Musculoskeletal misdiagnoses in pediatric patients with spinal tumors

OBJECTIVE

Childhood spinal tumors often present with musculoskeletal symptoms, potentially causing a misdiagnosis and delays in diagnosis and treatment. This study aims to identify, characterize, and compare children with spinal tumors who had prior musculoskeletal misdiagnoses to those without, analyzing clinical presentation, diagnostic interval, and outcome.

STUDY DESIGN

This retrospective cohort study evaluated all children aged 0-14 years diagnosed with a spinal tumor in Denmark from 1996 to 2018. The cohort was identified through the Danish Childhood Cancer Registry, and the registry data were supplemented with data from medical records. The survival was compared using the Kaplan-Meier method.

RESULTS

Among 58 patients, 57% (33/58) received musculoskeletal misdiagnoses before the spinal tumor diagnosis. Misdiagnoses were mostly nonspecific (64%, 21/33), involving pain and accidental lesions, while 36% (12/33) were rheumatologic diagnoses. The patients with prior misdiagnosis had less aggressive tumors, fewer neurological/general symptoms, and 5.5 months median diagnostic interval versus 3 months for those without a misdiagnosis. Those with prior misdiagnoses tended to have a higher 5-year survival of 83% (95% confidence interval [CI]: 63%-92%) compared to 66% (95% CI: 44%-82%) for those without (p = .15).

CONCLUSION

Less aggressive spinal tumors may manifest as gradual skeletal abnormalities and musculoskeletal symptoms without neurological/general symptoms, leading to misdiagnoses and delays.

[Ergonomics and organization of remote work - health aspect and recommendations for home office organization]

Analyses of the economic activity of the Polish population indicate that in 2023, about 7% of all employees performed, usually or sometimes, their work in the form of remote work. The purpose of this publication is to analyze the impact of working with screen-monitor devices on computer vision syndromes, musculoskeletal disorders, circadian rhythm, and to identify recommendations for the proper organization of the home office. A narrative review of the existing literature on the impact of work with the use of devices equipped with screen monitors on the health of employees was performed, as well as recommendations in the above-mentioned area were presented. The most important factors determining the load on the visual organs and musculoskeletal system and affecting the overall health and well-being of employees during remote work are the proper arrangement of the workstation (in accordance with ergonomic principles) and the organization of work (limiting the time spent working at the computer/laptop, systematic active breaks) and healthy sleep habits. It is crucial that both employers, occupational health professionals and employees themselves are aware of the importance to their health of correct preparation of the home office, and have adequate knowledge in this regard. Med Pr Work Health Saf. 2024;75(1):69-80.

Excessive use of electronic devices among children and adolescents is associated with musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life: a cross-sectional study

Objective

Electronic devices have become an indispensable part of our daily lives. The frequency and duration of device use in children and adolescents have increased drastically over the years and the study of its negative musculoskeletal, visual and psychosocial health impacts is necessary.

Materials and methods

This cross-sectional study aimed to evaluate the associations between electronic device use and the prevalence and severity of musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life in children and adolescents studying at primary and secondary schools. Data were collected through confidential online and paper-and-pencil questionnaires. Primary 4-5 and Secondary 1-4 students were recruited from 3 schools in Hong Kong. Demographics, frequency and duration of electronic device use, frequencies of musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life outcomes were measured.

Results

1,058 children and adolescents aged 9-17  years participated. Sixty-one percent and 78% of all students spent more than 2  h per day using electronic devices during school days and weekend/holidays, respectively. Extended electronic device use was associated with increased prevalence and severity of musculoskeletal symptoms (ρ's = 0.28-0.33, P's < 0.001), visual symptoms (ρ's = 0.33-0.35, P's < 0.001), and poorer device use-related psychosocial health (ρ's = 0.38-0.47, P's < 0.001). Secondary school students reported greater device use and severity of symptoms than primary school students.

Conclusion

Excessive electronic device use was associated with increased prevalence and severity of physical and psychosocial symptoms, and such use is more prevalent in adolescents when compared to the children. The findings have important health implications for children and adolescents, suggesting that early intervention is needed to reduce the risk of developing device use-related disorders.

Associations between observed time sitting at work and musculoskeletal symptoms: a repeated-measures study of manufacturing workers

Time sitting at work is known to affect health overall, but its specific effects on musculoskeletal symptoms are unclear. We evaluated the relationship between observed time sitting at work and self-reported musculoskeletal symptoms among 195 manufacturing workers. Longer time sitting at work was significantly associated with lower prevalence of neck/shoulder (prevalence ratio [PR] = 0.70, 95% confidence interval [CI] [0.68, 0.72]; p < 0.001) and arm/wrist/hand (PR = 0.46, 95% CI [0.31, 0.69]; p < 0.001) musculoskeletal symptoms. Associations remained largely unchanged after adjusting for job type or occupational postures and load. Time sitting at work was associated with musculoskeletal symptoms, and should be taken into consideration as part of interventions to prevent musculoskeletal disorders (MSDs) and promote health of manufacturing workers.

Ergonomics of E-Learning Workstations and the Prevalence of Musculoskeletal Disorders-Study among University Students

The prevalence of musculoskeletal disorders (MSD) has increased significantly in recent years. The COVID-19 pandemic has led to a fundamental change in the lifestyles, ways of learning and working patterns of the general population, which in turn, might lead to health consequences. The aim of this study was to evaluate the conditions of e-learning and the impact of the learning modality on the occurrence of musculoskeletal symptoms among university students in Poland. This cross-sectional study included 914 students who completed an anonymous questionnaire. The questions covered two time periods (before and during the COVID-19 pandemic) and were aimed at obtaining information about lifestyle (including physical activity using the modified International Physical Activity Questionnaire, 2007 (IPAQ), perceived stress and sleep patterns), the ergonomics of computer workstations (by Rapid Office Strain Assessment, 2012 (ROSA) method), the incidence and severity of musculoskeletal symptoms (by the Nordic Musculoskeletal Questionnaire, 2018 (NMQ)) and headaches. The main differences between the two periods were statistically significant according to the Wilcoxon test in terms of physical activity, computer use time, and severity of headaches. During the COVID-19 pandemic, there was a significant increase in MSD (68.2% vs. 74.6%) and their intensity (2.83 ± 2.36 vs. 3.50 ± 2.79 points) among the student population (p < 0.001). In the group of students with MSD, there was a high musculoskeletal load, due to the lack of ergonomic remote learning workstations. In future, a thorough study should be carried out, and there is an urgent need to raise students' awareness of arranging learning workstations according to ergonomic principles in order to prevent the occurrence of musculoskeletal problems.

Relationship between Locomotive Syndrome and Musculoskeletal Pain and Generalized Joint Laxity in Young Chinese Adults

This study aims to investigate the prevalence of locomotive syndrome (LS) and to examine the relationship of LS with musculoskeletal symptoms (pain, generalized joint laxity (GJL)) in young Chinese adults. Our study population (n = 157; mean age of 19.8 ± 1.2 years) comprises college student residents at Tsinghua University in Beijing, China. Three screening methods were used to evaluate LS: 25-question Geriatric Locomotive Function Scale (GLFS-25), a two-step test, and a stand-up test. Musculoskeletal pain was assessed by self-report and visual analog scale (VAS), and joint body laxity was evaluated using the GJL test. The prevalence of LS was 21.7% of all participants. Musculoskeletal pain affected 77.8% of the college students with LS and was strongly associated with LS. A total of 55.0% of college students with LS had four or more site joints that were positive for GJL, and higher scores of GJL were associated with a higher prevalence rate of LS. Young Chinese college students have a relatively high prevalence of LS, and musculoskeletal pain and GJL were significantly related to LS. The present results suggest that we need early screening of musculoskeletal symptoms and LS health education in young adults to prevent the mobility limitations of LS in the future.

Development and Initial Validation of the ONCOREUM Score to Differentiate Childhood Cancer with Arthropathy from Juvenile Idiopathic Arthritis

OBJECTIVE

To develop and validate a weighted score, the ONCOREUM score, that aids physicians in differentiation of cancer with arthropathy from juvenile idiopathic arthritis (JIA).

STUDY DESIGN

Data were extracted from the ONCOREUM Study, a multicenter, cross-sectional investigation aimed at comparing children with cancer and arthropathy to children with JIA. Three statistical approaches were applied to develop the ONCOREUM score and assess the role of each variable in the diagnosis of cancer with arthropathy, including 2 approaches based on multivariable stepwise selection (models 1 and 2) and 1 approach on a Bayesian model averaging method (model 3). The β coefficients estimated in the models were used to assign score points. Considering that not missing a child with cancer is a mandatory clinical objective, discriminating performance was assessed by fixing sensitivity at 100%. Score performance was evaluated in both developmental and validation samples (representing 80% and 20% of the study population, respectively).

RESULTS

Patients with cancer and arthropathy (49 with solid tumors and 46 with hematologic malignancies without peripheral blasts) and 677 patients with JIA were included. The highest area under the receiver operating characteristic (ROC) curve (AUC) in the validation data set was yielded by model 1, which was selected to constitute the ONCOREUM score. The score ranged from -18 to 21.8, and the optimal cutoff obtained through ROC analysis was -6. The sensitivity, specificity, and AUC of the cutoff in the validation sample were 100%, 70%, and 0.85, respectively.

CONCLUSIONS

The ONCOREUM score is a powerful and easily applicable tool that may facilitate early differentiation of malignancies with articular complaints from JIA.

Investigation of the multi-component ergonomics intervention effects on improving musculoskeletal outcomes and speech communication: A case study in open-plan offices

BACKGROUND

Office workers are at high risk of developing musculoskeletal symptoms (MSS) due to improper workstations. Open-plan bank office employees must communicate with bank clerks properly and perform financial activity precisely, but noise is a factor that disrupts their communication. Therefore, MSS and annoying noise are two of the main problems in open-plan offices.

OBJECTIVE

This study evaluated the effects of a multi-component intervention involving individual (employee ergonomics training) and physical (improvements in workstation design and work environment) ergonomic factors on musculoskeletal outcomes and speech communication in open-plan environments.

METHODS

A preliminary survey was carried out to investigate the overall ergonomics problems, the tasks and time analysis, workstations setup, the prevalence of MSS (Nordic Musculoskeletal Questionnaire), physical discomfort (Visual Analogue Scale [VAS]), and posture (assessed by Rapid Upper Limb Assessment [RULA] method), environmental status (measurement of noise), and speech intelligibility (assessed by Speech Interference Level [SIL] method based on ISO 9921). The multi-component interventions were performed afterward based on the data collected. A baseline assessment and a 9-month follow-up assessment were conducted.

RESULTS

The results showed a significant decrease in the prevalence of musculoskeletal complaints (shoulders, elbows, and low back), physical discomfort, and awkward working postures after the intervention. A considerable improvement was also found in speech intelligibility post-intervention. The post-intervention questionnaire survey also indicated that employees generally favored the redesigned workstations.

CONCLUSION

The results support the effectiveness of implementing multi-component interventions in open-plan bank offices to improve musculoskeletal complaints and speech communication.

Occupational Health: Physical Activity, Musculoskeletal Symptoms and Quality of Life in Computer Workers: A Narrative Review

Computer work has assumed a very important role for many companies, but specific occupational and health symptoms associated with the use of computers can appear. According to the literature, physical activity is considered a key player in the prevention and control of work-related musculoskeletal symptoms, contributing to a better quality of life in computer workers. The principal aims of this review are to contribute to a better understanding of the relationship among sedentary behavior, physical activity and quality of life of computer workers; to outline the importance of promoting the development of an educational program for Occupational Health directed at computer workers at the level of quality of life, musculoskeletal symptoms, and physical activity; and to call for attention to the factors needed to initiate and maintain a health program that involves the active participation of workers who must be concerned about their health. This review demonstrates the important role of workplaces in health promotion and the opportunities that workplaces provide to establish and continue successful health-promotion programs for computer workers, generating important benefits for the health and quality of life of individuals and groups.

Musculoskeletal Symptoms in Professional Musicians: Do Self-employed and Employer-employed Musicians Differ?

Concerns have been raised for the health and wellbeing of self-employed workers. Musicians are the ‘original’ gig workers, and musicians have a high prevalence of musculoskeletal symptoms (MSSs). Studies of musicians’ MSSs have typically focused on classical, employer-employed musicians; leaving self-employed musicians under-investigated. We investigated the prevalence of MSS outcomes in all types of professional musicians, and compared the MSS outcomes between self-employed and employer-employed musicians. We conducted a cross-sectional study of professional musicians. Given the large proportion of musicians who were both self-employed and employer-employed, three groups were compared: self-employed only (self-employed group), employer-employed only (employer-employed group), and both self-employed and employer-employed (both group) musicians. Multivariable regression analyses were conducted. A total of 225 professional musicians were included in the study, 87.9% of whom reported MSSs in the last 12 months. For MSSs that impaired musical activity, the 12-month prevalence was 43.2%. Musicians in the self-employed group reported a significantly higher 7-day prevalence of MSSs compared with those in the employer-employed group. Compared with musicians in the employer-employed group, musicians in the both group reported a higher 12-month prevalence of MSSs that impaired musical activity. A higher proportion of symptomatic musicians in the both group reported seeing a health professional for their MSSs, compared with the employer-employed group. Similarly, symptomatic musicians in the both group reported higher ratings of emotional impact from MSSs, compared with symptomatic musicians in the employer-employed group. The majority of musicians have experienced MSSs. Several significant differences were reported between the three groups of musicians, with musicians in the both group generally reporting poorer MSS outcomes, compared with musicians in the employer-employed group. There are several potential reasons for why musicians who are both self-employed and employer-employed appear to have poorer MSS outcomes, including the stress of balancing multiple demands. Further research is required into the risk factors for MSS outcomes in self-employed musicians, including those who are both self-employed and employer-employed, and interventions should be directed towards self-employed musicians to minimise the MSS burden.

The Effects of COVID-19 Lockdown on the Perception of Physical Activity and on the Perception of Musculoskeletal Symptoms in Computer Workers: Comparative Longitudinal Study Design

Lockdown resulting from the pandemic led to a change in the health habits of the computer workers community. Sedentary work, together with less active lifestyles, aggravated by the COVID-19 pandemic leads to impacts on physical activity (PA) and can contribute to the development of musculoskeletal symptoms (MSS). Aim(s): Understand the effects of lockdown on the perception of physical activity levels and on the perception of frequency of musculoskeletal symptoms, over periods of 12 months and 7 days, in computer workers. Methods: Longitudinal comparative study between 2019 (M1) and 2021 (M2), over 18 months, in 40 volunteer participants. The inclusion criteria were full-time workers aged between 18 and 65 and the exclusion criteria included diagnosis of non-work-related medical conditions. In addition to a socio-demographic questionnaire, the Nordic musculoskeletal questionnaire (NMQ) was used to evaluate the MSS and the International Physical Activity Questionnaire (IPAQ), was used to analyse the perception of the level of PA. These questionnaires were used in two assessment stages (M1 and M2). McNemar test and Wilcoxon paired test were used to evaluate the effect of lockdown on the perception of PA, and on the perception of frequency of musculoskeletal symptoms. Results: The MSS prevalence in the previous 12 months increased significantly in the neck (M1: 45.0%, M2: 62.5%, p = 0.046), in the shoulders (M1: 37.5%, M2: 55.0%, p = 0.033), and in the hands/wrists (M1: 25.0%, M2: 45.0%, p = 0.019). The mean pain score increased in the shoulders (1.43 ± 2.24, 2.35 ± 2.55, p = 0.003) and in the elbows (0.18 ± 0.59, 0.60 ± 1.34, p = 0.015). No differences were found in the PA between M1 and M2, but the weekly mean sitting time increased from 4.75 ± 2.26 to 6.26 ± 2.65 (p < 0.001). Conclusion: After 18 months it became clear that MSS perception increased mainly in the neck, shoulders and hands/wrists with a significant increase in pain intensity in the shoulder and elbow regions. The weekly sitting time increased significantly. Further studies are needed in order to determine the impact of teleworking in a pandemic context. But multifactor behind these results should be taken into account by health institutions and those responsible for the Prevention of Occupational Risks in Computer Workers in order to adopt educational strategies for the promotion of Physical activity (PA), in these workers.

Evaluation of computer workstations ergonomics and its relationship with reported musculoskeletal and visual symptoms among university employees in Jordan

OBJECTIVES

Computer workstations are considered a potential workplace hazard. This study sought to evaluate computer workstation ergonomics in a university office environment, and to determine its relationship with musculoskeletal (MS) and visual symptoms reported by employees.

MATERIAL AND METHODS

This was a cross-sectional observational study. A total of 231 university employees were recruited using a stratified random sampling technique. By means of direct observation, computer workstations were evaluated using the Occupational Safety and Health Administration (OSHA) Ergonomic Computer Workstation Evaluation Checklist. In addition, the participants reported MS and visual symptoms during the past week and 12 months by completing questionnaires.

RESULTS

Several ergonomic deficiencies in computer workstations were identified. Seating, working area, and keyboard and input devices had the most documented deficits. A significant proportion of employees reported various MS symptoms during the past 12 months. The most affected body parts were the shoulders (37%), the lower back (34%), and the neck (29%). The most prevalent visual symptom was tired eyes (68%). Logistic regression analysis indicated that MS symptoms, such as ache, pain and discomfort, were significantly associated with the total scores on the OSHA components. Deficits in monitor ergonomics and its placement, particularly the presence of glare reflected on the screen, were also associated with reported visual symptoms. Independent variables, such as gender, age, employment duration, job type, daily computer work hours, and work pattern, reliably predicted the participants' reported experience of various MS and visual symptoms.

CONCLUSIONS

Both MS and visual symptoms are associated with deficits in computer workstation ergonomics. Appropriate strategies, work practices, and preventive measures are needed to eliminate occupational hazards associated with computer workstations. Int J Occup Med Environ Health. 2022;35(2):141-56.

Musculoskeletal symptoms among radiation technologists in Saudi Arabia: prevalence and causative factors

BACKGROUND

Radiation technologists usually perform several physical tasks as part of their work routine that are related to imaging equipment and handling patients. These kinds of physical activities increase their risk of developing musculoskeletal symptoms (MSS).

PURPOSE

To determine the prevalence and causative factors of MSS among radiation technologists in Saudi Arabia.

MATERIAL AND METHODS

A previously validated and published questionnaire was sent electronically to 800 radiation technologists in Saudi Arabia. It focused on the presence and prior diagnosis of MSS. Questions to determine risk factors were included.

RESULTS

A total of 381 responses were obtained. MSS were indicated by 326 responders (85.6%). Furthermore, it was reported that 309 responders (81.1%) spent more than 2 h per day in awkward postures. Of the responders, 164 (43%) stated that they worked 4 h per day on a personal computer or PACS. The most frequently selected reasons for MSS included patient transfer (50.6%), chairs (38.5%), lead aprons (25.6%), moving heavy equipment (23.1%), and fixed table height (19.4%). An association between work-related MSS and gender was observed (χ²(1) = 5.338; P = 0.021). Similarly, an association between work-related MSS and age was also observed (χ²(3) = 48.58; P = 0.000).

CONCLUSION

Radiation technologists in Saudi Arabia reported a fairly high incidence of MSS, more commonly among female and senior workers. To have a better and safer workplace for radiation technologists, this study suggests preventive measures on organizational and individual levels.

Work exposures and mental and musculoskeletal symptoms in organic farming

This study focussed on harmful exposures and mental and musculoskeletal symptoms in organic and conventional farming using interview data of Finnish farmers over the winter of 2014-2015. The data consisted of 2,169 full-time farmers, out of whom 231 (11%) practiced organic farming and 1,938 (89%) conventional farming. Exposure to poisonous and irritating substances was less frequent while exposures to vibration and mould ('smell of root cellar') were more frequent on organic farms. Mental and musculoskeletal symptoms were slightly more common among organic farmers, but the associations were not statistically significant in regression modelling. Risk factors for mental symptoms included animal production, hired labour, female gender, constant hurry, working alone, economic uncertainty, and inadequate recovery from workdays. Risk factors for musculoskeletal symptoms included older age, female gender, constant hurry, economic uncertainty, difficult working postures, heavy lifting and carrying, and inadequate recovery. Workload and recovery, managing the transition period and better follow-up of the occupational well-being were identified as concerns among organic farmers. Practitioner summary: Converting from conventional to organic farming has become increasingly common. Farmer interviews indicated that exposure to poisonous and irritating substances was less frequent while exposures to vibration and mould were more frequent on organic farms. Mental and musculoskeletal symptoms and risk factors were similar in both types of farming.

Risk factors of musculoskeletal symptoms among mobile device users during work from home

Objectives. Coronavirus (COVID-19) is affecting people throughout the world. People are forced to conduct various activities at home using mobile devices (MDs) as a result of the outbreak. In this case, prolonged use of MDs is the major cause for work-related health problems. Methods. We used systematic cluster random sampling to sample a diverse group of Indians from India's various states. Subjects filled out a questionnaire with questions about their demographics, MD usage and musculoskeletal symptoms (MSSs) faced. The relationship between MSSs and various factors was investigated using χ² and binomial logistic regression analysis. Results. An online survey yielded 720 responses. More than half of employees registered MSSs in their upper body regions. Age, gender and MD usage were correlated with MSSs in various body regions. According to the binomial logistic regression findings, gender was significantly linked to MSSs in each body region. Conclusions. Results show that MDs can be used effectively in intermediate leisure activities if they are used in accordance with their basic needs.

Effects of an Artificial Intelligence-Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial

Background

Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem.

Objective

This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)–assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants’ adherence to exercises.

Methods

We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone’s chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC).

Results

We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75%) out of 48 participants in the intervention group and 3 (7%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95% CI 11.25-164.28; P<.001).

Conclusions

This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program.

Trial Registration

University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038307.

Occupational Health: Does Compliance with Physical Activity Recommendations Have a Preventive Effect on Musculoskeletal Symptoms in Computer Workers? A Cross-Sectional Study

A lack of physical activity in computer workers (CW) can contribute to the development of musculoskeletal symptoms (MSS). Aim: (i) Evaluate MSS over a 12 month and 7 days period, (ii) determine physical activity (PA) levels and compliance with World Health Organization (WHO) PA recommendations, and (iii) assess the relationship between compliance with WHO PA recommendations and MSS. Methods: A cross-sectional observational study comprising 119 computer workers. The Nordic Musculoskeletal Questionnaire (NMQ) was used to evaluate the MSS and the International Physical Activity Questionnaire (IPAQ) was used to analyse the perception of the level of PA. Results: MSS occurred in the lumbar region (56.3%), neck (43.7%), and shoulders (39.5%). 44.7% of the participants reported a low level of PA. The percentage of compliance was similar among women and men (62.2% vs. 58.5%, respectively). Negative correlations were found between pain intensity and metabolic equivalent values. The participants who followed the WHO PA recommendations reported a lower frequency of MSS compared to those who did not, but the differences were not statistically significant. Conclusion: It was possible to conclude that computer workers presented a higher frequency of MSS in the lower back, neck, and shoulders. Regarding the level of PA, participants were mostly classified as low. Participants who followed the WHO PA recommendations reported lower MSS than those who did not. This finding could be important in obtaining successful programs that promote health-oriented physical activity in this group of workers.

Analyzing musculoskeletal risk prevalence among workers in developing countries: an analysis of small-scale cast-iron foundries in India

Musculoskeletal disorders (MSDs) are the most common health issues around the globe and a major cause of disability among workers. In developing countries, most casting industries fall under Small and Medium Scale Enterprises (SMEs); SMEs lack modern equipment and often intensively rely on manual labor. As processes are mainly labor intensive, workers employed in the metal casting sector are often at risk of MSDs. The main objective of this study is to investigate the exposure of work-related musculoskeletal symptoms prevalent among male workers employed in small scale gray cast-iron foundries of northern India. The techniques used included the Nordic Musculoskeletal Questionnaire (NMQ), anthropometric measures, work postures analysis based on digital human modeling (DHM), Rapid Upper Limb Assessment/RULA and Biomechanics Single Action Analysis/BSAA ergonomic assessment tools. Based on the measured anthropometric variables and work postures attained during various routine tasks, virtual work manikins were created and analyzed using human activity analysis in CATIA V5R20. Subjective assessment revealed that distal upper extremity regions i.e. wrists/hands followed by lower back, neck and shoulders have higher frequency of reported MSDs symptoms. Higher musculoskeletal risk was observed with most of the analyzed work postures, with fettling and Manual Material Handling (MMH) tasks being the most affected. A regression model was developed to predict the L4-L5 spine compression load on the workers' lumbar regions; a coefficient of determination (R²) value of 0.761 indicates an acceptable model fit (R-value = 0.873). Based on the values of the standardized beta coefficients, findings suggested that trunk angle (β = 0.616), followed by upper arm angle (β = 0.408), were stronger predictors on the dependent variable (i.e. L4-L5 spine compression) than population percentile (β = 0.372), object weight (β = 0.208) and lower arm angle (β = 0.183). The findings suggest that factors like manual work demands, poor work station structure, repetitive actions and awkward postures held for a longer duration may likely be associated with MSDs risk severity. The present study may guide the foundry industrialists in analyzing the mismatch between the workers' job profiles and redesigning the work station layouts in small scale foundries based on minimizing the risk severity associated with the tasks carried out by staff.

Association of the Yips and Musculoskeletal Problems in Highly Skilled Golfers: A Large Scale Epidemiological Study in Japan

The yips are a set of conditions associated with intermittent motor disturbances that affect precision movement, especially in sports. Specifically, skilled golfers suffer from the yips, although its clinical characteristics and pathophysiology have not been well-studied. We surveyed skilled golfers to characterize their yips-related symptoms, to explore potential confounding factors associated with the yips. Golfers’ demographic information, golfing-career-related history, musculoskeletal status and manifestations of the yips are surveyed. Among the 1576 questionnaires distributed, 1457 (92%) responses were received, of which 39% of golfers had experienced the yips. The median age and golfing careers were 48 and 28 years, respectively. Golfers who had experienced the yips were older and had longer golfing careers and more frequent musculoskeletal problems than those without experience of the yips. The multivariate logistic regression analysis revealed that a longer golfing career and musculoskeletal problems were independent factors associated with yips experience. More severe musculoskeletal problems were associated with higher odds of experiencing the yips. A positive association between the yips and musculoskeletal problems was also observed. The yips have similar characteristics to task-specific movement disorders, with a detrimental effect caused by excessive repetition of a routine task. These findings support the notion that the yips are a type of task-specific dystonia.

Gender differences in health anxiety and musculoskeletal symptoms during the COVID-19 pandemic

BACKGROUND

Health anxiety is often associated with musculoskeletal symptoms and gender, but there are limited studies that investigate these relationships during the COVID-19 pandemic.

OBJECTIVE

We aimed to compare the genders regarding health anxiety and musculoskeletal symptoms during the COVID-19 pandemic and to investigate the relationship of musculoskeletal symptoms with physical activity and health anxiety.

METHODS

Assessments were performed through an online questionnaire. Eighty-five males and eighty-five females were included by matching genders in terms of age, body mass index, education level, number of days spent at home during the pandemic, and physical activity. The Short Health Anxiety Inventory, the International Physical Activity Questionnaire-Short Form, and the Nordic Musculoskeletal Questionnaire were used to assess health anxiety, physical activity, and musculoskeletal symptoms, respectively.

RESULTS

Females had a higher level of health anxiety and more musculoskeletal symptoms than males (p< 0.05). There were weak to moderate correlations in females and weak correlations in males between musculoskeletal symptoms and health anxiety (p< 0.05). Also, a weak negative correlation was found between physical activity and musculoskeletal symptoms in both genders (p< 0.05).

CONCLUSIONS

Females are more anxious and have more musculoskeletal symptoms during the pandemic than males. Also, health anxiety is related to musculoskeletal symptoms in both genders.

Health and Safety in Nail Salons: A Cross-Sectional Survey

OBJECTIVES

In recent years, nail salons have become more abundant than ever. The majority are small businesses, often employing immigrant women. Nail technicians have many exposures at work including chemical, biological, physical, and ergonomic hazards but few data exist on their symptoms or occupational health and safety practices, particularly in the Canadian context. The aim of this study was to learn about nail technicians, their work, and their health and safety practices.

METHODS

Nail technicians were recruited from nail salons in Toronto, Ontario. Participants completed an anonymous survey with questions about demographics, work tasks, workplace health and safety practices, and symptoms (skin, respiratory, and musculoskeletal).

RESULTS

A total of 155 nail technicians (95% female) participated in the survey. The majority of nail technicians performed manicures (99%) and pedicures (96%) and applied shellac polishes (86%). Only a third (34%) applied acrylic artificial nails. The reported use of personal protective equipment (PPE) was very high; 88% reported using a mask at work and 96% reporting using gloves. The most common symptoms reported by technicians were neck (44%) and back pain (38%). Skin and respiratory symptoms were less common with 6% of technicians reporting cough, 8% wheeze, and 5% a current rash. Technicians working over 30 h per week reported more neck pain (52 vs. 32%, P = 0.02). Technicians who reported using shellac polishes were more likely to report a runny nose (25 vs. 0%, P = 0.01).

CONCLUSIONS

Nail technicians in Toronto, Canada are experiencing work-related symptoms. Musculoskeletal symptoms were the most common symptoms reported. Much of the focus on nail salons and health has been on chemical exposures, but ergonomic hazards should not be overlooked. Efforts to increase knowledge and improve occupational health in nail salons should include information on multiple possible workplace hazards and how to reduce impacts of exposure.

Barriers and facilitators of productivity while working from home during pandemic

OBJECTIVES

This study aims to characterize the working environment, stress levels, and psychological detachment of employees working from home during the COVID-19 pandemic in the Philippines and investigate their relationship to productivity and musculoskeletal symptoms.

METHODS

Structural equation modeling was used to examine the direct effect of workstation characteristics, stress, and musculoskeletal symptoms to productivity and the indirect effect of psychological detachment to productivity. Data were gathered from a survey of employees working from home during the pandemic from different industries (n = 352). Multigroup analysis was also conducted to determine the effect of age, having a spouse, and having children less than 18 years old, to the model.

RESULTS

Ergonomic suitability of the workstation (WES) has a significant effect on musculoskeletal symptoms (MSS) (β = -0.31, SE = 0.06; p < .001). Both workstation suitability (β = -0.24, SE = 0.03; p < .001) and workstation ergonomic suitability (β = -0.18, SE = 0.01; p < .01) inversely affect STR. Psychological detachment has a significant inverse effect on stress (β = -0.31, SE = 0.07; p < .001) and stress has a significant negative effect on productivity (β = -0.13, SE = 0.09; p = .03). Multigroup analyses showed that stress significantly affected the productivity of those without spouses and young employees.

CONCLUSION

Workstation suitability helps improve the productivity of people working from home while stress negatively affects it. Workstation ergonomic suitability and musculoskeletal symptoms have no significant effect.

Effects of Time in Sitting and Standing on Pleasantness, Acceptability, Fatigue, and Pain When Using a Sit-Stand Desk: An Experiment on Overweight and Normal-Weight Subjects

BACKGROUND

Sit-stand desks have been suggested as an initiative to increase posture variation among office workers. However, there is limited evidence of what would be preferable combinations of time sitting and standing. The aim of this study was to determine and compare perceived pleasantness, acceptability, pain, and fatigue for 5 time patterns of sitting and standing at a sit-stand desk.

METHODS

Thirty postgraduate students were equally divided into a normal-weight (mean body mass index 22.8 kg/m2) and an overweight/obese (mean body mass index 28.1 kg/m2) group. They performed 3 hours of computer work at a sit-stand desk on 5 different days, each day with a different time pattern (A: 60-min sit/0-min stand; B: 50/10; C: 40/20; D: 30/30; E: 20/40). Pleasantness, acceptability, pain, and fatigue ratings were obtained at the beginning and at the end of the 3-hour period.

RESULTS

High ratings of pleasantness were observed for time patterns B, C, and D in both groups. All participants rated acceptability to be good for time patterns A to D. A minor increase in perceived fatigue and pain was observed in time pattern E.

CONCLUSION

For new sit-stand desk users, regardless of body mass index, 10 to 30 minutes of standing per hour appears to be an amenable time pattern.

Head forward flexion, lateral bending and viewing distance in smartphone users: A comparison between sitting and standing postures

BACKGROUND

Smartphones (SPs) are widely used by people of all age groups and genders. Users spend many hours per day on the SPs for different purposes, which imposes significant stress on their musculoskeletal system.

OBJECTIVES

This study explored head forward flexion, lateral bending angle, and viewing distance while working with a SP in sitting/standing postures and one-handed/two-handed grips. The users' performance as well as pain development were also investigated.

METHODS

Participants answered a questionnaire on pain experience before and after SP usage. Neck kinematics of 20 SP users were monitored by a motion analysis system while doing three tasks (typing, video watching, and reading) in sitting and standing postures. Performance was evaluated by number of typed words, amount of errors in typing, and total read words.

RESULTS

The results indicated a significant increase in pain complaints in neck and upper limbs after test completion. Working with SPs in sitting and standing postures were, respectively, associated with greater head forward flexion for watching and viewing distance for two-handed typing tasks. Higher left lateral bending values were measured for one-handed watching and reading tasks in standing posture. The performance measures were superior for two-handed grips in all conditions.

CONCLUSIONS

Overall, using SPs in sitting posture creates greater head forward flexion and lower lateral bending angles in all tasks and grip types. The findings of this study can be used to provide recommendations for SP users.

Association of Musculoskeletal and Radiological Features with Clinical and Serological Findings in Systemic Sclerosis: A Single-Centre Registry Study

AIM

Systemic sclerosis (SSc) is a chronic connective tissue disease with the clinical hallmark of skin thickening and tethering. Correlation of musculoskeletal features with other parameters should be considered in SSc patients.

METHODS

We reviewed the records of all patients who had more than one visit and standard anteroposterior radiography of hand. We used univariate analysis, and factors with p<0.05 were included in logistic regression to find out dependent factors.

RESULTS

Overall, 180 SSc patients were enrolled in our study, 161 (89.4%) of whom were women. Median age (IQR) was 47.0 years (16), and 52% had diffuse subtype of the disease. In multivariate analysis, tendon friction rubs (TFRs) was associated with the presence of calcinosis, muscle tenderness, and flexion contracture (FC) on physical examination (p<0.05). Arthritis showed no differences in the two subtypes of the disease (p=0.98), and in multivariate analysis, there were no correlations between radiographic arthritis and serological and clinical features. The radiographic results indicated that disease duration correlated with joint erosion, acro-osteolysis, resorption of distal ulna, calcinosis and radiologic FC (p< 0.05). Acro-osteolysis was more frequent in the dcSSc subtype, TFRs, and anti-TOPO I antibody. Radiologic FC showed association with skin score, calcinosis and haematocrit <30% (p<0.05). Joint flexion on radiography was associated with disease duration, modified Rodnan skin score, calcinosis, and low haematocrit (P<0.01).

CONCLUSION

Disease duration was a main dependent factor for developing joint erosion, acro-osteolysis, bone resorption, calcinosis, and flexion contracture on hand radiography. Acro-osteolysis presented in the severe form of the disease. Acro-osteolysis was the only dependent variable associated with bone demineralization.

Increased serum levels of galectin-9 in patients with chikungunya fever

Chikungunya fever (CHIKF) is an arboviral disease that has caused an epidemic burst of chronic inflammatory joint disease in Latin America in the last few years. Efforts are being spent in understanding the mechanisms by which it may cause such articular damage and in determining possible biomarkers of the disease. Galectins (GAL) are a family of animal lectins with an affinity for beta-galactosides. They have multiple functions including working as receptors in innate immunity and as a control for inflammatory responses in both innate and adaptive immunity. They regulate functions of immune cells, such as lymphocytes and macrophages, which have a main role in the chikungunya inflammatory process. Galectins are also involved in chronification of viral diseases, participate in the immunopathogenesis of chronic joint diseases such as rheumatoid arthritis, and have a role in inflammation in other arboviral diseases, such as dengue. Thus, we intended to determine the serum levels of galectin-1, -3, -4, -7, and -9 in patients with subacute and chronic articular manifestations of CHIKF and to evaluate their associations with clinical manifestations. We evaluated 44 patients with clinical manifestations of CHIKF and serological confirmation with IgM and/or IgG chikungunya virus (CHIKV) antibodies. Forty-nine age- and gender-matched healthy individuals served as controls. Anti-CHIKV IgM and IgG antibodies and galectins serum levels were measured by ELISA. We found higher levels of GAL-9 (patients median 2192 [1500-2631] pg/mL, controls median 46.88 [46.88-46.88] pg/mL, p < 0.0001) and lower levels of GAL-3 (patients median 235.5 [175.5-351.8] pg/mL, controls median 2236.0 [1256.0-2236.0] pg/mL, p < 0.0001) in patients than in controls. There was no statistical difference in levels of GAL-1, -4 and -7 between patients and control groups. There was no difference in GAL-9 serum levels between patients with subacute or chronic symptoms (median 2148 [1500-2722] pg/mL x 2212 [1844-2500] pg/mL, p = 0.3626). A significant association of GAL-9 with joint stiffness, both in its duration and intensity, was found. These results may reflect the participation of GAL-9 in the immunopathogenesis of the inflammatory process in chikungunya fever, as morning stiffness may reflect the systemic inflammatory process.

Musculoskeletal Symptoms among Stone, Sand and Gravel Mine Workers and Associations with Sociodemographic and Job-Related Factors

Stone, sand and gravel mining (SSGM) constitutes the vast majority of mining operations in the United States. Despite musculoskeletal disorders being one of the most common occupational health problems across several industries, limited research has examined the extent of reported musculoskeletal symptoms or disorders among actively employed SSGM workers. To address this knowledge gap, cross sectional data were collected from 459 SSGM workers in the Midwestern United States to determine the prevalence of musculoskeletal symptoms. Sociodemographic and job-related factors were examined to identify possible risk factors in SSGM. Musculoskeletal symptoms of the low back (57%), neck (38%), shoulder (38%) and knee (39%) were highly prevalent among SSGM employees. The results, among other findings, showed that working more than 60 h a week increased the likelihood of musculoskeletal symptoms at the low back (OR: 4.7 95% CI: 1.9–11.5), neck (OR: 5.1, 95% CI: 2.2–11.8) and knee (OR: 4.5, 95% CI: 2.0–10.3). Working as a mechanic/maintenance worker increased the likelihood of low back (OR: 2.1, 95% CI: 1.1–4.2) and knee (OR: 2.2, 95% CI: 1.1–4.6) musculoskeletal symptoms. Intervention measures aimed at improving ergonomic hazard identification for various job tasks as well as administrative controls limiting hours worked may help reduce the burden of musculoskeletal problems in the SSGM industry.

Cultural Adaptation and Psychometric Validation of the Standardised Nordic Questionnaire Spanish Version in Musicians

Background: The Standardised Nordic Questionnaire (SNQ) is an instrument to analyse the musculoskeletal symptoms in an ergonomic or occupational health context. We aimed to cross-culturally adapt and evaluate the psychometric properties of the SNQ among Spanish musicians. Methods: Cross-cultural adaptation and psychometric validation (reliability, validity, and feasibility) was performed. Reliability was analysed by test-retest reliability (Cohen’s Kappa) and internal consistency (Kuder–Richardson). Content and face validity were measured by the Expert Committee and the opinion of participants. Construct validity (Mann–Whitney U test) was measured by comparing with questionnaires used to assess pain and disability in neck, shoulders, upper back, and low back regions. Feasibility was calculated with the average response time. Results: A total of 312 Spanish musicians were included. The Spanish version of SNQ achieved good semantic, conceptual, idiomatic, and content equivalence. For most of the variables, test-retest reliability was good to very good (k = 0.60–0.81). The internal consistency showed good to acceptable (Kuder–Richardson 20 (KR20) = 0.737–0.873). Participants with versus without musculoskeletal problems in a related region showed significantly higher disability/pain, indicating a good construct validity. About the feasibility, the average response time of the questionnaire was 6 min (±2). Conclusions: The results show that the Spanish SNQ is reliable, valid, and feasible screening tool to assess musculoskeletal problems among musicians.

Not a Painless Condition: Rheumatological and Musculoskeletal Symptoms in Type 2 Diabetes, and the Implications for Exercise Participation

OBJECTIVES

People with type 2 diabetes (T2D) are more likely to develop a range of rheumatological and musculoskeletal symptoms (RMS), and experience both chronic and widespread pain, compared with the general population. However, these symptoms are not commonly acknowledged by researchers, which hampers our understanding of the impact on this population. Since exercise is a key lifestyle management strategy for T2D and participation levels are typically low, understanding the potential impact of RMS on exercise participation is critical. The aim of this review is to summarise the literature regarding the prevalence and pathophysiology of RMS in T2D, the evidence for the benefits and risks associated with exercise on RMS, and the currently available tools for the reporting of RMS in both research studies and community settings.

METHODS

A narrative review.

RESULTS

There are numerous exercise trials in T2D, but few have sufficiently reported pain-related adverse events and even fewer have investigated the effects of exercise on RMS and chronic pain.

DISCUSSION

Recommendations for future research are provided.

Musculoskeletal Symptoms Among Surgeons at a Tertiary Care Center: a Survey Based Study

Introduction:

Musculoskeletal (MSK) manifestations represent a common work-related physical complication that affect surgeons and impacts their life and the healthcare service negatively.

Aim:

The aim of this study was to determine the prevalence of work related MSK manifestations among surgeons in a tertiary care hospital and to identify the possible associated risk factors.

Methods:

A Web-based self-administered cross-sectional survey was conducted. This study targeted all surgeons regardless of their nationalities, ages, genders, and marital statuses. The questionnaire assessed the participants’ demographic data as well as musculoskeletal manifestations.

Results:

Most respondents (80%) suffered from MSK manifestations that were related to performing surgeries. Back and neck areas represented the most affected body parts (71.1% and 59.8%, respectively). A significantly higher percentage of those with musculoskeletal manifestations practiced for 5-10 years (28.9%) (p = 0.006).

Conclusion:

MSK pain is common among Saudi surgeons in different specialties. More attention should be directed to improving the physical environments in which the surgeons are operating. Moreover, surgeons should be educated about the recommended ergonomic positions that can prevent or decrease their work related MSK manifestations.

Using the OVAKO working posture analysis system in cleaning occupations

BACKGROUND

Cleaning workers experience severe musculoskeletal symptoms.

OBJECTIVE

The objective of this paper was to examine musculoskeletal symptoms in cleaners of different heights to evaluate the effects of height on working postures in the work environment (schools).

METHODS

We used a three-stage method including using the Nordic Musculoskeletal Questionnaire (NMQ) to evaluate musculoskeletal symptoms, a task analysis to confirm typical cleaning tasks, and the OVAKO Working Posture Assessment System (OWAS) for posture analysis. Multinomial logistic regression was performed to evaluate the adjusted effects of individual characteristics on painful body regions, using individuals without any pain as the reference category.

RESULTS

This study found that the prevalence of musculoskeletal symptoms is very high for cleaners, especially in the shoulders, elbows, and lower back. Odds ratios for the accumulation of two or more risk factors were higher among men and were inversely associated with national economic indicators. The relatively high prevalence of musculoskeletal symptoms may stem from the multiple operations involved in cleaning tasks, such as trash collecting, floor mopping, toilet cleaning, and mirror polishing. Workers of different heights had differential work loadings for different tasks.

CONCLUSIONS

This paper proposes recommendations for job adaptations and occupational safety training. Cleaners of different heights execute the typical tasks via different postures, and awkward postures often result in musculoskeletal symptoms. Cleaners should be provided with specific tools and training regarding working postures on the basis of height. These findings can be used as a reference for related operation designs and task improvements to ensure correct tool usage and safer working postures during cleaning.

Mobile touch screen device use and associations with musculoskeletal symptoms and visual health in a nationally representative sample of Singaporean adolescents

This study aimed to describe contemporary technology use, especially smartphones and tablets (mobile touch screen devices), and examine associations with musculoskeletal symptoms and visual health among adolescents in Singapore. A representative sample of 1884 adolescents (50.4% girls) from grades primary 5 to post-secondary (10-18 years old), recruited from 13 schools, completed an online questionnaire in class. Total technology use was high, with smartphone duration being highest (mean = 264 [SD = 243] min/day). Patterns of use, including multitasking and bout length, were influenced by gender, school level, type of device and activities. Musculoskeletal discomfort and visual symptoms were commonly reported. After adjusting for potential confounders, more hours/day of smartphone use was associated with increased risk of neck/shoulders, upper back, arms and wrist/hand discomfort (OR = 1.04[95%CI = 1.01-1.07] to 1.07[1.03-1.10]) and visual symptoms (OR = 1.05[1.02-1.08]), but was associated with decreased odds of myopia (OR = 0.97[0.94-0.99]). No significant associations were found for tablet use. Practitioner Summary: 1884 adolescents in Singapore completed an in-depth questionnaire regarding their use of technology. The smartphone was the device with the highest usage, and greater smartphone use was associated with increased odds of musculoskeletal and visual symptoms. High use of smartphones has physical health implications for adolescents.

The Influence of Using a Footstool during a Prolonged Standing Task on Low Back Pain in Office Workers

While many office workers experience low back pain (LBP), little is known about the effect of prolonged standing on LBP symptoms. This repeated-measures within-subjects study aimed to determine whether office workers with LBP are able to work at a standing workstation for one hour without exacerbating symptoms and whether using a footstool affects LBP severity. Sixteen office workers with LBP performed computer work at a standing workstation for one hour under the following two conditions, one week apart: with a footstool and without a footstool. The intensity of LBP was recorded at 10 min intervals. Maximal severity of LBP pain and change in LBP severity throughout the standing task were not different between the footstool and no footstool conditions (p > 0.26). There was a trend for more participants to have an increase in their pain between the start and end of the task when not using a footstool compared to using a footstool (p = 0.10). Most office workers with LBP are able to use a standing workstation without significant exacerbation of symptoms, but a proportion will experience a clinical meaningful increase in symptoms. Using a footstool does not change the severity of LBP experienced when using a standing workstation in individuals with a history of LBP.

Work-Related Musculoskeletal Symptoms among Loggers in the Ark-La-Tex Region

BACKGROUND

The U.S. logging sector is among the most dangerous industrial sectors, with high fatality and non-fatal injury rates. Limited research has addressed work-related musculoskeletal disorders among logging machine operators (LMOs). The purpose of this study was to estimate the 12-month prevalence of musculoskeletal symptoms and the associated work-related risk factors among LMOs in the Arkansas, Louisiana, and Texas (Ark-La-Tex) logging region.

METHODS

A self-administered 93-item questionnaire with six different sections: (1) demographics, (2) lifestyle and medical background, (3) work experience, (4) job training, (5) occupational heat-related stress, and (6) occupational injuries and MSS was administered to LMOs (n = 88) using Qualtrics Mobile Survey Software®. Poisson regression models were used to estimate crude prevalence ratios (PR), adjusted PR [aPR], and corresponding 95% confidence intervals (95% CI).

RESULTS

Regarding organizational, ergonomic, and handling equipment occupational factors and 12-month MSS prevalence, the adjusted model controlled for age, BMI, smoking status, and drinking status. For organizational, the most problematic factors for the lower back were performing a task over and over (63.2%) and working very fast, for short periods (60.0%). For ergonomics, the most problematic factor for the lower extremities was awkward or cramped conditions (58.1%) and for the lower back was bending/twisting back awkward (55.9%). Last, for handling equipment, the most problematic for both the lower back and lower extremities was handling or grasping small objects (57.1%).

CONCLUSION

Our findings revealed associations between work-related MSS and specific job factors (e.g., organizational, ergonomic, handling equipment, etc.), extreme environmental conditions or environmental, and personal risk factors. In particular, study findings suggest lower back and lower extremities MSS are associated with the a majority of job-related risk factors, lower extremities with extreme environmental conditions, and neck and upper back with personal risk factors.

Treatment of an Upper Extremity Chronic Repetitive Strain Injury of 28 Years Duration in a Professional Jazz Saxophonist Using 5% Dextrose

The treatment of chronic repetitive strain injury is a frustrating discourse of potential pathoanatomical causes and their treatments. This case describes an overlooked pathoanatomical cause and successful treatment for a chronic and debilitating repetitive strain injury of the upper extremities that lasted for 28 years and was resistant to a variety of conventional and alternative treatments in a professional jazz saxophone player. A series of fascial tissue infiltrations using 5% dextrose was used to successfully downregulate c-fiber activity within the upper extremities. This treatment resulted in the complete resolution of upper extremity pain and dysfunction with a full return to normal instrument practice and performance that has been sustained without recurrence for four years following treatment.

Determinants of Safety Climate in the Professional Logging Industry

Work involving forest logging is considered one of the most dangerous occupations in the world. In the intermountain region of Montana and Idaho in the United States, the extreme terrain, remote location and severe weather conditions escalate risk. Although safety has improved through the development of mechanized equipment, logging tasks continue to be very hazardous. Thus, as with leading companies in other occupational sectors, logging enterprises are beginning to consider safety climate as a useful measure in their safety systems. The purpose of this study was to quantify safety climate within the logging industry of Montana, USA and to identify specific determinants of safety climate. A demographic, musculoskeletal symptom (MSS), and safety climate survey (NOSACQ-50) was administered to 743 professional loggers. Analyses were conducted to determine the association between demographic characteristics, MSS, workplace variables and the scores on five safety climate dimensions (management safety priority and ability, workers' safety commitment, workers' safety priority and risk non-acceptance, peer safety communication, learning and trust in safety ability, and workers' trust in efficacy of safety systems). Variables identified as predictors of safety climate included logging system type, supervisory status, age, years of experience and reported MSS. As safety climate is a leading indicator of workplace safety, if work groups with the lowest safety climate scores can be identified, they could receive targeted safety intervention programs or resources; thereby directing resources to the groups who need it the most, without relying on lagging indicators such as injury and fatality rates.

Active Surveillance of Musculoskeletal Disorder Symptoms in the Development of Safety Interventions for Professional Loggers

Logging is one of the most dangerous occupations in the world. Logging tasks, whether they consist of operating a chainsaw, operating a mechanized harvester, or driving logging trucks, have an influence on the types of hazards and injuries among professional loggers. Using the Standardized Nordic Questionnaire, we investigated the 12-month period prevalence of musculoskeletal disorder symptoms (MSS) among professional loggers in the mountainous region of Montana. We also differentiated the prevalence of MSS based on logging system-type accounting for demographic and workplace covariates. Based on data from 743 professional loggers in Montana, loggers using conventional felling practices with chainsaws were more than twice as likely to report MSS (Odds Ratio (OR): 2.24 (1.07-4.69)) than those using mechanized logging equipment. In addition, increased MSS scores were associated with conventional harvesting systems, increased years of experience, and increased BMI. The active surveillance of MSS among professional loggers in Montana resulted in recommendations for safety interventions. The safety interventions included a greater mechanization of logging tasks and early career training on the heavy equipment used in logging operations.

The Role of Diuretics in Treatment of Aromatase Inhibitors Induced Musculoskeletal Symptoms in Women with Non Metastatic Breast Cancer

Background:

Around 50% of women receiving Aromatase Inhibitors (AIs) develop musculoskeletal symptoms which may become severe causing interruption of treatment. Patients with AI-induced arthralgia had higher rates of joint effusions and fluid in the tendons, so use of diuretics may be helpful.

Methods:

This prospective phase II study was conducted in department of clinical oncology and nuclear medicine, Menoufia University Hospital, Egypt, between Jan. to Dec. 2015. Fifty Women with stage I,II and III breast cancer receiving AIs as adjuvant hormonal treatment complaining of AIs related musculoskeletal symptoms received Lasilactone® 50 mg tablet; (an oral combination of Frusemide 20mg/Spironolactone 50 mg), every other day for 4 weeks. Patients were assessed by modified Western Ontario and McMaster Universities osteoarthritis (WOMAC) index for lower limb and the quick Disabilities of the Arm, Shoulder and Hand Score (DASH) scoring system for upper limbs, Arabic versions, at baseline and after 4 weeks of treatment.

Results:

The mean WOMAC pain score improved significantly (6.0 v 10; P < 0.001), the mean WOMAC stiffness score improved (2.3 v 3.9; P = 0.002), the mean WOMAC functional score improved (8.7 v 15; P < 0.001), the total WOMAC score improved (17 v 29; P < 0.001), also a significant difference was noticed for the quick DASH score; total score (16 v 25; P = 0.02) After use of diuretics for 4 weeks of treatment compared with baseline scores.

Conclusions:

The use of diuretics effectively reduces AI related musculoskeletal symptoms with good tolerance.

Resolution of a Greater Than 50-year History of Severe, Chronic Low Back Pain Following an Ultrasound-guided Platelet-rich Plasma Infiltration of the Thoracolumbar Fascia

The diagnosis of chronic low back pain is a scourge of society that does not take into account the pathoanatomical cause of pain. This case describes a six-year search for the pinpoint pathoanatomical diagnosis of a patient's 50-plus year history of debilitating chronic low back pain after he failed the standard nonoperative and operative treatment modalities. Ultrasound-guided diagnostic blocks identified a potential space within the thoracolumbar fascia. This was treated with platelet-rich plasma, yielding a complete resolution of his pain and a full return to normal activities of daily living for three years since the procedure.

Chinese Medicine Yishen Jiangu Granules () on Aromatase Inhibitor-Associated Musculoskeletal Symptoms

OBJECTIVE

To assess the effectiveness of Yishen Jiangu Granules (, YSJGG) on aromatase inhibitor-associated musculoskeletal symptoms (AIMSS).

METHODS

A single-arm, open-label study was conducted in 34 postmenopausal women with breast cancer who experienced AIMSS. Patients were treated with YSJGG for 12 weeks (12.4 g orally twice daily). The primary outcome was a change in the mean worst pain score of Brief Pain Inventory-Short Form (BPI-SF) over 12 weeks, and the second outcomes included changes in pain severity and pain-related interference of BPI-SF and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH), the Functional Assessment of Cancer Therapy-Breast (FACT-B), bone mineral density (BMD) and blood indices such as calcium (Ca), phosphate (P), and alkaline phosphatase (ALP).

RESULTS

Of 37 women recruited, 30 initiated the therapy and 24 were evaluable at 12 weeks. The primary outcome (BPI-SF worst pain scores) achieved a 2.17-point reduction compared with baseline (5.75±1.87 vs 3.58±2.15, P<0.01). There were reductions in pain severity (decreased 1.65, P<0.01) and pain-related interference (decreased 2.55, P<0.01). The changes in WOMAC and M-SACRAH scores were similar to BPI-SF (P<0.05). In the FACT-B, only physical well-being and functional well-being were improved compared with baseline (P<0.05). No clinical differences were found in BMD, Ca, P and ALP.

CONCLUSION

YSJGG is an effective and well-tolerated agent to reduce AIMSS.

The Association Between Musculoskeletal Symptoms and Traditional Chinese Medicine Use Among Chinese Older Adults in the Greater Chicago Area

Older adults disproportionately experience musculoskeletal symptoms, which are associated with morbidity and mortality. Traditional Chinese medicine (TCM) is an important part of Chinese culture and for millennia have been used to maintain health. This article aims to examine the association between musculoskeletal symptoms and different subtypes of TCM usage. Data were collected through the Population Study of Chinese Elderly in Chicago (PINE) study, a community-engaged, epidemiological study of a U.S. Chinese population. Review of systems was used to measure musculoskeletal symptoms. TCM use was measured by using a 5-point scale. Logistic regression analyses were conducted to control for potential confounding factors. Of 3,157 Chinese, older adults aged 60 and older, the mean age was 72.8 (SD = 8.3) and 58.9% were female. Older adults with any musculoskeletal symptoms had greater utilization of overall TCM use (odds ratio [OR] = 2.10, 95% confidence interval [CI] = [1.76, 2.52]), especially massage therapy (OR = 3.41, 95% CI = [2.51, 4.63]), herbal (OR = 2.68, 95% CI = [2.28, 3.14]), and acupuncture (OR = 2.49, 95% CI = [1.87, 3.32]). However, there was no statistically significant association between the presence of musculoskeletal symptoms and Tai-Chi (OR = 1.18, 95% CI = [0.93, 1.50]). This study demonstrated that musculoskeletal symptoms among Chinese older adults were strongly associated with the use of TCM. Future research is needed to examine the effectiveness of TCM in treating musculoskeletal symptoms.

Assessment of upper limb musculoskeletal pain and posture in workers of packaging units of pharmaceutical industries

BACKGROUND

Work-related musculoskeletal disorders are defined as the disabling or painful injury to the muscles, nerves or tendons that are caused by work or aggravated by it. Some studies confirm the association between working in packaging units in various industries and the pain in the upper limb, but also there are controversies about the possible risk factors among different working populations.

OBJECTIVE

The present study aims to define the potential ergonomic risk factors for musculoskeletal pain in the upper limb.

METHODS

The Nordic Musculoskeletal Questionnaire was used for assessment of the musculoskeletal pain. Some other questions about the possible risk factors were included in the questionnaire. In order to assess posture, rapid upper limb assessment (RULA) test was performed by trained ergonomists.

RESULTS

The findings of the study reveals that shoulder pain is associated with work history (P-value = 0.01), smoking (P-value = 0.02), the level of education (P-value = 0.04) and age more than 40 years old (P-value = 0.01). Wrist pain was associated with shiftwork (P-value = 0.04) and especially fixed shiftwork (P-value = 0.04) and also age more than 40(P-value = 0.03) and missed days from work with a cut point of 7 days (P-value = 0.03). After regression, only the work history (OR = 14.4 for 10 to 20 years and OR = 32.2 for more than 20 years) and shiftwork (OR = 2.35) remained statistically significant.

CONCLUSIONS

In this study, RULA was not associated with symptoms in the upper limb in non-heavy working industries so we do not recommend it for screening purposes. The use of decades of working history and shiftwork can be considered for this purpose in the shoulder and wrist pain respectively.

Musculoskeletal symptoms among hospital cleaners

Studies have indicated that cleaners are at risk for musculoskeletal symptoms (MSS). In 2001, the Norwegian Labor Inspectorate suggested improvements in cleaners' work environment to reduce MSS. We estimate prevalence of MSS among cleaners in a Norwegian hospital that had implemented improvements to reduce risk of MSS and calculate relative risk of MSS among cleaners compared to a group of office workers. Data were collected from 255 participants. MSS were investigated using the Nordic Questionnaire for Analysis of Musculoskeletal Symptoms. Cleaners reported a significantly higher prevalence of MSS compared to office workers but a lower prevalence compared to similar studies among cleaners in other countries. This may indicate that working conditions in Norway are better than in other countries; further studies are needed to compare MSS and working conditions in different settings.

Hospital nurses tasks and work-related musculoskeletal disorders symptoms: A detailed analysis

BACKGROUND

Hospital work-related musculoskeletal disorders (WRMSDs) symptoms are highly prevalent and nurses are considered the health care professional group more often affected by WRMSDs.

OBJECTIVES

Understanding the effects of nursing tasks on WRMSDs symptoms.

METHODS

Portuguese nurses answered to a modified Nordic Musculoskeletal symptoms Questionnaire. The increased likelihood of having WRMSDs symptoms was estimated from a daily working task schedule and the probability of suffering from lumbar WRMSDs symptoms intensity was also estimated.

RESULTS

Hospital nurses studied (n= 1.396) were mainly females (75.8%), and most of them reported more than 1 symptom (88%). Low-back pain was the most prevalent complaint (60.9%). Tasks performed more than 10 times a day, such as invasive procedures (OR = 2.142); care of hygiene and patient comfort in bed (OR = 2.484); patient mobilization in bed (OR = 2.022); and patient feeding (OR = 2.186) had an effect on dorsal and lumbar symptoms (p< 0.05).Those tasks involving invasive procedures were just the only ones producing symptoms simultaneously on every studied body part, such as lumbar, dorsal, wrist/hand and ankles/feet areas.

CONCLUSIONS

Tasks with a greater effect on low-back pain intensity were patient bed feeding and patient hygiene and care. We found, when analysing simultaneously the effects of every task on the likelihood of having low-back symptoms, that involving invasive procedures were that only ones affecting simultaneously the presence of almost all WRMSDs symptoms studied.

Influence of a community-based stretching intervention on the health outcomes among Korean-Chinese female migrant workers in South Korea: A randomized prospective trial

AIM

To investigate the long-term effectiveness of stretching exercises on the health outcomes of Korean-Chinese female migrant workers.

METHODS

This study was a randomized prospective trial. The study's participants (n = 80) were middle-aged, Korean-Chinese women who had worked full-time during the previous 6 months. They were assigned randomly to an enhanced stretching intervention group or a standard stretching intervention group. Both groups were instructed to carry out a structured 6 min stretching exercise program for at least three times per day and 5 days per week. The enhanced intervention group received additional interventions to increase exercise adherence through individual phone counseling and short message service during the 12 weeks, followed by three sets of acculturation workshops during the period of weeks 13-24. Musculoskeletal fitness, symptoms, and acculturative stress were assessed at baseline, week 12, and week 24. Linear mixed-models were used to test the interventions' effects.

RESULTS

The amount of stretching that was carried out, as a percentage of the recommended amount, was not significantly different between groups. There were significant improvements in flexibility of the back and work-related musculoskeletal disorder symptoms after completing the 24 week intervention but no significant difference existed between the groups. Acculturative stress decreased at week 12 but there was no significant change at week 24.

CONCLUSIONS

The 24 week, community-based stretching program for the Korean-Chinese female migrant workers was effective in increasing their flexibility and decreasing work-related musculoskeletal disorder symptoms. Culturally adaptive augmented interventions to increase social support are suggested in order to reduce acculturative stress.

Prevalence of musculoskeletal pain of the neck, upper extremities and lower back among dental practitioners working in Riyadh, Saudi Arabia: a cross-sectional study

OBJECTIVES

Studies have shown that dentists have a higher incidence of work-related musculoskeletal (MSK) pain than those in other occupations. The risk factors contributing to MSK pain among Saudi dentists has not been fully studied so this study aims to estimate the prevalence of MSK pain and investigate its associated risk factors among dentists in Saudi Arabia.

SETTING AND PARTICIPANTS

A cross-sectional survey was carried out in the capital city Riyadh, Saudi Arabia, using random cluster sampling. 224 surveys were distributed among dentists with a 91.1% response rate (101 women and 103 men).

OUTCOMES

The prevalence of MSK pain and its associated risk factors were investigated.

RESULTS

184 (90.2%) respondents reported having MSK pain. Lower back pain was the most commonly reported MSK pain (68.1%). Gender and age were reported to be predictors for at least one type of MSK pain. Older age was associated with lower back pain (OR 1.23; 95% CI 1.00 to 1.50) and women had double the risk of shoulder pain (OR 2.52; 95% CI 1.12 to 5.68). In addition, lower back pain was related to the time the dentist spent with patients (OR 0.28; 95% CI 0.14 to 0.54), while shoulder pain (OR 1.03; 95% CI 1.00 to 1.06) and lower back pain (OR 1.06; 95% CI 1.03 to 1.10) were significantly related to years of experience.

CONCLUSIONS

MSK pain is common among older and female Saudi dentists. Research on the impact of exercise and the ergonomics of the workplace on the intensity of MSK pain and the timing of its onset is required.

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.

Decision-making in job attendance within health care--a qualitative study

BACKGROUND

Musculoskeletal complaints are considered a major cause of sickness absence, particularly in areas such as the health sector. However, little is known about the personal decision-making process for self-certified sickness absence.

AIMS

To explore female health care workers' thoughts and experiences about work attendance when experiencing musculoskeletal symptoms.

METHODS

A qualitative study using individual, semi-structured, in-depth interviews with eight female health care workers was performed. Questions were related to factors influencing the decision to attend work and decision-making when facing the dilemma of attending work when experiencing musculoskeletal symptoms. The data were analysed according to the systematic text condensation.

RESULTS

Subjects reported a high threshold before calling in sick. Self-certified sickness absence was not a strategy for coping with musculoskeletal symptoms as participants chose to be physically active and work part-time rather than taking sickness absence. Making decisions about attending work fostered conflicting norms, as women faced a dilemma between feeling guilt towards colleagues and patients and taking care of their own health.

CONCLUSIONS

The findings highlight the complexity of managing work when experiencing musculoskeletal symptoms, and the dilemmas faced by those affected. The importance of work environment factors and the fact that some women feel compelled to work part-time in order to prioritize their own health require further consideration.

The phenotype of concurrent chronic bronchitis and frequent exacerbations in patients with severe COPD attending Swedish secondary care units

BACKGROUND

Chronic bronchitis and previous exacerbations are both well-known risk factors for new exacerbations, impaired health-related quality of life, and increased mortality in COPD. The aim of the study was to characterize the phenotype of concurrent chronic bronchitis and frequent exacerbation in severe COPD.

METHODS

Information on patient characteristics, comorbidity, and exacerbations from the previous year (total number and number requiring hospitalization) was collected from 373 patients with stage III and IV COPD attending 27 secondary care respiratory units in Sweden. Logistic regression used chronic bronchitis and frequent exacerbations (≥2 exacerbations or ≥1 hospitalized exacerbations in the previous year) as response variables. Stratification and interaction analyses examined effect modification by sex.

RESULTS

Chronic bronchitis was associated with current smoking (adjusted odds ratio [OR] [95% CI], 2.75 [1.54-4.91]; P=0.001), frequent exacerbations (OR [95% CI], 1.93 [1.24-3.01]; P=0.004), and musculoskeletal symptoms (OR [95% CI], 1.74 [1.05-2.86]; P=0.031), while frequent exacerbations were associated with lung function (forced expiratory volume in 1 second as a percentage of predicted value [FEV1% pred]) (OR [95% CI] 0.96 [0.94-0.98]; P=0.001) and chronic bronchitis (OR [95% CI] 1.73 [1.11-2.68]; P=0.015). The phenotype with both chronic bronchitis and frequent exacerbations was associated with FEV1% pred (OR [95% CI] 0.95 [0.92-0.98]; P=0.002) and musculoskeletal symptoms (OR [95% CI] 2.55 [1.31-4.99]; P=0.006). The association of smoking with the phenotype of chronic bronchitis and exacerbations was stronger in women than in men (interaction, P=0.040).

CONCLUSION

Musculoskeletal symptoms and low lung function are associated with the phenotype of combined chronic bronchitis and frequent exacerbations in severe COPD. In women, current smoking is of specific importance for this phenotype. This should be considered in clinical COPD care.

Validity and reliability of an online extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E2) to measure nurses' fitness

AIMS AND OBJECTIVES

To describe modifications to a second extended version of the Nordic Musculoskeletal Questionnaire for online use in nursing populations, and check validity and reliability.

BACKGROUND

The Nordic Musculoskeletal Questionnaire has been used to assess the severity and impact of musculoskeletal symptoms in occupational groups. The reliability of a previous extended version was established for paper-based, self-administration among nursing students. This current study extended the questionnaire to collect more information regarding musculoskeletal symptoms in all nine body regions and their work-relatedness, as an instrument is needed to gather evidence about the impact of fitness levels on occupational musculoskeletal disorders among nurses.

DESIGN

Psychometric evaluation.

METHOD

Sixty-five undergraduate nurses completed the online extended Nordic Musculoskeletal Questionnaire twice. Content validity was examined by expert review and construct validity by exploratory factor analysis of 90 responses from the first completion. Reliability was checked by examining internal consistency, kappa statistics, proportions of observed, and positive and negative agreements, intra-class correlation coefficient and standard error of measurement.

RESULTS

The instrument had high internal consistency and exploratory factor analysis revealed it was a relatively homogenous (unidimensional) measure of musculoskeletal symptom severity. Age of onset of symptoms questions were reliable, with high mean intra-class correlation coefficients and low mean standard errors of measurement. Overall, questions showed high mean strengths of agreement and proportions of observed agreement: three-quarters of the prevalence questions and 99% of the severity/impact questions had 10% or fewer disagreements.

CONCLUSIONS

Modifications to the Nordic Musculoskeletal Questionnaire and online administration did not diminish its validity or reliability for obtaining information about the severity of nurses' musculoskeletal symptoms.

RELEVANCE TO CLINICAL PRACTICE

Occupational musculoskeletal disorders are an issue for nurses. This questionnaire can be used to monitor nurses' musculoskeletal health, and in musculoskeletal disorder prevention studies.