Lennart Dimberg

Measurement properties of a self-report index of ergonomic exposures for use in an office work environment.

Office work-related upper extremity symptoms and disorders have been associated with static work posture, repetition, and inadequate recovery in the anatomic structures of the neck and upper extremities. Despite these associations, relatively little research has been conducted on the development of practical measures of these ergonomic exposures. The present study examines the measurement properties of an upper-extremity–specific self-report index of ergonomic exposures. Ninety-two symptomatic office workers completed a Web-based questionnaire measuring demographic variables, ergonomic exposures, pain, job stress, and functional limitations. Comparisons of internal consistency, construct validity, and discriminative and predictive abilities were made between the self-report index and an observational exposure assessment checklist. Results indicated that the self-report index had acceptable measurement properties. Furthermore, higher levels of self-reported ergonomic exposures were associated with upper extremity pain, symptom severity, and functional limitations. In contrast, higher levels of observed exposure were related only to lower levels of general physical function. The self-report measure has potential for use in occupational health surveillance programs for office work environments and as an outcome measure of ergonomic exposure in intervention trials. These results also suggest the need for using multiple methods when assessing ergonomic exposures.

Stress and business travel: Individual, managerial, and corporate concerns

Business travel is often a positive experience —offering close collaborations with distant colleagues and clients,the stimulation of different environments,and a change of routine. But it is also a source of a variety of stresses,often overlooked or denied by both organizations and travelers themselves.The World Bank,studying its own travelers,discovered that both their physical and mental health-care claims were significantly greater than those of nontravelers.And so the bank recently sponsored a symposium on the subject of business travel stress,at which more than 100 representatives of more than 50 organizations in a wide variety of industries met and agreed that travel stress,including jet lag, fatigue, family disruptions, and compromised work effectiveness were common outcomes of frequent business travel -and that responsibility for understanding and doing something about travel stress is shared among the individual employee,the manager,and the organization.

The Proactive Approach--Is it Worthwhile? A Prospective Controlled Ergonomic Intervention Study in Office Workers

Objective: Does proactive ergonomics program enhance office worker health and productivity? Method: The investigation was conducted in connection with the move of 1500 office staff to a building with improved ergonomics. It was focused on associations between workstation features, working postures, musculoskeletal pain symptoms, and eye strain before and 18 months after implementation of a proactive ergonomic program. The outcomes were compared between the intervention and a similar reference group. Results: Associations between improvement of postures and less musculoskeletal pain and eye strain were confirmed. A cross association between several features and postures and improved symptoms was noted, along with improved productivity. Conclusion: The study suggests that a proactive program adhering to the OSHA recommendations needs to include an individual workstation assessment to be effective in reducing symptoms and increasing productivity.

Can we trust the answers? Reliability and validity of ergonomic self-assessment surveys.

To the Editor: Two patients were recently evaluated and treated for acute onset abdominal pain, which occurred while performing relatively heavy physical activity. The patients were sent by different companies, to separate occupational medicine clinics. One of these patients, a 44-yearold man, was shoveling concrete when symptoms occurred. The other patient, a 30-year-old man, was lifting a heavy palette while twisting and then throwing it when pain occurred in the abdomen. Although uncomfortable, no vomiting, fever, or toxicity was noted in either case. A finding of tenderness to palpation of the epigastric area, right and left lower abdominal quadrants was noted in the 44-year-old patient. The diagnosis of “abdominal pain” and “possible ventral hernia” was made. The 30-year-old patient was noted to have tenderness, and was “very painful” in the left lower abdominal quadrant and the left inguinal region. No acute mass was noted in either patient and vital signs were normal. A urine “dipstick” analysis was normal in the 30-year-old. The 44-yearold patient had a “large, protuberant abdomen” whereas the 30-year-old was not considered obese. The 44year-old patient was sent to a surgeon and computed tomography (CT) imaging of the abdomen and pelvis was obtained (with contrast). The initial treating practitioner of the 30-year-old patient ordered a CT scan of the abdomen and pelvis (with contrast). Different radiologists interpreted the CT scans from the different patients. The 30-year-old patient was found to have “epiploic appendagitis of the proximal sigmoid colon” on CT scan. The 44-year-old patient exhibited “mild inflammatory change at the anterior aspect of the cecum, most consistent with epiploic appendagitis” on CT. The surgeon also diagnosed abdominal wall strain that was “work-related.” Primary epiploic appendagitis is produced by torsion and inflammation of finger-like projections of adipose tissue and blood vessels that extend from the colon. Symptoms can easily be mistaken for acute appendicitis, diverticulitis, hernia, or cholecystitis. Acute epiploic appendagitis is associated with obesity, hernia, and unaccustomed exercise. Historically, before CT scan was able to identify this entity, patients would sometimes undergo exploratory surgery for suspected appendicitis or acute abdomen. Treated conservatively, epiploic appendagitis generally resolves within 14 days. In the two cases reported here, one case resolved in approximately 3 weeks, and the other in approximately 5 weeks. Primary torsion of the omentum has been described in a jackhammer worker and was considered related to vibration. Torsion and inflammation of the epiploic appendages, although perhaps rare, should be a consideration in patients reporting for evaluation of work-related abdominal pain (after considering other serious causes requiring urgent treatment). There is possibility of the association of epiploic appendagitis with heavy physical activities.

A Safe Route to Work? Accident Experience of World Bank Group Bike Commuters

World Trade Center Multiple Myeloma: Police Responders Only? To the Editor: Moline et al. have now published data on their cases of multiple myeloma in World Trade Center (WTC) responders, which they have cited at conferences and which have been picked up by the popular and medical press. Of the eight cases, there was, if anything, a deficit in older subjects (who are the most likely to get this disease) and a surplus in those younger than 45 years, 4 versus 1.2 expected. This may be sufficient to warrant publication but does not prove causation of malignancy from WTC exposure. All the four younger patients were police. This raises questions; the article could equally be entitled “Multiple Myeloma in WTC Police Responders.” It is widely reported that various agents, to which police are exposed, may increase the risk for multiple myeloma, including vehicle exhaust and pesticides. Do the authors have information on myeloma incidence in police in New York City or elsewhere? Confirmation of this increase in multiple myeloma from another, carefully followed, group of WTC responders, NYC Firefighters, would be of interest. (Note that before September 11, 2001 increased multiple myeloma had been described in firefighters with at least 20 years of service.) The report is subject to selection bias in that symptomatic subjects or those with major illness are more likely to present for monitoring. “Patients were asked to self-report any diagnosed conditions to a WTC Medical Monitoring and Treatment Program (MMTP) clinician during a baseline monitoring or treatment visit.” How many of the cases were identified among those already enrolled in the program? Did the others present to the program because of the diagnosis already established?