Stefania Curti

Carpal tunnel syndrome and manual work: a longitudinal study.

Objective: To assess risks associated with work-related biomechanical overloads in onset/course of carpal tunnel syndrome. Methods: Workgroups with job tasks spanning different biomechanical exposures were evaluated at baseline in terms of American Conference of Governmental Industrial Hygienists hand-activity/peak force action limit and threshold limit values (TLV). Exposures of interest were “unacceptable” (hand-activity above TLV) and “borderline” (between action limit and TLV) overloads. Clinical/individual data were collected at baseline and 12 months. Results: One-year incidence of “classic/possible” carpal tunnel syndrome symptoms as defined by consensus criteria was 7.3% (153 of 2092). “Unacceptable” overload was associated with a 3-fold increased risk of onset with respect to “acceptable” load. At ordered logistic regression analysis of symptom-status variations, increased risks were recorded for “unacceptable” and “borderline” overloads. Conclusions: Effectiveness of encouraging workplace adherence to the American Conference of Governmental Industrial Hygienists recommendations deserves investigation as a possible key to wide-scale prevention.

Evaluation of Two Preventive Interventions for Reducing Musculoskeletal Complaints in Operators of Video Display Terminals

Background and Purpose The purpose of this study was to evaluate the efficacy of a preventive ergonomic intervention, which was provided by physical therapists, on spinal and upper-extremity work-related posture and symptom complaints of workers who use video display terminals (VDT). Subjects Two hundred employees who spent at least 20 hours per week at a VDT were randomly divided into 2 groups. Group E received the ergonomic intervention and an informative brochure, and group I received only the brochure. Methods Both groups were evaluated at the beginning of the study and at a follow-up 5 months later. The following tools were used: a pain drawing and the Rapid Entire Body Assessment (REBA) method to assess spinal and upper-extremity work-related posture. Results Group E had a lower REBA score and reduced lower back, neck, and shoulder symptoms compared with group I. Discussion and Conclusion The results suggest that a personalized preventive ergonomic intervention can improve spinal and upper-extremity work-related posture and musculoskeletal symptoms for workers who use VDTs.

Effectiveness of an ergonomic intervention on work-related posture and low back pain in video display terminal operators: A 3 year cross-over trial

UNLABELLED This study investigated the effectiveness of a workstation ergonomic intervention for work-related posture and low back pain (LBP) in Video Display Terminal (VDT) workers. 100 VDT workers were selected to receive the ergonomic intervention, whereas 100 were assigned to a control group. The two groups were then crossed-over after 30 months from baseline. Follow-ups were repeated at 5, 12, and 30 months from baseline and then at 6 months following crossover. OUTCOMES Work-related posture and LBP point-prevalence using the Rapid Entire Body Assessment method and a Pain Drawing, respectively. The ergonomic intervention at the workstation improved work-related posture and was effective in reducing LBP point-prevalence both in the first study period and after crossover, and these effects persisted for at least 30 months. In conclusion, our findings contribute to the evidence that individualized ergonomic interventions may be able to improve work-related posture and reduce LBP for VDT workers.

Musculoskeletal pain in Europe: the role of personal, occupational, and social risk factors

OBJECTIVES The prevalence of musculoskeletal pain in European countries varies considerably. We analyzed data from the fifth European Working Conditions Survey (EWCS) to explore the role of personal, occupational, and social risk factors in determining the national prevalence of musculoskeletal pain. METHODS Over the course of 2010, 43 816 subjects from 34 countries were interviewed. We analyzed the one-year prevalence of back and neck/upper-limb pain. Individual-level risk factors studied included: sex; age; educational level; socioeconomic status; housework or cooking; gardening and repairs; somatizing tendency; job demand-control; six physical occupational exposures; and occupational group. Data on national socioeconomic variables were obtained from Eurostat and were available for 28 countries. We fitted Poisson regression models with random intercept by country. RESULTS The main analysis comprised 35 550 workers. Among individual-level risk factors, somatizing tendency was the strongest predictor of the symptoms. Major differences were observed by country with back pain more than twice as common in Portugal (63.8%) than Ireland (25.7%), and prevalence rates of neck/upper-limb pain ranging from 26.6% in Ireland to 67.7% in Finland. Adjustment for individual-level risk factors slightly reduced the large variation in prevalence between countries. For back pain, the rates were more homogenous after adjustment for national socioeconomic variables. CONCLUSIONS Our analysis indicates substantial variation between European countries in the prevalence of back and neck/upper-limb pain. This variation is unexplained by established individual risk factors. It may be attributable in part to socioeconomic differences between countries, with higher prevalence where there is less risk of poverty or social exclusion.

Effectiveness of a 'Global Postural Reeducation' program for persistent low back pain: a non-randomized controlled trial.

BackgroundThe aim of this non-randomized controlled trial was to evaluate the effectiveness of a Global Postural Reeducation (GPR) program as compared to a Stabilization Exercise (SE) program in subjects with persistent low back pain (LBP) at short- and mid-term follow-up (ie. 3 and 6 months).MethodsAccording to inclusion and exclusion criteria, 100 patients with a primary complaint of persistent LBP were enrolled in the study: 50 were allocated to the GPR group and 50 to the SE group. Primary outcome measures were Roland and Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). Secondary outcome measures were lumbar Visual Analogue Scale (VAS) and Fingertip-to-floor test (FFT). Data were collected at baseline and at 3/6 months by health care professionals unaware of the study. An intention to treat approach was used to analyze participants according to the group to which they were originally assigned.ResultsOf the 100 patients initially included in the study, 78 patients completed the study: 42 in the GPR group and 36 in the SE group. At baseline, the two groups did not differ significantly with respect to gender, age, BMI and outcome measures. Comparing the differences between groups at short- and mid-term follow-up, the GPR group revealed a significant reduction (from baseline) in all outcome measures with respect to the SE group.The ordered logistic regression model showed an increased likelihood of definitive improvement (reduction from baseline of at least 30% in RMDQ and VAS scores) for the GPR group compared to the SE group (OR 3.9, 95% CI 2.7 to 5.7).ConclusionsOur findings suggest that a GPR intervention in subjects with persistent LBP induces a greater improvement on pain and disability as compared to a SE program. These results must be confirmed by further studies with higher methodological standards, including randomization, larger sample size, longer follow-up and subgrouping of the LBP subjects.Trial registrationNCT00789204

Search strings for the study of putative occupational determinants of disease.

Objective To identify efficient PubMed search strategies to retrieve articles regarding putative occupational determinants of conditions not generally considered to be work related. Methods Based on MeSH definitions and expert knowledge, we selected as candidate search terms the four MeSH terms describing ‘occupational disease’, ‘occupational exposure’, ‘occupational health’ and ‘occupational medicine’ (DEHM) alongside 22 other promising terms. We first explored overlaps between the candidate terms in PubMed. Using random samples of abstracts retrieved by each term, we estimated the proportions of articles containing potentially pertinent information regarding occupational aetiology in order to formulate two search strategies (one more ‘specific’, one more ‘sensitive’). We applied these strategies to retrieve information on the possible occupational aetiology of meningioma, pancreatitis and atrial fibrillation. Results Only 20.3% of abstracts were retrieved by more than one DEHM term. The more ‘specific’ search string was based on the combination of terms that yielded the highest proportion (40%) of potentially pertinent abstracts. The more ‘sensitive’ string was based on the use of broader search fields and additional coverage provided by other search terms under study. Using the specific string, the numbers of abstracts needed to read to find one potentially pertinent article were 1.2 for meningioma, 1.9 for pancreatitis and 1.8 for atrial fibrillation. Using the sensitive strategy, the numbers needed to read were 4.4 for meningioma, 8.9 for pancreatitis and 10.5 for atrial fibrillation. Conclusions The proposed strings could help health care professionals explore putative occupational aetiology for diseases that are not generally thought to be work related.

Risk factors for operated carpal tunnel syndrome: a multicenter population-based case-control study.

BackgroundCarpal tunnel syndrome (CTS) is a socially and economically relevant disease caused by compression or entrapment of the median nerve within the carpal tunnel. This population-based case-control study aims to investigate occupational/non-occupational risk factors for surgically treated CTS.MethodsCases (n = 220) aged 18-65 years were randomly drawn from 13 administrative databases of citizens who were surgically treated with carpal tunnel release during 2001. Controls (n = 356) were randomly sampled from National Health Service registry records and were frequency matched by age-gender-specific CTS hospitalization rates.ResultsAt multivariate analysis, risk factors were blue-collar/housewife status, BMI ≥ 30 kg/m2, sibling history of CTS and coexistence of trigger finger. Being relatively tall (cut-offs based on tertiles: women ≥165 cm; men ≥175 cm) was associated with lower risk. Blue-collar work was a moderate/strong risk factor in both sexes. Raised risks were apparent for combinations of biomechanical risk factors that included frequent repetitivity and sustained force.ConclusionThis study strongly underlines the relevance of biomechanical exposures in both non-industrial and industrial work as risk factors for surgically treated CTS.

Prevention of work related eye injuries: long term assessment of the effectiveness of a multicomponent intervention among metal workers.

Background: Systematic assessments of the effectiveness of interventions to prevent work related eye injuries are needed. Aim: To investigate the long term effectiveness of a multicomponent prevention campaign. Methods: The campaign (conducted in collaboration with the local Employers’ Association and Trade Unions) targeted all 237 metal-ware factories in the district of Imola, Italy. Based on preliminary inspections, the main intervention included distribution to all factories of specific educational brochures and broadcasting/publication of television/radio programmes and local newspaper articles containing expert advice on the subject. This was followed by a four year “post-intervention reinforcement” period of unannounced official inspections. Main outcome measures analysed were eye injury rates (versus non-eye injury rates) among metal workers during “pre-intervention” (1988–90), “peri-intervention” (1991–92), “post-intervention reinforcement” (1993–96), “late post-intervention” (1997–2000), and “very late post-intervention” (2001–03) periods with respect to two comparison sectors (construction and wood/ceramics). Results: A Poisson regression in which the eye injury rates were modelled for each sector, period, and interaction, adjusting for non-eye injury rates, was chosen. The periods did not by themselves determine an overall reduction in eye injuries. The period/sector interaction terms were related to significant reductions for the metal sector when crossed with the “post-intervention reinforcement” (IRR = 0.77, 95% CI 0.61 to 0.97; % decline = 23.4), the “late post-intervention” (IRR = 0.63, 95% CI 0.50 to 0.79; % decline = 37.4), and the “very late post-intervention” (IRR =  0.58, 95% CI 0.43 to 0.77; % decline = 42.4) periods, suggesting a sustained reduction in eye injury risk following the main intervention. Conclusion: Results suggest that a carefully coordinated, extensive, multicomponent intervention can lead to lasting reductions in the burden of eye injuries.

Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue- and white-collar workers and housewives in Tuscany, Italy

Objectives: Rates of surgically treated carpal tunnel syndrome (CTS) among blue- and white-collar workers and housewives in the general population were compared. Methods: Surgically treated cases of idiopathic CTS were investigated among 25–59-year-old residents of Tuscany, Italy, during 1997–2000, based on obligatory discharge records from all Italian public/private hospitals, archived according to residence on Tuscany’s regional database. Population data were extracted from the 2001 census. Results: After excluding repeat admissions, 8801 eligible cases were identified. Age-standardised rates (per 100 000 person-years) of surgical CTS were: “blue-collar women”, 367.8; “white-collar women”, 88.1; “housewives”, 334.5; “blue-collar men”, 73.5; and “white-collar men”, 15.3. Compared with reference categories (same-sex white-collar workers): female blue-collar workers experienced a 4.2-fold higher standardised rate; housewives, a 3.8-fold excess; and male blue-collar workers, a 4.8-fold excess (all p<0.001). Male and female blue-collar workers showed approximately three to sevenfold higher age-specific rates compared to their white-collar counterparts (all p<0.001). Housewives’ rates were similar to those of blue-collar female workers up to 40–44 years of age, after which they were significantly lower (p<0.002). At all ages, housewives’ rates were much higher (p<0.001) than those of white-collar women. Conclusions: Surgically treated CTS was three to seven times more common (depending on age/gender) in blue-collar than in white-collar workers, which is difficult to explain by differences in body weight or other individual factors. Thus, occupational risk factors seem relevant throughout working life. The high rates for full-time housewives suggest that domestic chores should be investigated as a possible risk factor for CTS.

Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

BackgroundCarpal tunnel syndrome (CTS) is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status.MethodsSeven regions were considered (overall population, 14.9 million) over 3–6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare). Incidence rates of in-hospital cases of CTS were estimated based on 1) codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence) on regional databases; 2) demographic general population data for each region. We compared (using the χscore test) age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs) for married/unmarried men and women.ResultsAge-standardized incidence rates (per 100,000 person-years) of in-hospital cases of CTS were 166 in women and 44 in men (106 overall). Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57–1.60) in women, and 1.42 (95% CI, 1.40–1.45) in men. As compared with married women/men, widows/widowers both showed 2–3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts).ConclusionThis large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.