Ute Latza

A Consensus Approach Toward the Standardization of Back Pain Definitions for Use in Prevalence Studies

Study Design. A modified Delphi study conducted with 28 experts in back pain research from 12 countries. Objective. To identify standardized definitions of low back pain that could be consistently used by investigators in prevalence studies to provide comparable data. Summary of Background Data. Differences in the definition of back pain prevalence in population studies lead to heterogeneity in study findings, and limitations or impossibilities in comparing or summarizing prevalence figures from different studies. Methods. Back pain definitions were identified from 51 articles reporting population-based prevalence studies, and dissected into 77 items documenting 7 elements. These items were submitted to a panel of experts for rating and reduction, in 3 rounds (participation: 76%). Preliminary results were presented and discussed during the Amsterdam Forum VIII for Primary Care Research on Low Back Pain, compared with scientific evidence and confirmed and fine-tuned by the panel in a fourth round and the preparation of the current article. Results. Two definitions were agreed on a minimal definition (with 1 question covering site of low back pain, symptoms observed, and time frame of the measure, and a second question on severity of low back pain) and an optimal definition that is made from the minimal definition and add-ons (covering frequency and duration of symptoms, an additional measure of severity, sciatica, and exclusions) that can be adapted to different needs. Conclusion. These definitions provide standards that may improve future comparisons of low back pain prevalence figures by person, place and time characteristics, and offer opportunities for statistical summaries.

Effects of nitrogen dioxide on human health: systematic review of experimental and epidemiological studies conducted between 2002 and 2006.

In order to assess health effects in humans caused by environmental nitrogen dioxide (NO(2)) a systematic review of studies in humans was conducted. MEDLINE database was searched for epidemiological studies and experiments on adverse effects of NO(2) published between 2002 and 2006. The evidence with regard to NO(2) exposure limits was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) grading system and the modified three star system. Of the 214 articles retrieved 112 fulfilled the inclusion criteria. There was limited evidence that short-term exposure to a 1-h mean value below 200 microg NO(2)/m(3) is associated with adverse health effects provided by only one study on mortality in patients with severe asthma (*2+). The effect remained after adjusting for other air pollutants. There was moderate evidence that short-term exposure below a 24-h mean value of 50 microg NO(2)/m(3) at monitor stations increases hospital admissions and mortality (**2+). Evidence was also moderate when the search was restricted to susceptible populations (children, adolescents, elderly, and asthmatics). There was moderate evidence that long-term exposure to an annual mean below 40 microg NO(2)/m(3) was associated with adverse health effects (respiratory symptoms/diseases, hospital admissions, mortality, and otitis media) provided by generally consistent findings in five well-conducted cohort and case-control studies with some shortcomings in the study quality (**2+). Evidence was also moderate when the search was restricted to studies in susceptible populations (children and adolescents) and for the combination with other air pollutants. The most frequent reasons for decreased study quality were potential misclassification of exposure and selection bias. None of the high-quality observational studies evaluated was informative for the key questions due to the choice of the dose parameter (e.g., 1-week mean) and exposure levels above the limit values. Inclusion of study designs unlisted in the SIGN grading system did not bring additional evidence regarding exposures below the current air quality limit values for NO(2). As several recent studies reported adverse health effects below the current exposure limits for NO(2) particularly among susceptible populations regarding long-term exposure further research is needed. Apart from high-quality epidemiological studies on causality and the interaction of NO(2) with other air pollutants there is a need for double-blinded randomized cross-over studies among susceptible populations for further evaluation of the short-term exposure limits.

Influence of occupational factors on the relation between socioeconomic status and self-reported back pain in a population-based sample of German adults with back pain

STUDY DESIGN Population-based cross-sectional postal survey and interview substudy. OBJECTIVES To examine the association between socioeconomic status and severe back pain and to determine whether this association can be explained by occupational factors. SUMMARY OF BACKGROUND DATA Like other disorders, back pain and its consequences are inversely related to indicators of high socioeconomic status. METHODS The associations between indicators of socioeconomic status and presence or severity of current back pain (no back pain or back pain of low intensity and low disability versus back pain with high intensity and/or high disability) were investigated in a survey among German adults 25 to 74 years of age (n = 2731) and an interview substudy of 770 participants with a recent history of back pain.- RESULTS In the survey, educational level was inversely associated with back pain and severe current back pain. Similarly, in the interview substudy, educational level, vocational training, occupational class, household income, and health insurance status were inversely related to severe current back pain. Age-adjusted and gender-adjusted odds ratios were 0.36 (95% confidence interval [CI] 0.25-0.52) for immediate educational level and 0.37 (95% CI 0.18-0.73) for high educational level. Recalled work tasks at the onset of back pain were significant risk factors of severe current back pain (heavy physical work: odds ratio [OR] 1.77, 95% CI 1.06-2.93; work in bent position among males: OR 1.89, 95% CI 1.03-3.46). After adjusting for occupational class or work tasks, the association between educational level and severe current back pain remained unchanged.- CONCLUSIONS The findings support the hypothesis that severe back pain is less prevalent among adults of higher socioeconomic status. The underlying mechanism could not be explained by differences in self-reported occupational factors.

Cohort study of occupational risk factors of low back pain in construction workers.

OBJECTIVES To identify work related risk factors of future low back pain (LBP) in a cohort of construction workers free of LBP at the start of follow up. METHODS The Hamburg construction worker study comprises 571 male construction workers who have undergone two comprehensive interview and physical examination surveys. A cohort of 285 subjects without LBP at baseline was identified. After a follow up of 3 years, the 1 year prevalence of self reported LBP was determined in the 230 men followed up (80.7%). Prevalence ratios (PRs) with 95% confidence intervals (95% CIs) of LBP at follow up according to self reported work tasks of construction workers measured at baseline were estimated from Coxs regression models which were adjusted for age, and anthropometric measures. RESULTS At follow up 71 out of 230 workers (30.9%) reported LBP during the preceding 12 months. Four work tasks (scaffolding, erecting roof structures, sawing wood, laying large sandstones) with an increased risk of 1 year prevalence of LBP at follow up were further evaluated. After further adjustment for occupation the relative risk was increased for workers who had reported ⩾2 hour/shifts laying large sandstones (PR=2.6; 95% CI 1.1 to 6.5). Work load of bricklayers was additionally estimated by an index on stone load (high exposure: PR=4.0; 95% CI 0.8 to 19.8), and an index for laying huge bricks/blocks (yes/no: PR=1.7; 95% CI 0.5 to 5.7). CONCLUSIONS The results suggest that self reported differences in brick characteristics (size and type of stone) and temporal aspects of the work of bricklayers (average hours per shift laying specified stones) can predict the future prevalence of LBP. The data have to be interpreted with caution because multiple risk factors were tested.

Dermal, inhalation, and internal exposure to 1,6-HDI and its oligomers in car body repair shop workers and industrial spray painters

Objectives: To study inhalation and dermal exposure to hexamethylene diisocyanate (HDI) and its oligomers as well as personal protection equipment (PPE) use during task performance in conjunction with urinary hexamethylene diamine (HDA) in car body repair shop workers and industrial spray painters. Methods: Personal task based inhalation samples (n = 95) were collected from six car body repair shops and five industrial painting companies using impingers with di-n-butylamine (DBA) in toluene. In parallel, dermal exposure was assessed using nitril rubber gloves. Gloves were submerged into DBA in toluene after sampling. Analysis for HDI and its oligomers was performed by LC-MS/MS. Urine samples were collected from 55 workers (n = 291) and analysed for HDA by GC-MS. Results: Inhalation exposure was strongly associated with tasks during which aerosolisation occurs. Dermal exposure occurred during tasks that involve direct handling of paint. In car body repair shops associations were found between detectable dermal exposure and glove use (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.09 to 0.57) and inhalation exposure level (OR 1.34, 95% CI 0.97 to 1.84 for a 10-fold increase). HDA in urine could be demonstrated in 36% and 10% of car body repair shop workers and industrial painting company workers respectively. In car body repair shops, the frequency of detectable HDA was significantly elevated at the end of the working day (OR 2.13, 95% CI 1.07 to 4.22 for 3–6 pm v 0–8 am). In both branches HDA was detected in urine of ∼25% of the spray painters. In addition HDA was detected in urine of a large proportion of non-spray painters in car body repair shops. Conclusion: Although (spray) painting with lacquers containing isocyanate hardeners results in the highest external exposures to HDI and oligomers, workers that do not perform paint related tasks may also receive a considerable internal dose.

Can health care utilization explain the association between socioeconomic status and back pain

Study Design. Cross-sectional population-based study. Objectives. To assess whether the association between socioeconomic status and severe back pain can be explained by the preceding health care utilization for back pain. Summary of Background Data. The ways in which socioeconomic status affects the occurrence of back pain are unclear. Methods. Age- and gender-adjusted odds ratios with 95% confidence intervals for the association between indicators of socioeconomic status and severe current back pain (high intensity and/or high disability: no/yes) were investigated in an interview among 770 study participants out of 1113 study participants with a recent history of back pain in a survey among 2731 adults. Results. The point prevalence of severe current back pain (39.8%) was related to educational level and health insurance status. Prior health care utilization for back pain was about 2-fold more prevalent in adults with severe current back pain. Members of private health insurance (odds ratio 0.60, 95% confidence interval 0.37–0.99) were less likely to report prior consultation of a general practitioner for back pain. Members of sick funds for white-collar workers (odds ratio 2.81, 95% confidence interval 1.43–5.51) and private insurance (odds ratio 2.81, 95% confidence interval 1.02–6.24) and individuals with intermediate educational level (odds ratio 1.76, 95% confidence interval 1.05–2.95) utilized more physical therapy for the treatment of back pain. After additionally adjusting for health care utilization, the associations between educational level or health insurance status and severe current back pain remained unchanged. Conclusions. The data suggest that education, health insurance status, and health care utilization are independently associated with severe current back pain in a society with universal access to health care.

Endotoxin exposure and respiratory symptoms in the cotton textile industry

Abstract One hundred fourteen male employees of a cotton spinning mill in western Germany participated in a cross-sectional study, the purpose of which was to clarify the dose effect of endotoxin exposure on respiratory symptoms. Airborne endotoxin exposures were classified as low (≤ 100 endotoxin units [EU]/m3), medium (> 100–450 EU/m3), or high (> 450 EU/m3), on the basis of endotoxin activity in the Limulus amoebocyte lysate assay. Age- and smoking-adjusted odds ratios (ORs) and confidence intervals (Cls) were estimated. The dose-response relationship between current endotoxin exposure and prevalence of wheezing (medium: OR = 2.15, 95% Cl = 0.48–9.62; high: OR = 5.49, 95% Cl = 1.17–25.81) and cough (medium: OR = 2.11; 95% Cl = 0.59–7.56; high: OR = 3.93; 95% Cl = 1.02–15.12) was significant (test for linear trend: p values = 0.020 and 0.040, respectively). The association between exposure and wheezing was stronger among atopic workers. The higher prevalence of chest tightness and shortness of breath among workers with medium and high current endotoxin exposure did not reach statistical significance. The results suggested that there was a dose-dependent increase in bronchial symptoms, with significant effects occurring at exposures that exceeded 450 EU/m3.

Codierung der Tätigkeitsangaben im Basiskollektiv der Gutenberg-Gesundheitsstudie unter Anwendung der Klassifikation der Berufe KldB 2010 — Darstellung des Vorgehens und der Datenqualität

ZusammenfassungIn der Basiserhebung der Gutenberg- Gesundheitsstudie Mainz wurden die Berufsbiografien von 15.010 Probanden erfasst. Um die Textangaben aus 67.389 einzelnen Tätigkeitsphasen für epidemiologische Auswertungen nutzen zu können, wurde eine Codierung nach der deutschen Klassifikation der Berufe KldB 2010 durchgeführt. Ziel des Artikels ist, das methodische Vorgehen und die Qualität der angewandten Berufscodierung darzustellen.Die Berufsphasen wurden auf der Ebene der 5-Steller (Berufsgattungen) codiert. Zur Qualitätssicherung wurden 10 % der Probanden doppelt codiert. Die Beurteilerübereinstimmung zwischen Primär- und Doppelcodierung wurde für verschiedene Dimensionen des Berufscodes berechnet. Insgesamt ist die Beurteilerübereinstimmung für die verschiedenen Dimensionen als gut bis sehr gut zu bewerten. Der Codierprozess führte bei akzeptablem Aufwand zu einer hohen Qualität der Berufscodierung. Praktische Relevanz Der Berufsstatus wird in Deutschland im Regelfall über Angaben zur beruflichen Tätigkeit sowie zur Stellung im Beruf erhoben. Dadurch ist es möglich, eine Einteilung der zahlreichen in Deutschland registrierten Bezeichnungen von Berufen in übersichtliche Gruppen vergleichbarer Tätigkeiten vorzunehmen. Um diese Angaben verwendbar zu machen, ist die Codierung der Tätigkeitsangaben erforderlich. Diese Berufscodierung muss eine hohe Qualität aufweisen, um die Daten für Auswertungen nutzen zu können.AbstractThe occupational history of 15,010 subjects was assessed as part of the baseline examination of the Gutenberg Health Study. In order to use the 67,389 single records of the different job-specific time periods for epidemiological analyses, the coding was done according to the German Classification of Occupations 2010. The aim of this article is to present the methodology and the quality of the coding of the available information on job titles and job description.The job-specific time periods were coded at the level of 5-digit codes. 10 % of the subjects were coded twice for quality assurance. The interrater agreement between the primary and secondary coding was evaluated for different dimension of the job codes.Overall, the interrater agreement for the different dimensions is considered as good to very good. The coding process resulted in a high quality of coding with a reasonable effort.

Möglichkeiten der kardiovaskulären Risikostratifikation und der Diagnostik präklinischer Atherosklerose — Nutzen ausgewählter Untersuchungsverfahren für die arbeitsmedizinische Forschung und Praxis

ZusammenfassungZum Thema „Möglichkeiten der kardiovaskulären Risikostratifikation und Diagnostik präklinischer Atherosklerose — Nutzen ausgewählter Untersuchungsverfahren für die arbeitsmedizinische Forschung und Praxis“ fand am 8. November 2011 ein Workshop in der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin in Berlin statt. Vo n sechs Referenten (Hans-Wener Hense, Uwe Nixdorff, Arno Schmidt-Trucksäss, Renate Schnabel, Irina Böckelmann, Georg Michelson) aus unterschiedlichen medizinischen Disziplinen wurden diagnostische Möglichkeiten für die frühe Detektion Atherosklerose assoziierter Herz-KreislaufErkrankungen vorgestellt und hinsichtlich der Eignung für die arbeitsmedizinische Forschung und Praxis diskutiert. Die Beiträge in diesem Heft sollen eine Einschätzung der Methoden ermöglichen und Entscheidungshilfen und Ideen für das weitere Vorgehen in Forschung und Praxis liefern.AbstractA workshop on opportunities for cardiovascular risk stratification and new diagnostic methods for the detection of preclini-cal atherosclerosis was held at the Federal Institute for Occupational Safety and Health in Berlin on 8 November 2011. Six speakers (Hans Wener Hense, Uwe Nixdorff, Arno Schmidt-Trucksäss, Renate Schnabel, Irina Böckelmann, Georg Michelson) from different medical disciplines presented diagnostic possibilities for early detection of atherosclerosis-associated cardio -vascular disease. The applicability of the presented methods for research and practice in occupational health were discussed. The articles in this issue shall allow for an appraisal of the methods and provide decision-making support as well as ideas for the next steps in research and practice.

Occupation-specific frequency of sick-leave due to cardiovascular diseases

Objectives Cardiovascular diseases (CVD) contribute to a large share of morbidity among workers in industrialised countries. The aim was to identify occupations with elevated sick-leave due to arteriosclerotic CVD for recognition of potentials for prevention and research needs. Methods Aggregated data for the German working population aged 15–64 years pooled from nearly all statutory health insurances (SHI) for the year 2008 were stratified by gender, occupation (KldB 1988), age group, and 6 frequent ICD-10 diagnoses. Standardised morbidity ratios (SMR) with 99.99% CIs of sick-leave cases were calculated (reference: office workers). Estimates with a SE <0.2 were considered. Results Data from 26.2 million employees were retrieved. The most frequent diagnoses were chronic ischaemic heart disease (I25), angina pectoris (I20), and acute myocardial infarction (I21). Significantly higher frequencies of sick-leave for 5 of the selected 6 diagnoses were observed for metal workers (SMR 1.31–1.96), street cleaners/ garbagemen (SMR 1.30–2.68), storage/ transport workers (SMR 1.17–1.63), and watchmen (SMR 1.29–2.11) among males and for cleaners (SMR 1.21–1.95), retail/ trade workers (SMR 1.29-1.92), assistant nurses (SMR 1.54–1.75), and domestic caregivers (SMR 1.23–1.97) among females. Conclusions The data are representative for employees with SHI comprising about 2/3 of the German working population. No causal inference is possible due to the cross-sectional design and the secondary data analysis with missing data on occupational history/risk factors, life style, and mortality due to CVD. Prevention should focus on high-risk occupations. Risk profiles among these occupations need to be investigated.