Friedrich Hofmann

Cumulative occupational lumbar load and lumbar disc disease – results of a German multi-center case-control study (EPILIFT)

BackgroundThe to date evidence for a dose-response relationship between physical workload and the development of lumbar disc diseases is limited. We therefore investigated the possible etiologic relevance of cumulative occupational lumbar load to lumbar disc diseases in a multi-center case-control study.MethodsIn four study regions in Germany (Frankfurt/Main, Freiburg, Halle/Saale, Regensburg), patients seeking medical care for pain associated with clinically and radiologically verified lumbar disc herniation (286 males, 278 females) or symptomatic lumbar disc narrowing (145 males, 206 females) were prospectively recruited. Population control subjects (453 males and 448 females) were drawn from the regional population registers. Cases and control subjects were between 25 and 70 years of age. In a structured personal interview, a complete occupational history was elicited to identify subjects with certain minimum workloads. On the basis of job task-specific supplementary surveys performed by technical experts, the situational lumbar load represented by the compressive force at the lumbosacral disc was determined via biomechanical model calculations for any working situation with object handling and load-intensive postures during the total working life. For this analysis, all manual handling of objects of about 5 kilograms or more and postures with trunk inclination of 20 degrees or more are included in the calculation of cumulative lumbar load. Confounder selection was based on biologic plausibility and on the change-in-estimate criterion. Odds ratios (OR) and 95% confidence intervals (CI) were calculated separately for men and women using unconditional logistic regression analysis, adjusted for age, region, and unemployment as major life event (in males) or psychosocial strain at work (in females), respectively. To further elucidate the contribution of past physical workload to the development of lumbar disc diseases, we performed lag-time analyses.ResultsWe found a positive dose-response relationship between cumulative occupational lumbar load and lumbar disc herniation as well as lumbar disc narrowing among men and women. Even past lumbar load seems to contribute to the risk of lumbar disc disease.ConclusionAccording to our study, cumulative physical workload is related to lumbar disc diseases among men and women.

Hepatitis A as an occupational hazard

Few studies have been carried out to evaluate the role of hepatitis A virus (HAV) as an occupational hazard. Our analysis of data on occupational diseases in Germany showed that hepatitis A ranks as third among infectious occupational diseases. Morbidity based on the frequency of compensation (15.2%) was in the same range as that observed for hepatitis B (19.7%). In another study, data were collected on anti-HAV prevalence among 2293 hospital workers in southwest Germany. Anti-HAV prevalence of hospital staff responsible for patient care and that of the general population were comparable, while food-handlers under the age of 30 years had a higher degree of anti-HAV prevalence. When an evaluation of anti-HAV prevalence data was carried out on persons younger than 30 years who comprised subsets of the medical staff, the relative risk was: charwomen 4.2, food-handlers 2.49, and paediatric nurses 1.84, showing that they had higher prevalence rates than nurses 1.25, physicians 1.09 and laboratory assistants 0.93. Vaccinations for the prevention of hepatitis A should therefore reach individuals that have an increased occupational risk: food-handlers, health care workers in infectious diseases and paediatrics, medical staff in laboratories handling stool samples, medical charwomen and, according to previously published work, staff of day care centres and sewerage workers.

Factors influencing immunity against diphtheria in adults

In about 50% of all adult Germans, serological immunity to diphtheria is lacking even though a vaccination history exists in most cases. In this study, the factors contributing to diphtheria immunity, up to 43 years after the last diphtheria vaccination, were analysed. Serum samples were taken from 287 adults whose complete vaccination history was available, and who had received a standard primary vaccination. The sera were tested by tissue culture neutralization assay for diphtheria antitoxin levels. The time lapse since the last diphtheria vaccination proved to be the most important factor influencing the protection rate. Secondly, the factor last vaccination within the first 3 years of life and, finally, female gender were found to correlate significantly with a low protection rate. No direct effect could be established for age, number of previous vaccinations, occupational contact with patients or travel within any endemic region during the last 10 years. Since diphtheritic infection can occur among previously vaccinated persons, the immunity gap observed among adults should be closed by regular diphtheria boosters. Special attention should be paid to the three groups mentioned. Further investigation is required to determine whether or not a single booster vaccination is sufficient to provide long-term protection for those in the risk groups indicated above.

Zusammenhang zwischen manueller Lastenhandhabung und lumbaler Chondrose–Ergebnisse der Deutschen Wirbelsäulenstudie

ZusammenfassungIn einer multizentrischen populationsbezogenen Fall-Kontroll-Studie bei 351 Fällen mit lumbaler Chondrose mit Bandscheibenverschmälerung und 901 Kontrollprobanden wurde die Dosis-Wirkung-Beziehung zwischen be-ruflichen Wirbelsäulenbelastungen durch Lastenhandhabung und Rumpfbeugung sowie lumbaler Chondrose mit 10 unter-schiedlichen Dosismodellen einschließlich des Mainz-Dortmunder Dosismodell (MDD) untersucht.Die Studie zeigt eine positive Dosis-Wirkung-Beziehung zwischen der kumulativen beruflichen Wirbelsäulenbelastung durch Lastenhandhabung und Rumpfbeugung auf der einen Seite und der Entwicklung einer lumbalen Chondrose bei Männern und Frauen auf der anderen Seite. Die Dosismodelle mit der besten Modellanpassung zeichnen sich durch abgesenkte Schwellenwerte für die lumbale Bandscheibendruckkraft bei Lastenhandhabung und Rumpfvorneigung im Vergleich zum MDD, fehlende Tagesdosisschwelle, Berücksichtigung von zusätzlichen Formen der Lastenhandhabung wie Ziehen, Schieben, Werfen oder Fangen von Lasten und die Nutzung spezifischer biomechanischer Simulationsrechnungen für jede Belastungssituation aus.In der höchsten Dosisklasse fand sich eine signifikant um den Faktor 3,6 erhöhte Odds Ratio für lumbale Chondrose bei Männern und eine signifikant um den Faktor 1,9 erhöhte Odds Ratio für lumbale Chondrose bei Frauen. Das MDD gehört nicht zu den am besten anpassenden Dosismodellen hinsichtlich der Beschreibung einer Dosis-Wirkung-Beziehung.SummaryIn a population-based multi-centre case-control study on 351 cases with lumbar chondrosis with disc narrowing and 901 control subjects, the dose-response relationship was investigated between occupational exposure to manual load handling and/or working postures with trunk inclination with 10 different dose models including the Mainz-Dortmund Dose Model (MDD).The results of the study reveal a positive dose-response relationship between, on the one hand, cumulative lumbar dose caused by load handling and working postures with trunk inclination and, on the other hand, the development of lumbar chondrosis in men as well as in women. The dose models with the best goodness of fit are characterised by reduced thresholds for lumbar disc compression regarding load handling and working postures with trunk inclination in comparison to the MDD, a missing shift-dose threshold, the consideration of other types of load handling besides lifting and carrying such as pulling, pushing, catching or throwing and the application of specific biomechanical simulation calculations for the relevant loading activities.In the highest dose class a significantly increased odds ratio of 3.6 for lumbar chondrosis in men and 1.9 in women was found. The MDD does not belong to the most appropriate dose models for describing a dose-response relationship between occupational exposure and lumbar chondrosis.RésuméDans une étude cas-témoins multicentrée portant sur une population et réalisée auprès de 351 cas atteints d’une chondrose lombaire accompagnée d’un rétrécissement du disque intervertébral et de 901 sujets témoins, la relation de dose-effet entre les stress professionnels de la colonne vertébrale entraînés par la manipulation de charges et la flexion du tronc d’une part et la chondrose lombaire d’autre part a été examinée au moyen de 10 modèles de dose différents, y compris le modèle de dose Mainz-Dortmund (MDD).L’étude révèle une relation de dose-effet positive entre le stress professionnel cumulé de la colonne vertébrale dû à la manipulation de charges et à la flexion du tronc d’une part et l’apparition d’une chondrose lombaire chez les hommes et les femmes d’autre part. Les modèles de dose les mieux adaptés se distinguent par des valeurs seuils réduites pour la force de compression lombaire sur le disque intervertébral lors de la manipulation de charges et de l’inclinaison vers l’avant du tronc en comparaison avec le MDD, l’absence d’un seuil de dose quotidienne, la prise en compte d’autres formes de manipulation de charges (tirer, pousser, lancer ou attraper des charges) et l’utilisation de calculs de simulation biomécaniques spécifiques pour chaque activité stressante.Dans la catégorie de dose maximum, on a constaté un odds ratio significativement accru pour la chondrose lombaire de 3,6 chez les hommes et de 1,9 chez les femmes. Le MDD ne rentre pas dans la catégorie des modèles de dose les mieux adaptés pour décrire la relation de dose-effet entre l’exposition professionnelle et la chondrose lombaire.

Study of Blood Contact in Simulated Surgical Needlestick Injuries With Single or Double Latex Gloving

OBJECTIVE Needlestick injuries are the most common injuries that occur among operation room personnel in the health care service. The risk of infection after a needlestick injury during surgery greatly depends on the quantity of pathogenic germs transferred at the point of injury. The aim of this study was to measure the quantity of blood transferred at the point of a percutaneous injury by using radioactively labeled blood. DESIGN This study was conducted to evaluate the risk of infection through blood contact by simulating surgical needlestick injuries ex vivo. The tests were conducted by puncturing single and double latex gloves with diverse sharp devices and objects that were contaminated with Technetium solution-labeled blood. RESULTS A mean volume of 0.064 microL of blood was transferred in punctures with the an automatic lancet at a depth of 2.4 mm through 1 layer of latex. When the double-gloving indicator technique was used, a mean volume of only 0.011 microL of blood was transferred (median, 0.007 microL); thus, by wearing 2 pairs of gloves, the transferred volume of blood was reduced by a factor of 5.8. CONCLUSIONS The results revealed that double gloving leads to a significant reduction in the quantity of blood transferred during needlestick injury.

Zusammenhang zwischen der kumulativen Wirbelsäulen-belastung durch Lastenhandhabungen und lumbalen Prolapserkrankungen — Ergebnisse der Deutschen Wirbelsäulenstudie

ZusammenfassungZiel der vorliegenden multizentrischen Fall-Kontroll-Studie ist die Untersuchung des Dosis-Wirkung-Zusammenhangs zwischen beruflichen Belastungen der Wirbelsäule und der Diagnose einer lumbalen Prolapserkrankung.286 Männer und 278 Frauen mit lumbaler Prolapserkrankung im Alter zwischen 25 und 70 Jahren wurden in vier Studien - regionen (Frankfurt am Main, Freiburg, Halle, Regensburg) prospektiv gewonnen. Bevölkerungsbezogene Kontrollpersonen (453 Männer und 448 Frauen) wurden über die regionalen Einwohnermeldeämter gewonnen. In einem strukturierten computergestützten persönlichen Interview wurde die gesamte Arbeitsanamnese unter Einschluss aller Berufsphasen mit mindestens einem halben Jahr Dauer erhoben. Auf der Grundlage einer zusätzlichen Expertenbefragung durch geschulte Technische Aufsichtspersonen der Unfallversicherungsträger wurde die Belastung der Lendenwirbelsäule in Form der Druckkraft auf die untere Lendenwirbelsäule für Lastenhandhabungsvorgänge und Arbeitssituationen mit Rumpfvorneigungen erhoben. Die kumulative Wirbelsäulenbelastung wurde mit 10 unterschiedlichen Dosismodellen abgeschätzt, die sich hinsichtlich der Druckkraftschwellen, hinsichtlich der Einführung eines schichtbezogenen Dosis-Schwellenwertes und hinsichtlich der Gewichtung der lumbalen Druckkraft gegenüber der Belastungsdauer unterschieden. Die Auswahl der Confounder basierte auf biologischer Plausibilität und auf dem Change-in-estimate-Kriterium1. Odds Ratios (OR) und 95%-Konfidenzintervalle (CI) wurden durch Hilfe der unkonditionalen logistischen Regressionsanalyse getrennt für Männer und Frauen berechnet, adjustiert für Alter, Region, Belastung durch Arbeitslosigkeit als bedeutsamem Lebensereignis (bei Männern) bzw. psychosozialer beruflicher Be -lastung (bei Frauen). Die Anpassungsgüte der einzelnen Dosismodelle wurde mit dem Akaike-Information-Kriterium bestimmt.Die vorliegende Fall-Kontroll-Studie zeigt einen statistisch signifikanten positiven Zusammenhang zwischen der kumulativen Wirbelsäulenbelastung durch berufliche Lastenhandhabungen oder Rumpfbeugehaltungen und der Diagnose einer Prolaps - erkrankung bei Männern wie bei Frauen. Bei Frauen findet sich eine monotone Dosis-Wirkung-Beziehung zwischen beruflicher Belastung und der Prolapserkrankung (OR für die höchste Expositionskategorie =2,5; 95%-Konfidenzintervall CI 1,6–3,8). Bei Männern findet sich ein Anstieg des Prolapsrisikos mit zunehmender kumulativer Belastung der Wirbelsäule (OR in der zweithöchsten Expositionskategorie=3,9; 95%-CI 2,6–6,0), allerdings fällt das Risiko in der höchsten Expositionskategorie wieder ab (OR=1,4; 95%-CI 0,6–3,2); dieses Ergebnis könnte sich mit dem Healthy-worker-Effekt erklären. Das Mainz-Dortmunder Dosismodell (MDD) gehört nicht zu den am besten anpassenden Dosismodellen zur Beschreibung des Dosis-Wirkung-Zusammenhanges; dies ist offensichtlich auf die hohen Schwellenwerte des MDD zurückzuführen. Überproportionale Gewichtung der Belastungshöhe gegenüber der Belastungsdauer führt nicht zu einer Verbesserung der Modellgüte bezüglich des Prolapsrisikos.Die vorliegende multizentrische Fall-Kontroll-Studie findet einen Zusammenhang zwischen der kumulativen Bandscheibenbelastung und einer lumbalen Prolapserkrankung bei Männern und Frauen. Auf der Grundlage der vorliegenden Studie findet sich auch unterhalb der MDD-Schwellenwerte (bezogen auf Druckkraft durch Lastenhandhabungen, Rumpfvorneigewinkel und Tagesdosis) ein erhöhtes Prolapsrisiko.SummaryThe aim of this multi-centre case-control study is to investigate the dose-response relationship between occupational load on the spine and diagnosis of a lumbar disc herniation.286 male and 278 female patients with lumbar disc herniation between 25 and 70 years of age were prospectively recruited in four study regions (Frankfurt am Main, Freiburg, Halle, Regensburg). Population control subjects (453 males and 448 females) were obtained from the regional population registers. In a structured computer-assisted personal interview, a complete occupational history was elicited, including every occupational period that lasted at least half a year. On the basis of job task-specific supplementary surveys performed by trained technical experts of the accident insurance institutions, the situational spinal load represented by the compression at the lower lumbar spine was assessed for materials handling and working situations with forward bending. The cumulative spinal load was calculated using 10 alternative dose models, varying the minimum exposure limits for disc compression and shift dose as well as the weighting of the lumbar disc compression in relation to the respective duration. Confounder selection was based on biologic plausibility and on the “change-in-estimate criterion“. Odds ratios (OR) and 95% confidence intervals (CI) were calculated separately for men and women using unconditional logistic regression analysis, adjusted for age, region, and unemployment as major life event (in males) and psychosocial strain at work (in females). The Akaike information criterion was used to measure the goodness of fit of the single dose models.The results of this case-control study reveal a statistically significant positive relationship between cumulative spinal load caused by occupational manual materials handling and working postures with forward bending and lumbar disc herniation in men as well as in women. In women, a positive doseresponse relationship between ccupational exposure and lumbar disc herniation (OR for the highest exposure category= 2.5; 95% confidence interval CI 1.6–3.8) was found. In men, prolapse risks increase in line with increasing cumulative spinal load (OR for the second-highest exposure category= 3.9; 95%-CI 2.6–6.0), but decrease in the highest exposure category (OR=1.4; 95%-CI 0.6–3.2); the latter result might be explained by healthy worker effect. The Mainz-Dortmund Dose Model (MDD) is not one of the most appropriate dose models for explaining the dose-response relationship, mainly because of the high threshold limits of the MDD. Overproportional weighting of workload intensity in relation to the respective duration does not improve the goodness of fit of the model regarding the risk of disc herniation.According to this multi-centre case-control study, cumulative load on the intervertebral discs is related to lumbar disc herniation in both men and in women. Based on the study shown here, there is also an increased risk of disc herniation below the MDD thresholds (regarding compression caused by materials handling, forward bending of the trunk and shift dose).RésuméL’objectif de la présente étude cas-témoins multicentrée est d’examiner la relation de dose-effet entre les stress professionnels de la colonne vertébrale et le diagnostic d’un prolapsus lombaire.286 hommes et 278 femmes entre 25 et 70 ans et atteints d’un prolapsus lombaire ont été recrutés prospectivement dans quatre régions d’étude (Francfort-sur-le-Main, Fribourg, Halle, Ratisbonne). Des sujets témoins prélevés dans la population (453 hommes et 448 femmes) ont été recrutés quant à eux par l’intermédiaire des bureaux régionaux de déclaration de résidence. Dans un interview personnel structuré et assisté par ordinateur, on a recueilli une anamnèse professionnelle complète incluant chaque période professionnelle ayant duré au moins six mois. Sur la base d’une enquête supplémentaire menée à bien par des experts techniques formés des organismes d’assurance accidents, la sollicitation de la colonne vertébrale représentée par la force de compression sur la colonne vertébrale lombaire inférieure a été évaluée pour la manipulation de charges et les situations professionnelles avec une inclinaison vers l’avant du tronc. Le stress cumulé de la colonne vertébrale a été apprécié au moyen de 10 modèles de dose différents qui divergent au point de vue des seuils de la force de compression, de l’introduction d’une valeur seuil de dose par roulement ainsi qu’au point de vue de la pondération de la force de compression lombaire par rapport à la durée respective de la sollicitation. Le choix des confondeurs s’est basé sur la plausibilité biologique et sur le critère change-in-estimate. Des odds ratios (OR) et des intervalles de confiance de 95% (CI) ont été calculés séparément pour les hommes et les femmes à l’aide de l’analyse de régression logistique non conditionnelle, puis ajustés selon l’âge, la région, le stress dû à la perte d’un emploi vécu comme un événement important (chez les hommes) voire le stress professionnel psychosocial (chez les femmes). La qualité d’adaptation de chacun des modèles de dose a été déterminée avec le critère d’information d’Akaike.La présente étude cas-témoins révèle un rapport positif statistiquement significatif entre le stress cumulé de la colonne vertébrale dû à la manipulation de charges dans le cadre du travail ou à l’inclinaison vers l’avant du tronc d’une part et le diagnostic d’un prolapsus chez les hommes ainsi que chez les femmes d’autre part. Les résultats obtenus révèlent chez les femmes une relation de dose-effet monotone entre le stress professionnel et le prolapsus (OR pour la catégorie d’exposition maximum=2,5 ; intervalle de confiance de 95% 1,6–3,8).-Chez les hommes, on constate une augmentation du risque de prolapsus lorsque le stress cumulé de la colonne vertébrale (OR dans la deuxième catégorie d’exposition=3,9 ; intervalle de confiance de 95% 2,6–6,0) s’accroît, mais ce risque diminue toutefois à nouveau dans la catégorie d’exposition maximum (OR=1,4 ; intervalle de confiance de 95% 0,6–3,2) ; ce résultat pourrait s’expliquer par l’effet healthy-worker. Le modèle de dose Mainz-Dortmund (MDD) ne rentre pas dans la catégorie des modèles de dose les mieux adaptés pour décrire la relation de dose-effet entre l’exposition professionnelle et le prolapsus ; cela est apparemment imputable aux valeurs seuils élevées du MDD. Une pondération surproportionnelle de l’import

Insulin Leakage Value in Relation to Pen Needle Length and Administered Dose After Subcutaneous Injection

OBJECTIVE During a subcutaneous injection with commonly used pen needles, the safety of drug administration plays an essential role. Today short needles with a length of 5.0 mm are increasingly being used. However, so far it is unresolved whether short needles of <5.0 mm affect the safety of insulin injections because of an increased backflow to the skin surface. We examined the influence of needle length and administered insulin dosage on the insulin backflow and the distribution of human insulin in the tissue by a quantitative determination of the amount of backflow of insulin to the skin surface. For the first time a new 4.5-mm pen needle was examined for its administration safety. RESEARCH DESIGN Human insulin was radioactively marked. By means of an insulin pen different insulin dosages with pen needles of different lengths into fresh pork rind (ex vivo model) were administered. The amount of the marked insulin leaking from the tissues at the injection site was covered and absorbed immediately into a cotton swab. The amount of leakage was calculated by means of the radioactivity taken up by the swab. RESULTS The amount of leakage for each measurement was less than 1% of the total dosage administered. The amount of leakage increased with increased dosage administered in absolute terms, but expressed as a percentage of the increased dosage administered the leakage decreased. CONCLUSION The needle length (between 12 mm and 4.5 mm) did not have a meaningful influence on the amount of leakage; however, significant differences with different needle lengths could be observed.

Occupational Risk for Hepatitis A and Hepatitis E among Health Care Professionals

AbstractBackground: Since transmission routes of hepatitis E virus (HEV) and hepatitis A virus (HAV) are believed to be similar, comparable risk factors and a correlation between the two seroprevalence rates may be assumed. Materials and Methods: Anti-HAV and anti-HEV serology was assessed in 511 German subjects from nursing, pediatric nursing and administration groups, none of whom had been vaccinated against HAV. At the same time a standardized questionnaire on occupational and individual parameters was completed. Results: Overall seroprevalence for anti-HEV was 3.9% for anti-HAV 28%. Multivariate analysis revealed that anti-HEV seroprevalence was significantly higher in persons working in emergency admission or in surgery, while persons working in childrens psychiatry were more likely to be anti-HAV positive. Comparing the two serological results, no contingency differences was found χ2 = 0.42 (df = 1), p > 0.05). Conclusion: Specific departments of health care show higher prevalence of anti-HAV or anti-HEV. In the case of HEV further studies in the exposed working field are needed. Since no connection between the two serological results was found, transmission mechanisms might be (partly) different.

Does the concurrent administration of an inactivated hepatitis A vaccine influence the immune response to other travelers vaccines

BACKGROUND Travelers seeking protection from hepatitis A also often need protection against other infections, prevalent at their destinations. METHODS A total of 396 volunteers received not only a hepatitis A vaccine but also either a vaccine against polio, hepatitis B, diphtheria, tetanus, yellow fever, Japanese encephalitis, typhoid fever or rabies according to their individual needs. We investigated the potential influence of the hepatitis A vaccination on the immune response to the other travelers vaccines that were administered concurrently. RESULTS With seroprotection rates of 100% for yellow fever, Japanese encephalitis and rabies immunization and tetanus boosters our data demonstrate that the concurrent administration of hepatitis A vaccine does not compromise the immune response of these vaccines. Also for oral typhoid, hepatitis B and diphtheria vaccination we did not detect a negative influence of concurrent hepatitis A vaccine administration as compared with respective vaccinations when given alone. Prior to vaccination, more than one third of our subjects lacked protective antibody levels against diphtheria and only 44% of initially seronegative travelers seroconverted to an anti-diphtheria titer > or = 0.01 mIU/mL, supporting a need for an additional dose. Furthermore, only two thirds of the vaccinees tested prior to vaccination were protected against polio type 3, and the seroconversion rate following the administration of oral polio vaccine, was lower for viral type 3 (80%), as has been previously demonstrated in settings without concurrent other vaccinations. CONCLUSION No negative effect of concurrent travelers vaccinations on the immune response of a hepatitis A vaccine has been detected in a previous report, and, likewise our data suggest no impairment of the antibody response of these travelers vaccines by the concurrent administration of the hepatitis A vaccine.

Erhebungen zur beruflichen Wirbelsäulenexposition durch die Technischen Aufsichtsdienste der Unfallversicherungs träger im Rahmen der Deutschen Wirbelsäulenstudie

ZusammenfassungIm Rahmen der Deutschen Wirbelsäulenstudie (DWS), einer populationsbezogenen Fall-Kontroll-Studie mit 915 Fällen und 901 Kontrollen, wurde zur Untersuchung von Dosis-Wirkung-Beziehungen zwischen beruflichen Wirbelsäulenbelastungen und bandscheibenbedingten Erkrankungen der Lendenwirbelsäule ein zweigestuftes Verfahren der Expositionsermittlung angewandt. In einer ersten Befragung durch Laien-Interviewer konnten 1317 Probanden identifiziert werden, die in ihrem Berufsleben gewissen Mindestbelastungen durch manuelle Lastenhandhabungen, Arbeiten mit stark bis extrem vorgeneigtem Oberkörper oder Ganzkörperschwingungen ausgesetzt waren. Von diesen erklärten sich schließlich 1202 Probanden bereit, an einer intensiven Belastungsermittlung durch arbeitstechnische Experten der gesetzlichen Unfallversicherungsträger teilzunehmen. Diese Ermittlung umfasste detaillierte Angaben zu beruflichen Belastungen durch Tätigkeiten wie Heben, Tragen, Ziehen, Schieben, Werfen oder Schaufeln von Lasten ab ca. 5 kg, Arbeiten in starker oder extremer Rumpfbeugung und–torsion sowie Einwirkungen von Ganzkörpervibrationen. Auf diese Weise wurde die Exposition über das gesamte Berufsleben eines Probanden rekonstruiert.Die Qualität der Expositionsermittlung in dieser Studie ist im Vergleich zu den bisher auf diesem Forschungsgebiet durchgeführten Studien als wesentlich höher einzustufen. Die Ergebnisse der Ermittlung weisen unabhängig von eventuellen Auswirkungen auf Berufskrankheiten (BK) darauf hin, dass zukünftig auch Belastungen, die nicht Gegenstand von BK-Tatbeständen sind, verstärkt ins Licht der Prävention von Rückenbeschwerden im Sinne der Verhütung arbeitsbedingter Gesundheitsgefahren rücken.SummaryIn the context of the German Spine Study, a population-based case-control study covering 915 cases and 901 controls, a two-stage method for investigating exposure was employed for the study of dose-effect relationships between occupational spinal workloads and disc-related disease of the lumbar spine. In an initial survey by lay interviewers, 1317 subjects were identified who were exposed in their working lives to certain minimum workloads from the manual handling of loads, working with strong or extreme forward bending of the trunk or whole-body vibration. Of these, 1202 subjects finally agreed to take part in an in-depth investigation of workloads by technical experts of the accident insurance institutions. This investigation covered detailed information on occupational workloads due to activities such as lifting, carrying, pulling, pushing, throwing and shovelling loads weighing about 5 kg or more, working with strong or extreme bending of the trunk and the effects of whole-body vibration. In this way, the exposure was reconstructed for each test subject’s entire working life.The quality of the investigation of exposure in this study can be considered much higher than that of the studies conducted so far in this field of research. Independently of any effects on the facts of occupational disease, the results of the investigation indicate that, in future, even workloads not considered contributory to occupational disease should be given greater attention in terms of the prevention of back complaints and work-related health hazards.RésuméDans le cadre de l’étude allemande de la colonne vertébrale, étude cas-témoins portant sur la population avec 915 cas et 901 témoins, on a utilisé une méthode en deux phases de détermination de l’exposition pour examiner les relations de dose-effet entre les stress professionnels de la colonne vertébrale et les maladies des disques intervertébraux de la colonne lombaire. Dans un premier questionnaire effectué par des amateurs, il a été possible d’identifier 1317 sujets qui avaient été exposés dans leur vie professionnelle à des stress minimaux déterminés par la manipulation manuelle de charges, des travaux avec le tronc incliné voire extrêmement incliné vers l’avant ou à des vibrations du corps entier. Parmi ces sujets, 1202 se sont déclarés prêts à participer à une étude intensive de détermination du stress par des experts techniques du travail des organismes d’assurance accidents légaux. Cette analyse contenait des informations détaillées concernant les stress professionnels provoqués par des activités telles que le levage, le port, la traction, la poussée, le lancer ou le pelletage de charges de plus de 5 kg environ, par le travail dans une inclinaison et flexion fortes ou extrêmes du tronc ainsi que par l’exposition à des vibrations du corps entier. Tout cela a permis de reconstruire l’exposition sur toute la vie professionnelle d’un sujet.La qualité des méthodes de définition de l’exposition dans cette étude doit être considérée comme bien supérieure à celle des études réalisées jusqu’ici dans ce domaine de recherche. Les résultats obtenus indiquent, indépendamment de l’impact éventuel sur les maladies professionnelles (BK), que les stress qui ne relèvent pas de maladies professionnelles également, sont de plus en plus souvent visés par la prévention des troubles du dos au sens de la prévention de risques pour la santé associés à une activité professionnelle.