in the lower back, shoulders, and knees for men, and in the shoulders, lower back, and wrists/hands for women. However, there was no statistical change compared with the frequency of MSSs in 2002. In 2013, there was a tendency for younger dairy farmers (≤35 years) to report MSSs, especially in the shoulders, elbows, lower back, and feet, more frequently than younger farmers in 2002. The males who worked with robot milking systems in 2013 indicated less discomfort in the shoulders than men who worked with other systems. The corresponding females indicated fewer problems in the lower back in 2013. Various aspects of milking system design and technology have been improved to reduce the workload and prevent MSSs in dairy farmers. Nevertheless, more improvements are needed to make the milking process more attractive and reduce health problems, especially in younger farmers currently working with milking and in new recruits.

Human-animal interactions and safety during dairy cattle handling--Comparing moving cows to milking and hoof trimming

Cattle handling is a dangerous activity on dairy farms, and cows are a major cause of injuries to livestock handlers. Even if dairy cows are generally tranquil and docile, when situations occur that they perceive or remember as aversive, they may become agitated and hazardous to handle. This study aimed to compare human-animal interactions, cow behavior, and handler safety when moving cows to daily milking and moving cows to more rarely occurring and possibly aversive hoof trimming. These processes were observed on 12 Swedish commercial dairy farms. The study included behavioral observations of handler and cows and cow heart rate recordings, as well as recording frequencies of situations and incidents related to an increased injury risk to the handler. At milking, cows were quite easily moved using few interactions. As expected, the cows showed no behavioral signs of stress, fear, or resistance and their heart rate only rose slightly from the baseline (i.e., the average heart rate during an undisturbed period before handling). Moving cows to hoof trimming involved more forceful and gentle interactions compared with moving cows to milking. Furthermore, the cows showed much higher frequencies of behaviors indicative of aversion and fear (e.g., freezing, balking, and resistance), as well as a higher increase in heart rate. The risk of injury to which handlers were exposed also increased when moving cows to hoof trimming rather than to routine milking. Some interactions (such as forceful tactile interactions with an object and pulling a neck strap or halter) appeared to be related to potentially dangerous incidents where the handler was being kicked, head-butted, or run over by a cow. In conclusion, moving cows to hoof trimming resulted in higher frequencies of behaviors indicating fear, more forceful interactions, and increased injury risks to the handler than moving cows to milking. Improving potentially stressful handling procedures (e.g., by better animal handling practices and preparation of cows to cope with such procedures) can increase handler safety, animal welfare, ease of handling, and efficiency.

Development of a Safety Management Web Tool for Horse Stables

Simple Summary

A new web tool for equine activities, InnoHorse, was developed to support horse stable managers in business, safety, pasture and manure management. The aim of the safety section of the web tool was to raise awareness of safety issues in daily horse stable activities. This section contains a safety checklist, stable safety map and good practices to support human health and horse welfare and to prevent injuries in horse-related activities. Reviews of the literature and statistics, empirical horse stable case studies, expert panel workshops and stakeholder interviews were utilized in designing the web tool.

Abstract

Managing a horse stable involves risks, which can have serious consequences for the stable, employees, clients, visitors and horses. Existing industrial or farm production risk management tools are not directly applicable to horse stables and they need to be adapted for use by managers of different types of stables. As a part of the InnoEquine project, an innovative web tool, InnoHorse, was developed to support horse stable managers in business, safety, pasture and manure management. A literature review, empirical horse stable case studies, expert panel workshops and stakeholder interviews were carried out to support the design. The InnoHorse web tool includes a safety section containing a horse stable safety map, stable safety checklists, and examples of good practices in stable safety, horse handling and rescue planning. This new horse stable safety management tool can also help in organizing work processes in horse stables in general.

An analytical ergonomic risk evaluation of body postures during daily cleaning tasks in horse stables

BACKGROUND

Musculoskeletal disorders (MSDs) are a common reason for health problems and sick leave in many professions. A work arena where MSDs have not been sufficiently studied is stable work. Here many heavy and repetitive work tasks are performed manually with old-fashioned working tools.

OBJECTIVE

The aim of this study was to use an analytical approach to identify, evaluate and grade ergonomic problems in physical work performed during daily activities in horse stables and relate these to MSDs among the workers and to the design of the tools.

METHODS

Three common work tasks were studied to identify, evaluate and grade ergonomic problems; mucking out, sweeping and bedding replacement. Used methods were Hierarchical Task Analysis, Heuristic Evaluation and Rapid Entire Body Assessment.

RESULTS

Several high-risk operations were found in mucking out boxes and disposal of bedding material. The problems consisted of awkward working postures such as a twisted and bent back, arms in an elevated position, wrists in extreme joint positions and handling of heavy loads.

CONCLUSIONS

By using an analytical approach it is possible to identify presumptive ergonomic problems without extensive empirical research. In most high-risk operations, long-shafted tools or a wheelbarrow were used, which emphasize a need to develop tools with better ergonomic design to improve the working situation. The limitation is that the ergonomics problems found are not finally validated. The results show where deeper empirical research is needed, both regarding how MSDs occur and how tools and environment contribute to physical problems.

The Effect of Stress, Attitudes, and Behavior on Safety during Animal Handling in Swedish Dairy Farming

Working with livestock is a hazardous activity, and animals have been found to be the most frequent injury source on dairy farms. Understanding the risk factors for injury and the causal relationships related to injuries and animal handling is important for developing prevention strategies and effective safety interventions. This study examined stress and handler attitude as possible risk factors for animal handling injuries in dairy farming, in particular when moving cows. Twelve dairy farms were visited on two occasions representing different stress levels: when cows were being moved to milking (low stress) and to hoof trimming (high stress). Behavioral observations of handlers and cows were performed, and questionnaires were completed on attitudes (risk acceptance, safety locus of control, and attitudes toward cows) and stress (perceived stress/energy level and job strain). The injury risks were found to be higher when moving cows to hoof trimming compared with moving cows to milking and gentle, moderately forceful, and forceful interactions were more frequently used. When moving cows to milking, observed risk situations were related only to the perceived energy level of the handler. When moving cows to hoof trimming, injury risks were correlated to job strain and time spent in the risk zone (defined as the area where the handler could be hit by the cow's head or hind legs). The time spent in the risk zone was positively correlated with job strain, age, and experience. Attitudes were not found to have significant impact on safety but were to some extent indirectly involved. These results suggest that the main focus in injury reduction work should be on reducing the time the handler spends in close proximity to animals during aversive procedures and on minimizing cow fear and stress by proper handling techniques and appropriate design of handling facilities.

The Significance of Experiences of Nature for People with Parkinson's Disease, with Special Focus on Freezing of Gait--The Necessity for a Biophilic Environment. A Multi-Method Single Subject Study

Freezing of Gait (FOG) is a common condition in people with Parkinson's disease (PD). FOG entails suddenly experiencing difficulties moving or feeling that one's feet are as glued to the ground. It is triggered, e.g., when passing through doorways. Earlier studies suggest that being in natural environments affects FOG in a positive way. Five subjects were recruited to serve as five single subject cases. We used interviews, observations, questionnaires and collected gait pattern data with aid of an accelerometer. A special designed outdoor setting was used, where we investigated whether passing through hedge openings with or without built elements triggered FOG. We found that no one experienced a FOG reaction when they passed through hedge openings without built elements. However, FOG was triggered when a doorframe was inserted into a hedge opening, and/or when peripheral vision was blocked. We interpret the results such that the doorframe triggered a phobic reflex, causing a freezing reaction. Passing through hedge openings does not trigger FOG, which we interpret as a biophilic reaction. Our results, if repeated in future studies, may have significance to everyday lives of PD patients, who could get a simpler life by consciously prioritizing stays in natural surroundings.

Work-related injuries and fatalities on dairy farm operations-a global perspective

Agriculture is among the most hazardous sectors for workers globally, and dairy farming has been associated with a high risk of injury among workers in several countries. The purpose of this paper is to provide an update on what is known about modern dairy farms and related injuries and fatalities in different regions of the world. As in other sectors of agriculture, fatalities appear to be associated with heavy equipment usage, whereas injuries occur at higher rates with animal production, specifically cattle and milk production. Dairy farming is associated with higher rates of injury as compared with other industrial sectors, but a lack of work-related injury reporting continues to be an issue in several countries. Worker fatality associated with heavy equipment use is not a new observation (e.g., tractors); however, manure-handling systems, livestock handling, and quad bike operation continue to be associated with worker injuries and fatalities on modern farms. Opportunities exist for improvement of safety-related equipment to reduce injury and fatality risk during worker interactions with large animals and farm equipment.

Occupational accidents among elderly farmers in Sweden

The workforce in many countries nowadays is becoming older due to demographic change. Compared with many other occupations, farmers often work until a higher age. This study analysed occupational accidents to farmers in Sweden from an age perspective using data on 223 work injuries on farms and 990 road accidents involving tractors. The results showed that older farmers were not significantly more often injured than younger farmers, but appeared to suffer more hits and kicks from animals and were involved in more vehicle accidents than younger farmers. Older tractor drivers were more often involved in road turning accidents and in overtaking accidents involving private cars. Older farmers also sustained more skeletal injuries and took longer to heal after an accident.

The farrier's work environment

The horse industry in Sweden has rapidly expanded in recent years. This increasing number of horses implies a greater need for more farriers. Shoeing a horse is hard physical work, and includes awkward work postures and repetitive movements. It is well known that hard physical work increases the risk of injuries and musculoskeletal problems. The risk is especially high for musculoskeletal disorders when certain movements are constantly repeated. Heavy or repeated unilateral loads lead to considerable stress on the muscles, which can lead to rupture and fatigue that can cause long term problems. A case study showed that farriers worked 75% of their work time with their backs in bent positions (often more than 70 degrees). Farriers are also exposed to risk factors in their physical environment like dust, noise and poor lighting. Risk of kicks and bites, eye injuries and burns are other factors that make their work environment hazardous. There are only a few studies available that have documented the farriers' working environment and these are not of recent date. A US study from 1984 described kicks and bites from horses, metal splinters in the eyes, heat exhaustion and problematic postures to be perceived as the greatest risks in their work. The back, knees and wrists were the most exposed body regions. There is a need for more current and in-depth studies investigating the farriers' working conditions in order to gain more knowledge of their health and work environment. The aim of the present study is to investigate the physical health and work environment of farriers. The investigation will use questionnaires, work load measurements and workplace analysis. The results will serve as a base for improvements concerning the design of the workplace, equipment, tools and aids as well as supplying recommendations about physical exercise and the correct work technique, etc. The results are planned to be incorporated in the education of farriers.

Riding instructors, their musculoskeletal health and working conditions

The aim of this study was to gain a deeper understanding of riding instructors' working conditions, work load, and frequency of musculoskeletal problems and to identify potential risk factors for the development of musculoskeletal problems. A questionnaire was mailed to 800 instructors in Sweden containing questions on their work environment, work tasks, work load, and musculoskeletal symptoms. The Borg CR-10 scale was used to estimate the work load, and the Standardized Nordic Questionnaire was used to analyze the occurrence of musculoskeletal symptoms. Perceived symptoms were most frequently reported to be in the shoulders (60%), lower back (56%), and neck (52%) during the past 12 months; 91% of the riding instructors had experienced symptoms from at least one of nine anatomical areas during the past 12 months and 55% in the seven days prior to answering the questionnaire. Removal of manure from the stable was considered to be the task involving the heaviest work, and 14.5% had suffered an injury at work during the past year. The risk of developing musculoskeletal problems was 50% less for those who did physical exercise at least two hours a week besides riding (OR = 0.47, CI 0.25-0.89).

CONCLUSIONS

The prevalence of symptoms was high, considering the low median age (33 years). Reducing workload, guarding against injury, and performing other exercises besides riding could be important measures for the prevention of musculoskeletal symptoms in this particular group of workers.

Ache, Pain, and Discomfort

The main purpose of the study was to investigate the prevalence of perceived symptoms of musculoskeletal disorders (MSD) among workers on large-scale dairy and pig farms in Sweden (herd size more than 300 cows and 450 sows) and to identify potential risk factors in the development of MSD. A study based on questionnaires was carried out among 42 workers on 10 large dairy farms and among 37 workers on 10 large pig farms in Southern Sweden during the autumn of 2002. Most importantly, the study showed that 86% of the dairy workers and 78% of the pig workers reported some kind of MSD during a period of 12 months prior to the study. The most frequently reported MSD among both the dairy and the pig workers were in the "upper extremities" (52% and 62%, respectively) especially in the shoulders and in "the back" (60% and 57%, respectively) especially in the lower back. Furthermore, being of short stature, doing repetitive work, working in awkward positions and being exposed to dust were significant risk factors in having MSD among the workers in this study. Thus, working with many cows and sows on large-scale farms in Sweden can be considered as a high risk job with regard to MSD.

Slow-moving vehicles in Swedish traffic

The objective of this study was to reach a better understanding of accidents on Swedish roads involving slow-moving vehicles and to suggest ways of preventing such accidents. We analyzed accident data from a 5-year period (1992-1996) involving all types of farm vehicles as well as horses and horse-drawn vehicles. During each year of the period under investigation, slow-moving vehicles were involved in more than 250 traffic accidents on Swedish roads, and an average of 10 people were killed, 66 sustained serious injuries, and 192 sustained slight injuries. This was about 1.3% of all persons injured in traffic accidents in Sweden. The deaths and injuries mostly involved car drivers and passengers. Tractor drivers and unprotected road users (people walking or traveling by motorcycle, moped, or bicycle) also sustained serious injuries and deaths. Vehicles overtaking slow-moving vehicles from behind were the most common type of accident (30%), followed by turning accidents (27%), accidents at crossroads (26%), and with oncoming vehicles (17%). To strengthen the suggestions for improvement, a questionnaire was sent out to driving school teachers in Sweden. Subjects were asked about their experiences with farm vehicles on the roads and their suggestions for ways to increase traffic safety. Based on the accident data and the questionnaire responses, we developed several suggestions for reducing road accidents, including measures for making farm vehicles more visible, improvement of the training provided at driving schools, and information campaigns directed at drivers of farm vehicles and other road users. Further in-depth research is needed to analyze road accidents involving slow-moving vehicles and to test different intervention measures.

Changes in working conditions and health among dairy farmers in southern Sweden. A 14-year follow-up

The objective of this study was to describe and analyse the changes in working conditions and health among dairy farmers in Scania in southern Sweden during the period 1988-2002 by a repeat of a mail-in survey. Altogether, 83 % of the male and 90 % of the female dairy farmers reported some kind of symptoms in the musculoskeletal system during the 12 months prior to the 2002 questionnaire. This is an increase compared to the farmers in 1988. The highest significant changes were an increase of symptoms in the shoulder, neck and in the wrists/hands. The milkers reported most often incidental as well as persistent symptoms in the shoulders. The frequency of hip symptoms was significantly higher among those male milkers who had quit milking during the interim than for the active milkers in 1988. The milkers studied in 2002 had, on average, increased their working time per week, increased the number of cows milked as well as the use of more milking units. In 1988, almost all the milkers studied were working in tethering systems while in 2002 more than one quarter were working in loose-housing systems. The opinion among most of the farmers, both in 1988 and in 2002, regardless of age or sex, was that silage handling and the milking procedure were the most strenuous work operations. On the other hand, the milkers obtained their greatest pleasure from the actual milking job as well as from their work to promote the welfare of the animals. Unprofitability and great investment demands had a bearing on the retirement of milkers but, on the other hand, a high potential of the milkers could have continued 10-15 more years as dairy farmers if the work conditions had been better, e.g. associated with fewer health problems. Apart from the need for developing technical devices to facilitate the milking operation, further research is needed concerning the dairy farmers' well-being and quality of life, perceived stress, and leisure time activities and how these and similar factors influence the prevalence of musculoskeletal symptoms. Strategies for preventive and intervention measures must consider physical workplace factors as well as personal and lifestyle characteristics.

Highly repetitive work operations in a modern milking system. A case study of wrist positions and movements in a rotary system

With the use of electrogoniometers wrist positions and movements were measured in 13 milkers while working in a modern rotary milking system. The rotary system put considerable demands on the wrists and hands regarding both velocities and repetitiveness. Values were found close to those described in other repetitive industrial work with high risk of wrist and hand disorders. For the right hand the repetitiveness was 0.57 Hz and 0.46 Hz for the left hand. In addition, the median value (50th percentile) of the angular velocity distribution was also high, being 36 degrees /s for the right hand and 26 degrees /s for the left, and with respect to the peak value (90th percentile) the corresponding values were 155 degrees /s and 135 degrees /s, respectively. Furthermore, when milking in the rotary system, there was less possibility to hold the hands still than in the other milking systems. The right hand rested only 1.4% of the milking time and the left only 1.0%. The hands were therefore moving throughout almost the entire milking procedure. High velocity, repetitiveness and fewer opportunities for rest are risk factors that might lead to disorders in the wrists and hands. Regarding wrist positions, the left wrist was held in a more dorsiflexed position than the right, 37 degrees and 29 degrees, respectively. Compared with tethering and loose-housing parlour milking, the wrist positions were, however, improved in the rotary system. When introducing new milking systems these negative effects on wrist and hand movements must be borne in mind in order to minimize the prevalence of wrist and hand disorders.

Marker-less systems for tracking working postures--results from two experiments

Two experiments are performed to examine the usability of different marker-less approaches in image analysis and computer vision for automatic registration of OWAS (Ovako working posture analysing system) postures from video film. In experiment 1, a parametric method based on image analysis routines is developed both for separating the subject from its background and for relating the shapes of the extracted subject to OWAS postures. All 12 analysed images were correctly classified by the method. In experiment 2 a computer neural network is taught to relate postures of a subject to OWAS postures. When the network was trained with 53 images the rest of the set of 138 images was correctly classified. The experiments described in this paper show promising results regarding the use of image analysis and computer vision for tracking and assessing working postures. However, further research is needed including tests of different human models, neural networks, and template matching for making the OWAS method more useful in identifying and evaluating potentially harmful working postures.

Physical workload on upper extremities in various operations during machine milking

The aim of the study was to quantify the workload on the upper extremity for fundamental work tasks during machine milking. Eleven milkers working in a loose-housing system with a milking parlour participated in the study. Muscle activity for the biceps and the forearm flexors, as well as positions and movements of the wrists were simultaneously measured by electromyography and electrogoniometry while video-recording the work. The milking work was broken up in three main tasks "Drying (the cow's udder)", "Pre-milking (the first milk)" and "Attaching (the milking unit to the udder)" and three supplementary tasks. All three main tasks show high muscle load values and almost no time for rest. The highest load values for the biceps and flexor muscles were found during the tasks "Attaching, holding the milking unit" and "Drying", respectively. For 10% of the recording time, the milkers held active hands in 42 degrees dorsal flexion during the milking tasks "Pre-milking" and "Attaching" and in deviated positions exceeding 50% of their maximum values during "Attaching" and "Drying". The high muscle loads in combination with extreme positions and movements of the hand and forearm might contribute to the development of injuries among milkers. The result from the study aims to form a basis for technical improvements of the milking equipment to decrease the risk for arm wrist and hand disorders.

The Natural Course of Musculoskeletal Symptoms and Clinical Findings in Upper Extremities of Female Milkers

To explore milkers' state of health with regard to symptoms in the wrists and hands, a study of 80 female milkers was carried out 12 months after a Nordic questionnaire study of these subjects. Of these 80, 41 had reported pain and discomfort in the wrists and hands at the time of the questionnaire study, whereas the remaining 39 had had no such symptoms. To determine the sensitivity and specificity of the Nordic questionnaire, the follow-up study included examination by an unbiased clinician. The occurrence of symptoms in the wrists and hands during the preceding 12 months was found to have been rather stable-30 of the 41 milkers still reported pain, aching, and discomfort, and eight new cases were recorded. On clinical examination, symptoms including numbness, tingling, and coldness in the forearms and hands were reported by 51 of the 80 milkers, 14 of whom had clinical symptoms and signs indicating median nerve entrapment. Peritendinitis was diagnosed in four subjects and a ganglion cyst in one. The findings in the remaining group did not meet diagnostic criteria. All subjects with wrist and hand symptoms were still at work a year after the initial study. The sensitivity of the Nordic questionnaire when it came to identifying subjects with clinical findings was found to be unsatisfactory. The actual incidence of wrist and hand disorders may be underestimated if the Nordic questionnaire is used as the only instrument in epidemiologic screenings.