Work-relatedness of lumbosacral radiculopathy syndrome: Review and dose-response meta-analysis

Back pain in the midwifery profession in northern Poland

Background

Neck pain (NP) and low back pain (LBP) are increasingly significant medical, social, and economic concerns. The midwifery profession, similar to other healthcare occupations, is particularly predisposed to these issues.

Methods

This study aimed to analyze the prevalence of back pain among midwives and evaluate the associated disability levels using the Neck Disability Index (NDI) and the Oswestry Disability Index (ODI). The study group included 208 actively practicing midwives aged 23 to 67 years (mean ± SD: 48.1 ± 10.7 years). Participants completed an anonymous survey comprising a custom-designed questionnaire, the Polish language versions of the NDI and ODI, and the Visual Analog Scale (VAS) for pain intensity.

Results

The analysis revealed a statistically significant correlation between VAS pain intensity and both age (r = 0.2476) and work experience (r = 0.2758), indicating higher pain scores with increasing age and seniority. No significant association was found between BMI and VAS scores (r = 0.0011). Additionally, NDI and ODI scores correlated significantly with age (r = 0.1731; r = 0.3338), BMI (r = 0.1685; r = 0.2718), and work experience (r = 0.1987; r = 0.4074). Higher values for age, BMI, and seniority were associated with increased disability levels.

Conclusions

Neck and low back pain represent prevalent and impactful issues for midwives in Poland, contributing to mild to moderate disability, absenteeism, reliance on pain medication, and limited physical activity. Key contributing factors include age, professional experience, BMI, and low levels of physical activity.

Diagnosing and Reporting of Occupational Diseases: An Assessment Study of Reports from an Italian Workplace Safety Prevention Program Service

BACKGROUND

The criteria for diagnosing and compensating for occupational diseases vary significantly between countries. The lists of occupational diseases often include diagnostic and attribution criteria that are usually not very specific. As a result, the quality of occupational disease reports is frequently subpar. The aims of this study were to assess the quality of diagnosis and reporting, as well as to evaluate the causal link between reported occupational diseases and occupational risk factors.

METHODS

Four occupational physicians assessed the quality of diagnosis by blindly applying Spreeuwers' performance indicators for diagnosis and reporting. Following Violante's criteria, the four evaluators also tested the levels of evidence to evaluate the quality (and associated likelihood) of the diagnosis and the quality of exposure to occupational risk factors in a sample of 104 occupational disease reports, grouped by diagnosis and examined by the local Workplace Safety Prevention Service. Separate scores for each performance indicator and the Total Quality Score (TQS, ranging from 0 to 10), along with the progressive levels of evidence, were then assigned for each occupational disease report.

RESULTS

The mean TQS was below the threshold of sufficiency (<6) for 28% of the diagnoses, while an almost sufficient score (>6) emerged for 72% of the diagnoses, primarily including musculoskeletal disorders, pulmonary silicosis, and noise-induced occupational hearing loss. When applying Violante's criteria for the level of evidence of the diagnosis, it was insufficient for 13.5% of the reported cases, while the level of evidence for exposure to occupational risk factors was deemed insufficient for 19% of the cases, and no cases demonstrated a level of evidence that was highly probable or nearly certain.

CONCLUSIONS

Despite the overall quality of the reported cases of occupational diseases being reasonably good, improvements in the quality of diagnosis and reporting could be achieved through strict adherence to standardized diagnostic criteria and by training health personnel to collect data regarding occupational and non-occupational risk factors properly.

Occupational mechanical exposures as risk factor for shoulder osteoarthritis: a systematic review

OBJECTIVES

The aim of this systematic review was to study the association between occupational mechanical exposures and shoulder osteoarthritis (OA).

METHODS

A protocol was registered in PROSPERO. Four databases were systematically searched based on PECOS criteria. Outcome was defined as shoulder OA (acromioclavicular (AC) and/or glenohumeral OA) and exposure as occupational mechanical exposures (vibration, upper arm elevation, force, lifting, repetition, and combined mechanical exposures). We included epidemiological studies estimating the prevalence of shoulder OA or the association between occupational mechanical exposures and shoulder OA. Two researchers independently screened articles, performed data extraction, and assessed the risk of bias and level of evidence using GRADE.

RESULTS

A total of 1642 articles were screened, of which 7 met the inclusion criteria. Four studies were assessed as having a high risk of bias, 1 with a moderate risk, and 2 with a low risk. Based on job titles, higher prevalence estimates (2.9% to 61.8%) were found in exposed job groups. For all occupational mechanical exposures, exposure-response relations were found in relation to AC OA. For vibration, the odds ratio (OR) ranged between 1.7 and 3.1 in the highest exposure groups, while the ORs for upper arm-elevation, force, lifting, repetition, and combined mechanical exposures ranged between 0.5 to 2.2, 1.3 to 1.8, 7.3 to 10.3, 2.4, and 2.2 to 2.9. Low or very low level of evidence was found for all exposures.

CONCLUSIONS

This systematic review found an indication of an association between occupational mechanical exposures and shoulder OA, especially AC OA. However, the level of evidence varied between low and very low. High-quality studies assessing the association and differentiating between the specific shoulder joints are highly warranted.

Dupuytren's disease and occupational mechanical exposures: a systematic review and meta-analysis

The risk of developing Dupuytren's disease among workers exposed to occupational mechanical exposures has been reported in few systematic reviews, mainly related to vibration. Expanding the investigation to all occupational mechanical exposures is essential for advancing scientific knowledge, health policies and improving workplace safety. The aim of this systematic review and meta-analysis was to study the association between occupational mechanical exposures and Dupuytren's disease.We conducted a systematic review and meta-analysis using guidelines stated by PRISMA. The systematic literature search was performed in Medline, EMBASE, CINAHL, Cochrane Library and Web of Science databases in April 2023. Inclusion criteria were conducted using the PECOS. Two independent authors conducted the literature screening, data extraction and risk of bias assessment. In the meta-analyses, data was pooled using random-effects models and stratified by the risk of bias and study design. The level of evidence was evaluated using GRADE.The literature search identified 563 unique articles and 15 were deemed eligible for inclusion, categorised into hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. Exposure to hand-transmitted vibration showed an OR of 2.0 (95% CI 1.5 to 2.7, I2=64%), lifting/carrying loads had an OR of 1.5 (95% CI 1.1 to 2.0, I2=77%) and combined mechanical exposures had an OR of 2.1 (95% CI 1.4 to 3.1, I2=94%). When grading the level of evidence, we found moderate evidence for hand-transmitted vibration, while low evidence was found for lifting/carrying loads and combined mechanical exposures.We found an association between hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. The level of evidence was considered moderate for hand-transmitted vibration and low for lifting/carrying loads and combined mechanical exposures.

Evaluating the categorisation of interventions in individual working practice aimed at preventing work-related musculoskeletal disorders: An international experts consultation

In a previous scoping review, eight categories of interventions in individual work practice were defined. The aim of the present study is to evaluate the relevance and completeness of these eight categories and to increase the clarity of the nomenclature and definitions of each category. An international expert consultation has been carried out for this purpose. Thirty-eight experts from 13 countries participated. Data collection was conducted using a survey design comprising structured questions. Consensus was reached if 75% of the experts answered 'Strongly agree' or 'Agree' on a 5-point Likert scale. For the topic 'Relevance', there was consensus for six of the eight categories (range 78%-86%), the exceptions were the categories: 'Exercising' (72%) and 'Professional manners' (64%). With regard to the topic 'Nomenclature', consensus was reached for six categories and for the topic 'Definition' this was five categories. The present definitions have been improved based on the expert recommendations. With respect to the topic 'Completeness': although a limited number of suggestions were given, this did not lead to one or more categories being added to the existing eight categories. The final 'Nomenclature' for the categories is: 'Variation', 'Professional behaviour', 'Motoric skills', 'Vocational working techniques', 'Physical workplace', 'Physical training', 'Assistive devices and tools' and 'Task content and task organisation'. This expert consultation has provided a solid basis for endorsing the categorisation of interventions in IWP and is an important step in building a framework to develop and evaluate interventions in IWP.

Narrative review of occupational exposures and noncommunicable diseases

OBJECTIVE

Within the scope of the Exposome Project for Health and Occupational Research on applying the exposome concept to working life health, we aimed to provide a broad overview of the status of knowledge on occupational exposures and associated health effects across multiple noncommunicable diseases (NCDs) to help inform research priorities.

METHODS

We conducted a narrative review of occupational risk factors that can be considered to have "consistent evidence for an association," or where there is "limited/inadequate evidence for an association" for 6 NCD groups: nonmalignant respiratory diseases; neurodegenerative diseases; cardiovascular/metabolic diseases; mental disorders; musculoskeletal diseases; and cancer. The assessment was done in expert sessions, primarily based on systematic reviews, supplemented with narrative reviews, reports, and original studies. Subsequently, knowledge gaps were identified, e.g. based on missing information on exposure-response relationships, gender differences, critical time-windows, interactions, and inadequate study quality.

RESULTS

We identified over 200 occupational exposures with consistent or limited/inadequate evidence for associations with one or more of 60+ NCDs. Various exposures were identified as possible risk factors for multiple outcomes. Examples are diesel engine exhaust and cadmium, with consistent evidence for lung cancer, but limited/inadequate evidence for other cancer sites, respiratory, neurodegenerative, and cardiovascular diseases. Other examples are physically heavy work, shift work, and decision latitude/job control. For associations with limited/inadequate evidence, new studies are needed to confirm the association. For risk factors with consistent evidence, improvements in study design, exposure assessment, and case definition could lead to a better understanding of the association and help inform health-based threshold levels.

CONCLUSIONS

By providing an overview of knowledge gaps in the associations between occupational exposures and their health effects, our narrative review will help setting priorities in occupational health research. Future epidemiological studies should prioritize to include large sample sizes, assess exposures prior to disease onset, and quantify exposures. Potential sources of biases and confounding need to be identified and accounted for in both original studies and systematic reviews.

Occupational psychosocial exposures and chronic low-back pain: a systematic review and meta-analysis

OBJECTIVE

This study aimed to explore the association between occupational psychosocial exposures and chronic low-back pain (LBP) by conducting a systematic review and meta-analysis.

METHODS

The research protocol was registered in PROSPERO. A systematic literature search was performed in six databases, identifying articles complying with predefined inclusion criteria. In our PECOS, we defined outcome as chronic LBP ≥3 months, exposures as occupational psychosocial exposures, and restricted study design to case-control and cohort studies. Two authors independently excluded articles, extracted data, assessed risk of bias, and graded evidence levels. Meta-analyses were performed using random-effects models.

RESULTS

The 20 included articles encompassed six different occupational psychosocial exposures (job control, demand, strain, support, stress, and satisfaction), only 1 had low risk of bias. For all occupational psychosocial exposures, odds ratios ranged from 0.8 to 1.1. Sensitivity analyses based on risk of bias was conducted for two outcomes ie, job control and job demand, finding no differences between high and low-to-moderate risk of bias studies. Using GRADE, we found a very low level of evidence of the association for all occupational psychosocial exposures.

CONCLUSION

In this study, we found no association between occupational psychosocial exposures and chronic LBP. However, it is important to underline that the level of evidence was very low. High quality studies are highly warranted.

Manual traction is effective in alleviating lumbosacral spine pain: Evidence from a randomized controlled trial

Background

Manual traction, a therapeutic technique frequently employed in healthcare, involves applying controlled pulling force by hand, usually to the spine, to stretch muscles and decompress joints, thereby alleviating pain. This method can be particularly beneficial for addressing lumbosacral spine pain exacerbated by radicular symptoms, characterized by pain radiating from the lower back due to compression or irritation of spinal nerves.

Purpose

This study aimed to compare the effects of manual traction against control group in alleviating the lumbosacral spine pain caused by radicular symptoms.

Methods

A randomized controlled study design was utilized with a sample of 60 patients experiencing lumbosacral spine pain, evenly distributed between an experimental group (n = 30; receiving manual traction) and a control group (n = 30). Patients underwent assessments before and after six treatment sessions, which included the Straight Leg Raise test, modified Bragard's test, Kernig's test, and the visual analogue scale for pain perception.

Results

Between-group significant differences were found at post-intervention, favoring the experimental group on SLR - Left (°) (p = 0.004; medium effect size), SLR - Right (°) (p = 0.004; medium effect size), Modified Bragard test - Left (°) (p = 0.024; small effect size), Modified Bragard test - Right (°) (p = 0.003; medium effect size), Kernig's Test - Left (°) (p = 0.013; medium effect size) and Kernig's Test - Right (°) (p = 0.010; medium effect size). Additionally, between-group significant differences were found at post-intervention, favoring the experimental group on VAS scores at SLR left (p < 0.001; medium effect size), and right (p < 0.001); medium effect size, Modified Bragard test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size) and at Kernig's Test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size).

Conclusions

In conclusion, manual traction is recommended as an effective approach for alleviating lumbosacral spine pain in patients experiencing symptoms resulting from irritation or compression of a spinal nerve root.

Hip osteoarthritis and occupational mechanical exposures: a systematic review and meta-analysis

OBJECTIVES

The aim was to conduct a systematic review and meta-analysis investigating the association between occupational mechanical exposures and hip osteoarthritis.

METHODS

The study was registered in PROSPERO. A systematic literature search was conducted in six databases to identify relevant articles. Two authors independently excluded articles, extracted data, assessed the risk of bias of each included article, and graded the level of evidence. We conducted a meta-analysis using random-effects model and performed a sensitivity analysis stratifying articles based on the risk of bias assessment, study design, and the outcome measurement.

RESULTS

Twenty-four articles were eligible for inclusion. The highest pooled odds ratio (OR) was found for combined mechanical exposures [OR 1.7, 95% confidence interval (CI) 1.4-2.0], non-neutral postures (OR 1.7, 95% CI 1.4-2.1), lifting/carrying loads (OR 1.6, 95% CI 1.3-1.9), and climbing stairs (OR 1.6, 95% CI 1.1-2.2). The range of pooled OR for the remaining mechanical exposures (eg, standing, walking, kneeling, squatting, and sitting) was 0.6-1.6. Grading the quality of evidence, a moderate level of evidence was found for the combined mechanical exposures and for lifting/carrying loads. The remaining exposure categories were graded as having either low or very low levels of evidence.

CONCLUSIONS

Considerable heterogeneity was observed across the included studies, and high-quality literature using objective exposure measurements is warranted. Despite various limitations affecting the comparability, occupational mechanical exposures seem to influence the likelihood of developing hip osteoarthritis.

Predisposition and Working Conditions for the Occurrence of Lumbar Syndrome in Medical Workers of the Clinical Center of Montenegro during the COVID-19 Pandemic

Background: Lumbar pain is a condition of discomfort in the lower back caused by numerous factors, lasting for short or longer periods of time. Healthcare professionals, regardless of the type of care they are engaged in, are at risk of lumbar pain. This is the first study that deals with the problem of lumbar syndrome in health workers in Montenegro. Methods: This cross-sectional study included full-time health workers employed in the Clinical Center of Montenegro who were involved in the treatment of COVID-19 patients during 2020 and 2021. The survey consisted of general questions for collecting socio-demographic and COVID-19 engagement data; the Modified Nordic questionnaire was used for the analysis of musculoskeletal symptoms, and the EQ-5D-questionnaire was used to measure the quality of life associated with health. Results: The one-year prevalence of lumbar pain was 68.1%. Factors associated with lumbar pain were as follows: a higher degree of physical inactivity (each subject with a higher degree of physical inactivity had a 24% higher chance of occurrence of lumbar pain); a higher degree of load and over-engagement during the COVID-19 pandemic (each subject with a higher degree of workload had a nearly 50% higher chance of occurrence of lumbar pain); duration of engagement during the COVID-19 pandemic (subjects engaged up to a month were 4 times more likely to develop lumbar pain, and subjects engaged for 1-3 months were 3.5 times more likely to develop lumbar pain compared to those who were not engaged in COVID-19 treatment). This study also confirms that lumbar syndrome affects the quality of life of health workers. Conclusions: Lumbar syndrome is highly prevalent among healthcare professionals in the Clinical Center of Montenegro, especially in the population of nurses, where evidence-based preventive measures are needed.

Association between night work and prostate cancer: a systematic review and meta-analysis

OBJECTIVE

The aim was to conduct a systematic review and meta-analysis to study the association between night work and the development of prostate cancer.

METHODS

A systematic literature search was conducted in CINAHL, Embase, MEDLINE, and Web of Science. Studies were included based on a PECOS; the population included men in/above the working age, exposure defined as night work, outcome defined as prostate cancer, and study design restricted to cohort studies. The exclusion of articles, risk-of-bias assessment, and data extraction were performed by two reviewers. A meta-analysis was conducted using a random-effects model, including a sensitivity analysis stratified based on the risk-of-bias assessment. We evaluated publication bias using a funnel plot and Egger´s test, and the level of evidence was assessed using GRADE.

RESULTS

A total of 528 articles were identified, and eight cohort studies were included. Three studies had a moderate risk of bias, while five studies had a high risk of bias. The meta-analysis showed a pooled hazard ratio (HR) of 1.0 (95% CI 0.6-1.7). In the sensitivity analysis, moderate vs. high risk-of-bias studies showed a pooled HR of 1.2 (95% CI 0.3-4.1) and 0.9 (95% CI 0.6-1.3), respectively. Based on GRADE, the level of evidence was rated low.

CONCLUSION

We found no association between night work and the development of prostate cancer. The evidence was assessed as limited and inconsistent. Future studies encompassing consistent definitions of night work, including objective exposure data, are highly warranted.

Occupation-based demographic, clinical, and psychological presentation of spine pain: A retrospective analysis of 71,727 patients from urban India

BACKGROUND

Although many studies have investigated the physical and ergonomic risks of spine pain in specific occupation groups, the literature is lacking on occupation-based clinical and psychological presentation in patients with spine pain.

OBJECTIVE

To analyze occupation-based variation in demographic, clinical, and psychological presentation in patients with spine pain.

METHODS

This retrospective study analyzed the clinical data of 71727 patients with spine pain visiting a chain of spine rehabilitation clinics. Demographic and clinical variables such as gender, age, affected site, symptom duration, clinical symptoms and presentation, pain intensity, disability, and STarT Back Screening Tool (SBT) risk were compared between 9 occupational groups.

RESULTS

The service and sales workers (44%) and students (43.5%) groups had the highest percentage of patients who presented with central spine pain; military personnel had the highest percentage of patients who presented with unilateral radicular pain (51.5%); and the retired or unemployed group had the highest percentage of patients who presented with severe myotomal loss (grade≤3) (6%). Homemakers had significantly higher pain intensity and disability (p < 0.001) and had the highest percentage of patients who presented with severe pain (47%), severe and crippled disability (59.5%), and medium to high risk (59%) with SBT when compared to other occupational groups.

CONCLUSION

Patients with spine pain showed variation in demographic, clinical, and psychological presentation based on their occupation. The findings of this study can be the basis for identifying risk factors for spine pain and helping plan preventive and treatment measures based on their occupation.

Quantum Molecular Resonance Radiofrequency Disc Decompression and Percutaneous Microdiscectomy for Lumbar Radiculopathy

Within the practice of pain management, one of the most commonly encountered events is low back pain. Lumbar radiculopathy (LR) is a pain syndrome caused by the compression or irritation of the nerve roots in the lower back due to lumbar disc herniation, vertebra degeneration, or foramen narrowing. Symptoms of LR include low back pain that propagates toward the legs, numbness, weakness, and loss of reflexes. The aim of this study is to assess the long-term effectiveness of quantum molecular resonance disc decompression and its combination with a percutaneous microdiscectomy using Grasper© forceps (QMRG) in patients with persistent lumbar radiculopathy (LR) in relation to patient physical stress status. The main outcome measures of this prospective observational study were DN4, NRS, ODI, SF12, PGI, CGI, and MOS Sleep Scale. An improvement 12 months post-intervention was observed in patients without physical stress, presenting better overall results. The mean change was over the minimal clinically important difference in 64.3% of outcome measures studied for the whole sample. QMRG appears to be an effective treatment option for LR, but a reduction in physical stress is needed to ensure long-term effectiveness.

The Prevalence of Neck and Back Pain among Paramedics in Poland

Neck Pain (NP) and low back pain (LBP) are ubiquitous musculoskeletal conditions and some of the major causes of disability worldwide. The aim of the study was to assess the incidence and risk factors of back pain among paramedics and their correlation with the nature of work, anthropometric features and the level of recreational physical activity. A group of 201 individuals (39 females (19.40%); 162 males (80.60%)), licensed to practice as paramedics in Poland completed a questionnaire containing the author's interview as well as the Neck Disability Index (NDI) questionnaire and the Revised Oswestry Disability Index (ODI). Among the examined paramedics, 92% of the subjects reported the presence of back pain in different parts of the spine (36% C; 17% Th; and 85% LBP). The pain intensity, determined by VAS, was on average 4.26 (SD 1.77). The level of disability, assessed by NDI, was 7.67 (SD 5.73) on average, while the ODI was 7.51 (5.90). Work-related spinal strain has a major impact on the intensity and incidence of spinal pain. Spinal pain in paramedics mainly occurs in the lower back.

Occupational mechanical exposures as risk factor for chronic low-back pain: a systematic review and meta-analysis

OBJECTIVES

The association between occupational mechanical exposures and low-back pain (LBP) has been studied in several systematic reviews. However, no systematic review addressing chronic LBP exists. The aim of this systematic review and meta-analysis was to examine the association between occupational mechanical exposures and chronic LBP.

METHODS

The study was registered in PROSPERO. We used an existing systematic review to identify articles published before January 2014. For studies published between January 2014 and September 2022, a systematic literature search was conducted in six databases. Two authors independently excluded articles, extracted data, and assessed risk of bias and level of evidence (GRADE). Meta-analyses were conducted using random-effects models comparing highest versus lowest exposure group with sensitivity analyses based on study quality (low/moderate versus high risk of bias), study design (cohort versus case-control), and outcome definition (non-specific LBP versus specific chronic LBP).

RESULTS

Twenty-six articles were included. Highest pooled odd ratios (OR) were found for combined mechanical exposures [OR 2.2, 95% confidence interval (CI) 1.4-3.6], lifting/carrying loads (OR 1.7, 95% CI 1.4-2.2), and non-neutral postures (OR 1.5, 95% CI 1.2-1.9). For the remaining mechanical exposures (ie, whole-body vibrations, standing/walking, and sitting), OR ranged between 1.0 and 1.4. In the sensitivity analyses, generally, higher pooled OR were found in low/moderate risk of bias studies, case-control studies, and studies of specific chronic LBP.

CONCLUSIONS

Moderate evidence of an association was found for lifting/carrying loads, non-neutral postures, and combined mechanical exposures. Low or very low evidence was found for whole-body vibrations, standing/walking, and sitting. Studies using standardized exposure definition, metric, and technical measurements are highly warranted.

Health effects of railway-induced vibration combined with railway noise - A systematic review with exposure-effect curves

BACKGROUND

The combined health impact of concurrent railway noise and railway vibration exposure is not yet well understood.

OBJECTIVES

This systematic review gives an overview of epidemiological studies on health effects from railway vibration, aiming to quantify this association with exposure-effect curves. Moreover, the combined health effects of vibration and concurrent noise were investigated.

METHODS

We converted the vibration metric to an equivalent noise level and calculated an overall noise level by energetically summing the equivalent and railway noise level. The combined health effect was determined by using published evidence-based exposure-effect formulas.

RESULTS

Studies included in this systematic review predominately investigated annoyance and self-reported sleep disturbances; no studies on manifest diseases were identified. For the combined effects of vibration and noise on "total" annoyance, the results based on the pooled analysis of CargoVibes project are recommended as conservative approach.

DISCUSSION

Converting railway vibration into equivalent noise levels in dB may offer a pragmatic approach to assess the combined health effects of railway noise and railway vibration exposure. Future studies should include cardiovascular and mental diseases in addition to vibration-induced annoyance and sleep disturbances. Furthermore, future studies should include in-depth investigations of the interaction between railway noise and railway vibration to allow for a more accurate assessment of the railway-induced burden of disease.

A Health-Impact Assessment of an Ergonomic Measure to Reduce the Risk of Work-Related Lower Back Pain, Lumbosacral Radicular Syndrome and Knee Osteoarthritis among Floor Layers in The Netherlands

Sand-cement-bound screed floor layers are at risk of work-related lower back pain, lumbosacral radicular syndrome and knee osteoarthritis, given their working technique of levelling screed with their trunk bent while mainly supported by their hands and knees. To reduce the physical demands of bending of the trunk and kneeling, a manually movable screed-levelling machine was developed for floor layers in the Netherlands. The aim of this paper is to estimate the potential health gains of working with a manually movable screed-levelling machine on the risk of lower back pain (LBP), lumbosacral radicular syndrome (LRS) and knee osteoarthritis (KOA) compared to traditional working techniques. This potential health gain was assessed using the epidemiological population estimates of the Population Attributable Fraction (PAF) and the Potential Impact Fraction (PIF), combined with work-related risk estimates for these three disorders from systematic reviews. The percentage of workers exceeding these risk estimates was based on worksite observations among 28 floor layers. For LBP, 16/18 workers were at risk when using traditional working techniques, with a PAF = 38%, and for those using a manually movable screed-levelling machine, this was 6/10 with a PIF = 13%. For LRS, these data were 16/18 with a PAF = 55% and 14/18 with a PIF = 18%, and for KOA, 8/10 with a PAF = 35% and 2/10 with a PIF = 26%. A manually movable screed-levelling machine might have a significant impact on the prevention of LBP, LRS and KOA among floor layers in the Netherlands, and health-impact assessments are a feasible approach for assessing health gains in an efficient way.

A first step towards a framework for interventions for individual working practice to prevent work-related musculoskeletal disorders: a scoping review

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are a key topic in occupational health. In the primary prevention of these disorders, interventions to minimize exposure to work-related physical risk factors are widely advocated. Besides interventions aimed at the work organisation and the workplace, interventions are also aimed at the behaviour of workers, the so-called individual working practice (IWP). At the moment, no conceptual framework for interventions for IWP exists. This study is a first step towards such a framework.

METHODS

A scoping review was carried out starting with a systematic search in Ovid Medline, Ovid Embase, Ovid APA PsycInfo, and Web of Science. Intervention studies aimed at reducing exposure to physical ergonomic risk factors involving the worker were included. The content of these interventions for IWP was extracted and coded in order to arrive at distinguishing and overarching categories of these interventions for IWP.

RESULTS

More than 12.000 papers were found and 110 intervention studies were included, describing 810 topics for IWP. Eventually eight overarching categories of interventions for IWP were distinguished: (1) Workplace adjustment, (2) Variation, (3) Exercising, (4) Use of aids, (5) Professional skills, (6) Professional manners, (7) Task content & task organisation and (8) Motoric skills.

CONCLUSION

Eight categories of interventions for IWP are described in the literature. These categories are a starting point for developing and evaluating effective interventions performed by workers to prevent WMSDs. In order to reach consensus on these categories, an international expert consultation is a necessary next step.

The association between cold exposure and musculoskeletal disorders: a prospective population-based study

OBJECTIVES

The aim of the study was to determine the association between occupational ambient cold exposure and neck-shoulder pain (NSP), low back pain (LBP), and radiating LBP.

METHODS

The study cohort comprised of 3,843 working subjects in northern Sweden who answered a baseline (spring 2015) and a follow-up questionnaire (spring 2021). NSP, LBP, and radiating LBP were assessed in both surveys. Occupational cold exposure was assessed at baseline, on a whole number numerical rating scale (NRS) and categorized in quartiles. Binary logistic regression determined the association between cold exposure at baseline and incident NSP, LBP, and radiating LBP, adjusted for age, gender, body mass index, smoking, mental stress, and physical workload.

RESULTS

There were statistically significant associations between high occupational ambient cold exposure (NRS 5-7 and NRS 8-10) and NSP (1.59; 95% CI 1.08-2.33 and OR 1.50; 95% CI 1.03-2.19); NRS 8-10 and LBP (OR 1.61; 95% CI 1.13-2.29); and NRS 5-7 and radiating LBP (OR 1.87; 95% CI 1.12-3.16). Gender-stratified analyses showed statistically significant associations between high occupational ambient cold exposure (NRS 5-7 and NRS 8-10) and NSP (OR 1.97; 95% CI 1.07-3.61 and OR 1.97; 95% CI 1.06-3.67) for men and between NRS 8-10 and LBP (OR 1.82; 95% CI 1.14-2.91) and NRS 5-7 and radiating LBP (OR 2.20; 95% CI 1.15-4.24) for women.

CONCLUSIONS

Occupational ambient cold exposure was associated with NSP, LBP, and radiating LBP, and should be recognised as a possible occupational risk factor.

Association between occupational exposures and chronic low back pain: Protocol for a systematic review and meta-analysis

INTRODUCTION

The association between occupational mechanical exposures and chronic low back pain (LBP) has been widely studied, however, few systematic reviews have evaluated the evidence of an association. Furthermore, little is known of the impact of occupational psychosocial exposures on chronic LBP. The aim of this systematic review and meta-analysis is to study the association between occupational mechanical and psychosocial exposures and chronic LBP.

METHODS

The study will be conducted as a systematic review using another systematic review published in 2014 as basis and has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42021281996. A systematic literature search will be performed in 6 scientific databases to identified potential relevant studies published after 2014. Studies will systematically be excluded through a screening process performed independently by 2 reviewers. Exposures will include occupational mechanical and psychosocial exposures, and outcome will include chronic LBP (LBP ≥3 months, "degenerative" diseases, and lumbosacral radiculopathy). Study population will include persons in or above working age, and study designs will comprise cohort and case-control studies. The quality of each included study will be methodologically assessed by 2 independent reviewers and level of evidence of an association will be graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. In meta-analyses, effect sizes will be addressed using random-effect models, sensitivity analyses will explore the robustness of the meta-analysis, and heterogeneity assessed.

DISCUSSION

This systematic review and meta-analysis will assess the evidence available of the association between occupational mechanical and psychosocial exposures and chronic LBP. The review can provide essential knowledge on the association, exposure-response relationships, thresholds, which may pave the way for political decisions on the occupational environment and the labour market insurance policy.

Influence of Occupation on the Prevalence of Spinal Pain among Physiotherapists and Nurses

(1) Background: Neck pain (NP) and low back pain (LBP) are common musculoskeletal disorders, one of the major causes of disability globally. The aim of the study was to determine the influence of medical occupation (physiotherapist and nurse) on the prevalence of spinal pain, functional status and degree of disability. (2) Methods: a total of 544 people (462 females (84.9%) and 82 males (15.1%)), licensed to practice as a physiotherapist (n1 = 240 (44.1%)) or nurse (n2 = 304 (55.9%)) in Poland completed a special questionnaire designed by the authors of the study, and were assessed using the Neck Disability Index (NDI, Polish language version) and Revised Oswestry Disability Index (ODI, Polish language version). (3) Results: Compared to physiotherapists, nurses were older, shorter, had higher BMI, and longer work experience. In the whole study group, 30.2% of subjects reported NP, 17.7% reported thoracic pain (ThP) and 80.5% reported LBP. During working life, 90.9% of physiotherapists and 97.7% of nurses experienced spinal pain. Pain intensity measured with Visual Analogue Scale (VAS) was higher among nurses (mean 5.37) than among physiotherapists (mean 4.64). Nurses had a higher degree of disability caused by LBP and NP measured with ODI and NDI compared to physiotherapists. (4) Conclusions: Excessive strain of the spine associated with occupational activities has a strong impact on the intensity and frequency of spinal pain episodes. Physiotherapists and nurses mainly suffer from low back pain. Pain scores measured with VAS are higher in nurses than in physiotherapists.

The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients

Purpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation "to advise", low to very low in a recommendation "to consider", unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines "lifting" and "whole body vibration". The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.

Musculoskeletal health climate is associated with musculoskeletal pain and sickness absence among workers: a cross-sectional study

OBJECTIVES

This study aimed to investigate whether a musculoskeletal health climate, expressing the shared perceptions among workers concerning musculoskeletal health, is associated with number of musculoskeletal pain sites and sickness absence.

DESIGN

Cross-sectional study.

SETTING

Six slaughterhouses from 2 companies in Denmark and 6 home-nursing units and 12 nursing homes from 1 municipality in Jutland, Denmark.

PARTICIPANTS

A total of 1092 slaughter house workers and 410 care workers completed an online questionnaire from February to October 2019.

OUTCOME MEASURES

The exposure variable was musculoskeletal health climate assessed by two domains; (1) perceived management priority of musculoskeletal health measured by a modified subscale from the Nordic Safety Climate Questionnaire and (2) work group pain acceptance which was a modified version of the activity engagement subscale of the chronic pain acceptance scale. Outcomes variables were number of musculoskeletal pain sites (0-6) and days with sickness absence.

RESULTS

The associations between the two subscales, number of musculoskeletal pain sites and sickness absence were calculated using mixed linear and generalised estimating equation regression models. Higher perceived management priority scores were associated with a lower number of musculoskeletal pain sites across both job groups: β=-.57 (95% CI -0.91 to -0.23) and sickness absence (>5 days) due to musculoskeletal pain prevalence ratio (PR) 0.79 (95% CI 0.57 to 1.08). In contrast higher work group pain acceptance scores were associated with higher number of musculoskeletal pain sites: β=0.38 (0.11 to 0.66), whereas associations with sickness absences seemed to be modified by job groups; PR 1.59 care workers and PR 0.86 slaughterhouse workers.

CONCLUSION

The observed relationship between musculoskeletal health climate, musculoskeletal pain sites and sickness absence indicate that cultural factors should receive increased attention in work place preventive interventions.

Diseases-attributable disability-adjusted life years in copper and molybdenum ore workers in Mongolia: 1999-2019

Most illnesses and deaths in industry workers are associated with occupational diseases (ODs). In recent years, mining has grown rapidly into a major driver of the Mongolian economy. In this study, the organization-based registry data on OD incidence and mortality from the archival data of the 'Erdenet' Copper and Molybdenum Concentrator Plant in Mongolia were used. We estimated the ODs burden in disability-adjusted life years (DALYs) loss between 1999 and 2019. A total of 72,802 DALYs were lost over 20 years, of which 97.5% were due to years lived with disability and 2.5% for years of life lost. The disease burden was high in men, accounting for 76.8% of total DALY. In terms of age groups, among people aged 46-55, DALY accounted for the largest percentage of losses. We found that workplace dust, noise, ergonomics, and vibration were the main factors attributed to the DALYs during the past two decades.

Occupational risk factors for meniscal lesions: a systematic review and meta-analysis

BACKGROUND

Meniscal lesions are common and are associated with the development of knee osteoarthritis. Knee-straining activities at work such as kneeling or squatting cause high biomechanical stresses on the knee joints that can lead to acute or chronic injuries. The objective of this systematic review is to update the evidence on the potential relationship between occupational risk factors and meniscal lesions.

METHODS

We searched the Medline, Embase and Web of Science databases until August 2021 to identify epidemiological observational studies on the association between occupational risk factors and meniscal lesions. Study selection, data extraction and risk of bias assessment were performed independently by two reviewers. Effect measures were extracted from individual studies and pooled with random effects meta-analysis. Heterogeneity analyses were conducted. We used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the overall quality of evidence.

RESULTS

The database search resulted in 11,006 references, and 46 additional studies were identified through hand search. Twenty-two studies (represented in 25 publications) met the predefined eligibility criteria and nine records were included in the meta-analysis. There was only one study with an overall low risk of bias. Significant associations between occupational risk factors and the development of meniscal lesions were found for kneeling (effect size (ES) 2.15, 95% CI 1.67-2.76), squatting (ES 2.01, 95% CI 1.34-3.03), climbing stairs (ES 2.28, 95% CI 1.58-3.30), lifting and carrying weights ≥ 10 kg (ES 1.63, 95% CI 1.35-1.96), lifting and carrying weights ≥ 25 kg (ES 1.56, 95% CI 1.08-2.24), playing football on a professional level (ES 5.22, 95% CI 3.24-8.41), working as a hard coal miner (ES 5.23, 95% CI 2.16-12.69) and floor layers (ES 1.99, 95% CI 1.43-2.78). The overall quality of evidence according GRADE was moderate to low.

CONCLUSION

We found consistent evidence of an increased risk of meniscal lesions by occupational knee-straining exposures. Our findings are important for the development of preventive strategies to reduce work-related knee disorders and work absence.

TRIAL REGISTRATION

PROSPERO (registration no. CRD42020196279 ).

Towards harmonisation of case definitions for eight work-related musculoskeletal disorders - an international multi-disciplinary Delphi study

Background

International consensus is needed on case definitions of work-related musculoskeletal disorders and diseases (MSDs) for use in epidemiological research. We aim to: 1) study what information is needed for the case definition of work-related low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral and medial elbow tendinopathy, and knee and hip osteoarthritis, and to 2) seek consensus among occupational health professionals/researchers regarding the case definitions of these work-related MSDs.

Methods

A two-round Delphi study was conducted with occupational health professionals/researchers from 24 countries. Definition of work-related MSDs were composed of a case definition with work exposures. Round 1 included 32 case definitions and round 2, 60 case definitions. After two rounds, consensus required 75% of the panellists to rate a case definition including work exposures ≥7 points on a 9-point rating scale (completely disagree/completely agree).

Results

Fifty-eight panellists completed both rounds (response rate 90%). Forty-five (70%) panellists thought that for LBP a case definition can be based on symptoms only. Consensus was only reached for work-related medial elbow tendinopathy, while the lowest agreement was found for knee osteoarthritis. Where consensus was not reached, this was – except for LBP - related to physical examination and imaging rather than disagreement on key symptoms.

Conclusion

Consensus on case definitions was reached only for work-related medial elbow tendinopathy. Epidemiological research would benefit from harmonized case definitions for all MSDs including imaging and physical examination for LRS, SAPS, CTS, lateral elbow tendinopathy and hip and knee osteoarthritis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04871-9.

[Impact of wearing face masks in public to prevent infectious diseases on the psychosocial development in children and adolescents: a systematic review]

Hintergrund

Zur Prävention tröpfchenübertragener Infektionskrankheiten wird das Tragen einer Maske im öffentlichen Raum unter bestimmten Bedingungen empfohlen.

Ziel der Arbeit

Ziel war, über eine sensitive Literatursuche möglichst alle deutsch- und englischsprachigen Forschungsergebnisse aus begutachteten Fachzeitschriftenartikeln zu den Auswirkungen des Masketragens zur Prävention von Infektionen auf die psychosoziale Entwicklung von Kindern und Jugendlichen zusammenzutragen.

Methoden

Es wurde ein systematischer Review unter Berücksichtigung verschiedener Studiendesigns durchgeführt (Suchzeitraum bis einschließlich 12.07.2021). Das Verzerrungsrisiko der Studien wurde mit einem Risk-of-Bias-Verfahren ermittelt. Es fand eine deskriptiv-narrative Ergebnissynthese statt.

Ergebnisse

Es wurden 13 Studien eingeschlossen, wobei das Gesamtverzerrungsrisiko in allen Primärstudien als hoch eingeschätzt wurde. Es gibt Hinweise aus Befragungsstudien, dass die Fähigkeit zum Lesen der Mimik von Kindern/Jugendlichen und/oder ihren Betreuer:innen im (Vor‑)Schulsetting durch das Masketragen als beeinträchtigt erlebt wird, die durch mehrere Experimentalstudien bestätigt wurden. 2 Studien berichteten über psychische Symptome wie Ängste oder Stresserleben sowie Konzentrations- und Lernschwierigkeiten durch das Masketragen während der COVID-19-Pandemie. Eine Studie während der SARS-Pandemie 2002/2003 untersuchte mündliche Prüfungsleistungen in Englisch als Fremdsprache und zeigte keinen Unterschied zwischen den Bedingungen „Maske“ versus „keine Maske“.

Diskussion

Zu den Auswirkungen des Masketragens auf verschiedene Entwicklungsbereiche von Kindern und Jugendlichen lassen sich basierend auf der unzureichenden Studienlage nur wenige Erkenntnisse ableiten. Es fehlen Forschungsdaten zu den Folgen für die Endpunkte psychische Entwicklung, Sprachentwicklung, sozioemotionale Entwicklung, soziales Verhalten, Schulerfolg und Teilhabe. Weitere qualitative Studien und epidemiologische Studien sind unbedingt nötig.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03443-5) enthalten.

What work-related exposures are associated with post-traumatic stress disorder? A systematic review with meta-analysis

OBJECTIVES

Although there is evidence that work-related exposures cause post-traumatic stress disorder (PTSD), there are few quantitative studies assessing the degree to which these factors contribute to PTSD. This systematic review with meta-analysis identified work-related exposures associated with PTSD, and quantified their contribution to this disorder.

METHODS

We searched Medline, PsycINFO, Embase, PILOTS and Web of Science (2005-10 September 2019) for longitudinal studies on work-related exposures and PTSD. We described included articles, and conducted meta-analyses for exposures with sufficient homogeneous information. We performed subgroup analyses for risk of bias, study design and PTSD ascertainment. We assessed evidence quality using Grades of Recommendations, Assessment, Development and Evaluation, and estimated population attributable fractions.

RESULTS

After screening 8590 records, we selected 33 studies (n=5 719 236). From what was moderate quality evidence at best, we identified various work-related exposures that were associated with PTSD, mainly involving individuals in the military and first responder (eg, police or fire brigade) occupations. These exposures included the number of army deployments (OR: 1.15 (95% CI 1.14 to 1.16)), combat exposure (OR 1.89 (95% CI 1.46 to 2.45)), army deployment (OR 1.79 (95% CI 1.45 to 2.21)) and confrontation with death (OR 1.63 (95% CI 1.41 to 1.90)). Effects were robust across subgroups and exposures attributed modestly (7%-34%) to PTSD. We identified additional exposures in other occupations, including life threats, being present during an attack, and hearing about a colleague's trauma.

CONCLUSIONS

We identified various work-related exposures associated with PTSD and quantified their contribution. While exposure assessment, PTSD ascertainment and inconsistency may have biased our findings, our data are of importance for development of preventive interventions and occupational health guidelines.

A Rapid Review on the Influence of COVID-19 Lockdown and Quarantine Measures on Modifiable Cardiovascular Risk Factors in the General Population

Preceding coronavirus outbreaks resulted in social isolation, which in turn is associated with cardiovascular consequences. Whether the current COVID-19 pandemic negatively impacts cardiovascular health is unclear. The aim of the rapid review was to investigate, whether COVID-19 lockdown influences modifiable cardiovascular risk factors (i.e., physical inactivity, sedentary behaviour, smoking, alcohol use, unhealthy diet, obesity, bad blood lipids, and hypertension) in the general population. Medline and EMBASE were searched until March 2021. Title, abstracts, and full texts were screened by one reviewer and 20% by a second reviewer. Only studies using probability sampling were included in order to ensure the representativeness of the target population. Data extraction and critical appraisal were done by one reviewer and double-checked by another reviewer. We identified 32 studies that fulfilled our inclusion criteria. Findings show that physical activity decreased, and sedentary behaviour increased among all age groups during the COVID-19 lockdown. Among adults, alcohol consumption increased, dietary quality worsened, and the amount of food intake increased. Some adults reported weight gain. Studies on children and adolescents were sparse. This rapid review found a high number of epidemiological studies on the impact of COVID-19 lockdown measures on modifiable cardiovascular risk factors, but only a few used probability sampling methods.

Stigmatization from Work-Related COVID-19 Exposure: A Systematic Review with Meta-Analysis

Stigmatization from work-related COVID-19 exposure has not been investigated in detail yet. Therefore, we systematically searched three databases: Medline, Embase, and PsychInfo (until October 2020), and performed a grey literature search (until February 2021). We identified 46 suitable articles from 24 quantitative and 11 qualitative studies, 6 systematic reviews, 3 study protocols and 1 intervention. The assessment of stigmatization varied widely, ranging from a single-item question to a 22-item questionnaire. Studies mostly considered perceived self-stigma (27 of 35 original studies) in healthcare workers (HCWs) or hospital-related jobs (29 of 35). All articles reported on stigmatization as a result of work-related COVID-19 exposure. However, most quantitative studies were characterized by convenience sampling (17 of 24), and all studies-also those with an adequate sampling design-were considered of low methodological quality. Therefore, it is not possible to determine prevalence of stigmatization in defined occupational groups. Nevertheless, the work-related stigmatization of occupational groups with or without suspected contact to COVID-19 is a relevant problem and increases the risk for depression (odds ratio (OR) = 1.74; 95% confidence interval CI 1.29-2.36) and anxiety (OR = 1.75; 95% CI 1.29-2.37). For promoting workers' health, anti-stigma strategies and support should be implemented in the workplace.

Diagnostic criteria for musculoskeletal disorders for use in occupational healthcare or research: a scoping review of consensus- and synthesised-based case definitions

BACKGROUND

The aim of this study was to identify case definitions of diagnostic criteria for specific musculoskeletal disorders (MSDs) for use in occupational healthcare, surveillance or research.

METHODS

A scoping review was performed in Medline and Web of Science from 2000 to 2020 by an international team of researchers and clinicians, using the Arksey and O'Malley framework to identify case definitions based on expert consensus or a synthesis of the literature. Seven MSDs were considered: non-specific low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral or medial elbow tendinopathy, and knee and hip osteoarthritis (OA). Case definitions for occupational healthcare or research were charted according to symptoms, signs and instrumental assessment of signs, and if reported, on work-related exposure criteria.

RESULTS

In total, 2404 studies were identified of which 39 were included. Fifteen studies (38%) reported on non-specific LBP, followed by knee OA (n = 8;21%) and CTS (n = 8;21%). For non-specific LBP, studies agreed in general on which symptoms (i.e., pain in lower back) and signs (i.e., absence of red flags) constituted a case definition while for the other MSDs considerable heterogeneity was found. Only two studies (5%), describing case definitions for LBP, CTS, and SAPS and lateral and medial elbow tendinopathy respectively, included work-related exposure criteria in their clinical assessment.

CONCLUSION

We found that studies on non-specific LBP agreed in general on which symptoms and signs constitute a case definition, while considerable heterogeneity was found for the other MSDs. For prevention of work-related MSDs, these MSD case definitions should preferably include work-related exposure criteria.

The Risk of Knee Osteoarthritis in Professional Soccer Players—a Systematic Review With Meta-Analyses

BACKGROUND

We address the question whether professional soccer players with and without macroinjury of the knee joint are at an elevated risk for knee osteoarthritis.

METHODS

A systematic review with meta-analyses was conducted. The study protocol was prospectively registered (registration number CRD42019137139). The MEDLINE, EMBASE, and Web of Science databases were searched for relevant publications; in addition, forward searching was performed, and the listed references were considered. All steps of the process were undertaken independently by two reviewers, and any discordances were resolved by consensus. For all publications whose full text was included, the methods used were critically evaluated. The quality of the evidence was judged using the GRADE criteria.

RESULTS

The pooled odds ratio for objectively ascertained osteoarthrosis of the knee was 2.25 (95% confidence interval [1.41-3.61], I2 = 71%). When only radiologically ascertained knee osteoarthrosis was considered, the odds ratio was 3.98 [1.34; 11.83], I2 = 58%). The pooled risk estimator in studies in which knee joint macroinjury was excluded was 2.81 ([1.25; 6.32], I2 = 71%).

CONCLUSION

A marked association was found between soccer playing and knee osteoarthritis in male professional soccer players. For female professional soccer players, the risk of knee osteoarthritis could not be assessed because of the lack of data. Knee injuries seem to play an important role in the development of knee osteoarthritis in professional soccer players.

Criteria for diagnosis and attribution of an occupational musculoskeletal disease

BACKGROUND

Criteria for diagnosis and compensation of occupational musculoskeletal diseases varies widely between countries as demonstrated by the large differences between countries with comparable economics and social systems (for example, within the European Union). Several countries have a list of occupational diseases and sometimes these lists include diagnostic and attribution criteria, but these criteria are usually not very specific, and they may also be very different.

OBJECTIVES

The aim of this paper is to explicitly define what are the information needed for an evidence-based diagnosis and attribution of an occupational musculoskeletal disease.

METHODS

Based on the general framework of evidence-based medicine, a review is presented of the information required to define: - when a musculoskeletal disease is present, according to the best available techniques; - how to define a relevant exposure to biomechanical risk factors, according to the best available techniques.

RESULTS

Criteria are presented to combine information regarding the diagnosis of a musculoskeletal disease and exposure to biomechanical risk factors for an evidence-based attribution of the disease to the occupational exposure. The criteria use a probabilistic model that combine epidemiologic and medical findings, workplace exposure assessment, and non-occupational factors evaluation.

DISCUSSION

The use of the proposed criteria may improve the process of diagnosis and attribution of an occupational musculoskeletal disease. In addition, it makes possible to associate a probability rank to the attribution and, ultimately, it may improve the overall quality of the decisional process of the occupational physician.

Work-relatedness of inguinal hernia: a systematic review including meta-analysis and GRADE

Purpose

Clinicians need to know whether inguinal hernia (IH) can be attributed to work to answer questions regarding prevention and medical causation. This review describes whether work-related risk factors are associated with IH.

Methods

A systematic review was performed in Medline via PubMed until February 3rd, 2020. Inclusion criteria were that IH was diagnosed by a clinician, and workers exposed to work-related risk factors were compared to workers less exposed or not at all. A quality assessment and a meta-analysis using Cochrane’s RevMan 5.3 were performed, including GRADE for quality of evidence.

Results

The search resulted in 540 references. Fourteen studies fulfilled the inclusion criteria, of which three were included in a meta-analysis, all three being of high quality, including 621 workers diagnosed with IH. The meta-analysis revealed significant associations with physically demanding work (OR 2.30, 95% CI 1.56–3.40). Two prospective studies, including 382 and 22,926 cases revealed associations that this was true for male workers with a lateral IH that reported standing or walking for more than six hours per workday (OR 1.45, 95% CI 1.12–1.88) or lifting cumulative loads of more than 4000 kg per workday (OR 1.32, 95% CI 1.27–1.38). The level of certainty for the latter two work-related risk factors was moderate and high according to GRADE.

Conclusion

Lateral IH among males is associated with work-related risk factors depending on the level of exposure to the time standing/walking per workday, or the amount of load lifted per workday.

Electronic supplementary material

The online version of this article (10.1007/s10029-020-02236-0) contains supplementary material, which is available to authorized users.

Is age more than manual material handling associated with lumbar vertebral body and disc changes? A cross-sectional multicentre MRI study

OBJECTIVE

Conflicting evidence exists to what extent manual material handling (MMH) causes lumbar disc disease, lack of evidence exist that this effect takes place especially at L5-S1 level, where the greatest moment occurs. The aim was to assess if lumbar vertebral body and disc changes are more common in people whose job involves significant MMH and, if so, to evaluate if lumbar vertebral body and disc changes are more prevalent in the lower part of the lumbar spine (L4-L5 and L5-S1).

DESIGN

Observational, cross-sectional, with quasi-random recruitment.

SETTING

Outpatient radiology units of three large hospitals in northern (Bologna and Brescia) and southern (Bari) Italy.

PARTICIPANTS

183 consecutive adult subjects (89 males, 94 females) aged 20-70 years referred by the general practitioner or a specialist for MRI of the lumbar spine.

PRIMARY AND SECONDARY OUTCOME MEASURES

Neuroradiologists (blind to clinical assessment) evaluated the prevalence of intervertebral disc and vertebral body changes in standardised MRI examinations. History of personal and family musculoskeletal diseases and injuries, current and previous MMH at work and during leisure time were assessed by interview and self-administered questionnaire.

RESULTS

Participants were classified according their occupational exposure to MMH. No association was found between MMH and vertebral body and intervertebral disc changes, whereas age over 45 years was consistently associated with more disc extension beyond the interspace changes, Pfirrmann changes, osteophytes and Modic changes: the association was statistically significant at the conventional 5% level.

CONCLUSIONS

Age, and not MMH, seems to primarily affect the presence of intervertebral disc changes; prospective studies are needed to better explore the relationship between MMH and the possible presence (and level) of lumbar vertebral body and/or disc changes.

The risk of cytomegalovirus infection in daycare workers: a systematic review and meta-analysis

PURPOSE

The primary aim of this review was to summarize the evidence on the relationship between being a daycare worker working with children and the possible increased risk of cytomegalovirus infection.

METHODS

We searched the Medline and Embase databases using search strings defined according to the population, exposure, comparison, and outcomes (PECO) applicable to our research questions in order to find studies published since 2000. Two independent reviewers evaluated the search hits using predefined inclusion and exclusion criteria. A manual search was performed to identify additional relevant literature. We extracted the resulting studies and assessed them in eight domains of bias. The pooled CMV seroprevalence for daycare workers compared to the general population was calculated.

RESULTS

After evaluating the 6879 records, six methodologically adequate studies were identified: five cross-sectional studies and one cohort study. The pooled seroprevalence of daycare workers was 59.3% (95% CI 47.6-70.9). The four studies investigating risk of infection indicated an increased seroprevalence for daycare workers compared to a reference population (prevalence ratio, PR = 1.54, 95% CI 1.33-1.77). No study evaluated CMV seroconversions for daycare workers.

CONCLUSIONS

Our findings suggest a higher CMV seroprevalence for daycare workers compared to the general population. Notwithstanding the need for longitudinal and intervention studies, preventative efforts are needed. A pooled PR of 1.54 is compatible with a doubled seroconversion risk corresponding to a vocational probability of 50% if the substantial underestimation of the actual occupational seroconversion risk by prevalence-based estimators is considered.

The profile of chiropractors managing patients with low back-related leg pain: analyses of 1907 chiropractors from the ACORN practice-based research network

Background

Approximately 60% of people with low back pain also have associated leg pain symptoms. Guidelines for low back pain recommend non-pharmacological approaches, including spinal manipulation - a therapy provided by chiropractors. However, limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Our objective is to describe the prevalence, profile and practice characteristics of Australian chiropractors who often treat LBRLP, compared to those who do not often treat LBRLP.

Methods

This is a cross-sectional analysis of a nationally representative sample from the Australian Chiropractic Research Network (ACORN). This study investigated the demographic and practice characteristics as well as clinical management of chiropractors who ‘often’ treated patients with LBRLP compared to those who treated LBRLP ‘never/rarely/sometimes’. Multiple logistic regression models identified independent factors associated with chiropractors who ‘often’ treated patients with LBRLP.

Results

A total of 1907 chiropractors reported treating patients experiencing LBRLP, with 80.9% of them ‘often’ treating LBRLP. Chiropractors who ‘often’ treated LBRLP were more likely to manage patients with multi-site pain including axial low back pain (OR = 21.1), referred/radicular neck pain (OR = 10.8) and referred/radicular thoracic pain (OR = 3.1). While no specific management strategies were identified, chiropractors who ‘often’ treated LBRLP were more likely to discuss medication (OR = 1.8), manage migraine (OR = 1.7) and degenerative spine conditions (OR = 1.5), and treat women during pregnancy (OR = 1.6) and people with work-related injuries (OR = 1.5), compared to those not treating LBRLP frequently.

Conclusions

Australian chiropractors frequently manage LBRLP, although the nature of specific management approaches for this condition remains unclear. Further research on the management of LBRLP can better inform policy makers and educators interested in upskilling chiropractors to deliver safe and effective treatment of LBRLP.

Are Daycare Workers at a Higher Risk of Parvovirus B19 Infection? A Systematic Review and Meta-Analysis

Objective: In this systematic review, we aimed to summarize the evidence on the association between being a daycare educator working with children and the possible increased risk of parvovirus B19 infection compared to the general population. Methods: The Medline and Embase databases were searched using a defined search to find studies published since 2000. Two reviewers evaluated the search hits using predefined inclusion and exclusion criteria. The resulting studies were extracted and were assessed in eight domains of bias. A pooled relative risk (RR) of parvovirus infection for daycare workers compared to the general population was calculated. Results: After evaluating the 7781 search hits and manual search, four methodologically-adequate studies were identified: three cross-sectional studies and one retrospective cohort study. Of the three studies investigating the risk of infection, one evaluated parvovirus B19 seroconversion rates for daycare workers. There was an indication for an increased risk for daycare workers compared to the unexposed population (RR = 1.12, 95% CI 0.98-1.27) using prevalence estimators. Furthermore, daycare workers had a higher seroconversion rate compared to the unexposed population (RR = 2.63, 95% 1.27-5.45) in the low risk of bias study. Conclusions: Our findings suggest a higher risk of parvovirus B19 infection for daycare workers compared to an unexposed comparison population, which necessitate preventative efforts. Considering the underestimation of the occupational seroconversion risk by prevalence-based estimators, parvovirus B19 infections among daycare workers might mostly be occupationally acquired.