Can single-use versus standard duodenoscope improve ergonomics in ERCP? A comparative, simulation-based pilot study.

Background and study aims Musculoskeletal disorders (MSDs) and injuries (MSIs) are frequent in gastrointestinal endoscopy. The aim of this study was to assess potential ergonomic advantages of a lighter single-use duodenoscope compared with a standard reusable one for endoscopists performing endoscopic retrograde cholangiopancreatography (ERCP). Methods Three experienced endoscopists performed an ergonomic, preclinical, comparative protocol-guided simulation study of a single-use and a standard reusable duodenoscope using an anatomic bench model. Surface EMG signals from left forearm and arm muscles were recorded. A commercial inertial sensor-based motion capture system was applied to record body posture as well. Results A significant lowering of root mean square amplitude and amplitude distribution of biceps brachii signal (ranging from 13% to 42%) was recorded in all the participants when using a single-use duodenoscope compared with a reusable one. An overall reduction of muscle activation amplitude and duration was also associated with the single-use duodenoscope for forearm muscles, with different behaviors among subjects. Participants spent most of the time in wrist extension (> 80%) and ulnar deviation (> 65%). A consistent pattern of functional range of motion employed for completing all procedures was observed. Conclusions Our study showed that a lighter scope has a promising effect in reducing upper arm muscle activity during ERCP with potential benefit on musculoskeletal health in the ERCP setting.

Elbow tendinopathy and occupational biomechanical overload: A systematic review with best-evidence synthesis.

OBJECTIVES: To evaluate the evidence of an association between occupational and non-occupational exposure to biomechanical risk factors and lateral elbow tendinopathy, medial elbow tendinopathy, and olecranon bursitis. METHODS: We carried out a systematic review of the literature. We searched MEDLINE (up to November 2019) and checked the reference lists of relevant articles/reviews. We aimed to include studies where (a) the diagnosis was based on physical examination (symptoms plus clinical signs) and imaging data (if any); and (b) the exposure was evaluated with video analysis and/or direct measurements. A quality assessment of the included studies was performed along with an evaluation of the level of evidence of a causal relationship. RESULTS: We included four studies in the qualitative synthesis: two prospective cohorts and two cross-sectional studies. All the included studies investigated "lateral/medial epicondylitis", albeit the diagnosis was not supported by imaging techniques. Two cohort studies suggested that a combination of biomechanical risk factors for wrist/forearm is associated with increased risk of "lateral epicondylitis". This association was not observed in the two included cross-sectional studies. The cohort studies suggested that a Strain Index score higher than 5 or 6.1 could double the risk of "lateral epicondylitis". No association with increased risk of "medial epicondylitis" was observed. CONCLUSIONS: There is limited evidence of a causal relationship between occupational exposure to biomechanical risk factors and lateral elbow tendinopathy. For medial elbow tendinopathy, the evidence is insufficient to support this causal relationship. No studies on olecranon bursitis and biomechanical overload were identified.

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.

Perceived work ability at return to work in women treated for breast cancer: a questionnaire-based study.

BACKGROUND: Breast cancer survivors often perceive reduced work ability upon returning to work. OBJECTIVES: To identify predictors of perceived reduced work ability following return to work among women treated for breast cancer and to describe workplace interventions and support after returning to work. METHODS: A questionnaire was sent to 18-65 years-old women (no. 1578) treated for breast cancer and residing in the catchment area of the Bologna Local Health Authority between 2010 and 2012. The study population was identified through a Hospital Discharge Database. The questionnaires included items about personal characteristics, cancer and work-related factors, perceived work ability and the return to work process. A multivariable logistic regression analysis was performed to identify predictors of reduced work ability upon returning to work. RESULTS: Among the 841 respondents, 503 questionnaires were evaluable. In the study, 43.5% of the respondents reported reduced work ability with respect to the pre-diagnosis period. Reduced work ability was more common in non-cohabiting (OR=1.81, 95%CI 1.10-2.98) than in cohabiting/married women, and after mastectomy (OR=2.77, 95%CI 1.26-6.11) than after breast-conserving surgery. Office staff/sales assistants and managers were less likely to report reduced work ability (OR=0.51, 95%CI 0.30-0.88 and OR=0.21, 95%CI 0.06-0.76, respectively) than labourers. Women who perceived reduced work ability reported more frequently adjustment of work assignments, consultation of an occupational physician, insufficient support from employers and colleagues and discrimination. CONCLUSIONS: Reduced work ability is commonly perceived among women who return to work after treatment for breast cancer. Occupational physicians and general practitioners should be aware of a wide range of factors influencing this perception in order to facilitate a successful return to work.

Observed Differences between Males and Females in Surgically Treated Carpal Tunnel Syndrome Among Non-manual Workers: A Sensitivity Analysis of Findings from a Large Population Study.

Objectives: We aimed at assessing whether differences among males and females in carpal tunnel syndrome (CTS) epidemiology might be attributable to segregation with respect to occupational biomechanical exposures or differential access to care by sex. Methods: We analysed surgically treated cases of CTS occurring among non-manual workers in Tuscany between 1997 and 2000. We conducted a Monte Carlo simulation to estimate the difference in occupational biomechanical exposures between males and females necessary to explain the observed incidence rate ratios. We also accounted for the sex-specific probability of receiving surgery after the diagnosis of CTS, as women were reported to be more likely to undergo surgery in a subset of our study population. We quantified the hypothetical biomechanical overload through the hand activity level (HAL) metric proposed by the American Conference of Governmental Industrial Hygienists. To quantify the effect of HAL on CTS risk, we assumed a prior distribution based on findings from two large cohort studies of industrial workers. Results: After adjustment for the probability of receiving surgery, women showed a 4-fold incidence of CTS as compared with men. To explain this association among non-manual workers, women should have an average value of HAL at least 5 points higher. Conclusions: Our analysis does not support the hypothesis that the difference in CTS incidence between males and females is entirely attributable to occupational risk factors or to differential access to surgery. The causal pathway between sex and CTS might include more determinants such as hormonal factors, anthropometric characteristics, and non-occupational exposure to biomechanical overload (e.g. household tasks).

Knee osteoarthritis in a chestnut farmer - Case Report.

INTRODUCTION: Several studies have dealt with the issue of professional risk factors and onset of knee osteoarthritis (OA). In particular, occupational epidemiological studies have provided evidence that activities resulting in biomechanical overload may be linked with an increased risk of knee OA - also among farmers. To our knowledge, no cases of knee OA among chestnut farmers have been reported in the literature. CASE REPORT: We report the case of a 70-year-old Caucasian male who has worked for more than 50 years on a chestnut farm. In 2007, an X-ray and a MRI, performed after a workplace accident to his left knee, showed the presence of knee OA. His job required a range of repetitive tasks, such as squatting, kneeling, climbing, walking on sloping terrain, assuming uncomfortable postures, and lifting and carrying heavy loads for the great majority of the working day. All the aforementioned tasks are known occupational risk factors for knee OA. Regarding individual risk factors, at the time of the first diagnosis of knee OA, the worker was 64-years-old with a body mass index of 26.5 kg/m2. He reported no cases of arthritis among his relatives and no sports playing on his part. In addition, his medical history revealed the presence of two minor lumbar disc herniations and tendinitis of the long head of the biceps. CONCLUSION: Considering the lack of major individual risk factors for knee OA, it is reasonable to suppose that five decades of exposure to biomechanical overload as a chestnut farmer was a relevant risk factor for the onset of the disease.

[Health and work in a gender perspective.] / Salute e lavoro in un'ottica di genere.

OBJECTIVES: A literature review was performed to highlight which work-related diseases express sex/gender differences in health outcomes and focus the main limits of studies in this field. METHODS: The research, carried out on PubMed by specific search string, identified 4828 articles (1997-2017 period) of which 381 are eligible for review (4-22%, depending on the disease). RESULTS: Among them, 68% reported sex/gender differences in health outcomes, which in most cases appear to be due to different exposure and/or work segregation rather than to biological differences. However, few studies place this assessment among the research goals and results are almost never discussed and hypothesis are seldom formulated about any observed differences. CONCLUSIONS: It seems necessary to use research methodologies and study design that can detect and explain the described complexity and useful in defining appropriate preventive strategies.

[Gender-sensitive risk assessment and health medical surveillance: some operative tools.] / Valutazione dei rischi e sorveglianza sanitaria in ottica di genere: proposta di strumenti operativi.

OBJECTIVES: A thorough and fully application of the principles of gender mainstreaming, in accordance with the European Community guidelines, to the health and safety at work, implies the systematic review of the whole prevention from the gendered point of view. This means that both biology- and gender-based differences between male and female workers should be conceived not only as determinants of health but also as factors affecting either positively or negatively the health and safety risk prevention. In this evolutionary cultural step the role of the occupational physician is particularly important. METHODS: In this paper we propose some operative tools that can concretely implement gender perspective in all the various areas of prevention, where the occupational physician has a leading, if not even exclusive, role such as risk assessment, training and health medical surveillance.

Carpal tunnel syndrome and manual work: the OCTOPUS cohort, results of a ten-year longitudinal study.

OBJECTIVE: The American Conference of Governmental Industrial Hygienists (ACGIH) proposed a method to assess the hand, wrist and forearm biomechanical overload based on exertions frequency (hand-activity level) and force use (normalized peak force). We applied the ACGIH threshold limit value (TLV)® method to a large occupational cohort to assess its ability to predict carpal tunnel syndrome (CTS) onset. METHODS: A cohort of industrial and service workers was followed-up between 2000 and 2011. We investigated the incidence of CTS symptoms and CTS confirmed by nerve conduction studies (NCS). We then classified exposure with respect to action limit (AL) and TLV. Cox regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate hazard ratios (HR) of CTS and population attributable fractions. RESULTS: We analyzed data from 3131 workers [females, N=2032 (65%); mean age at baseline 39.3, standard deviation (SD) 9.4 years]. We observed 431 incident cases of CTS symptoms in 8000 person-years and 126 cases of CTS confirmed by NCS in 8883 person-years. The ACGIH TLV® method predicted both CTS symptoms [HR between AL and TLV 2.18, 95% confidence interval (95% CI) 1.86-2.56; above TLV 2.07, 95% CI 1.52-2.81] and CTS confirmed by NCS (HR between AL and TLV 1.93, 95% CI 1.38-2.71; above TLV 1.95, 95% CI 1.27-3.00). About one third of CTS cases were attributable to exposure levels above the AL. CONCLUSIONS: The ACGIH TLV® method predicted the risk of CTS, but the dose-response was flat above the AL; a fine-tuning of the proposed thresholds should be considered.

Analytical characterization of movements of the spinal column and risk assessment due to repeated movements of the upper limbs of building painters.

Manual activities of construction workers may induce musculoskeletal disorders. This study on a group of painters aimed to analytically characterize movements of the spinal column by both lumbar motion monitor and television cameras and to determine, using the Occupational Repetitive Actions (OCRA) Index method, the risk exerted by repeated movements of the upper limbs. The main results are: painting with a roller generally exposes workers to a lesser risk for upper limbs than painting with a brush; a roller-stick fixed at the wrong length can lead to stretching of the back at lumbar and cervical levels; to remain within the range of 'acceptable risk' (OCRA Index evaluation), a worker should not paint a vertical wall for over 3 h if using a roller and 2.5 h if painting with a brush; and, on average, a painter who paints for 5 h in a day lifts the bucket about 120,140 times.

How job demands affect absenteeism? The mediating role of work-family conflict and exhaustion.

PURPOSE: To investigate how psychosocial factors (such as job demands and work-family conflict) produce absenteeism in the workplace, using the health impairment process of the job demands-resources model. According to this model, job demands lead to burnout (often measured with the emotional exhaustion component), which in turn could lead to outcomes (such as absenteeism). Work-family conflict (WFC) was also studied, because of contradictory results collected in the existing literature on absenteeism in the workplace, regarding the role of WFC in causing absenteeism. METHODS: Data were collected on 245 workers using both subjective (questionnaire on psychological risk factors and work-related health) and objective data (sickness leave frequency records). To test the hypothesis that job demands and WFC contribute to absenteeism in the workplace, a subsequent mediation analysis was used, which analysed both (a) the subsequent mediation of WFC and emotional exhaustion and (b) the separate roles played by the mediators proposed (WFC and emotional exhaustion). RESULTS: Job demands affect absenteeism through the subsequent mediation of WFC and emotional exhaustion. In addition, emotional exhaustion mediates the relationship between job demands and absenteeism, while WFC does not. CONCLUSION: In conclusion, subsequent mediation highlights the role of emotional exhaustion in causing absenteeism; in fact, when emotional exhaustion is included in the analysis, job demands are associated with higher levels of absenteeism. The results of this study suggest that without the concurrent contribution of emotional exhaustion, WFC does not influence absenteeism in the workplace. Our findings are useful for organizations that aim to reduce absenteeism.

Workplace Bullying as a Risk Factor for Musculoskeletal Disorders: The Mediating Role of Job-Related Psychological Strain.

Workplace bullying is considered by the European Agency for Safety and Health at Work one of the emerging psychosocial risk factors that could negatively affect workers' health. Thus, the aim of this study was to analyze the process that leads from bullying to negative health (such as musculoskeletal disorders (MSDs)), testing the mediating role of job-related strain. Data were collected on 512 workers (62.9% female; mean age = 43.6 years) of a retail chain who filled in a self-report questionnaire after a one-hour training session on work-related stress. Data analyses were performed controlling for potentially confounding variables (i.e., gender, age, organizational role, type of contract, and perceived physical job demands). Preacher and Hayes analytical approach was used to test the indirect relationship between bullying and MSDs. Results showed that work-related strain mediates the relationship between bullying and MSDs considered (low back, upper back, and neck) except for MSDs of the shoulders. Our study confirms the role played by bullying and job-related strain in determining workers' MSDs.

Low-back pain.

Low-back pain is one of the most common painful conditions experienced by humans throughout their life. Some occupational risk factors (namely, heavy manual material handling) may also contribute to the development of low-back pain: due to the high prevalence of both low-back pain and manual material handling in the adult working population, it has been estimated that low-back pain is probably the most common occupational disorder worldwide. Lifetime prevalence of low-back pain has been reported to be as high as 84%, depending on the case definition used, and no age group is spared, even children. Although low-back pain is not a lethal condition, it was estimated at the third rank among all diseases by disability-adjusted life-years in 2010 in the USA, after ischemic heart disease and chronic obstructive pulmonary disease, and at the first rank by years lived with disability. It also ranked high (13th) globally for the same year, in disability-adjusted life-years. Low-back pain is currently classified as nonspecific/specific as to putative cause and as acute (lasting less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks) according to duration of symptoms. The distinction between nonspecific/specific and acute/subacute/chronic low-back pain is useful not only for epidemiologic studies, but also (mainly) for choosing the appropriate strategy for the diagnosis and treatment of the disorder. Workplace risk factors for low-back pain include manual lifting and whole-body vibration exposure. This chapter will provide an overview of modern concepts of low-back pain (in general) and will then outline some distinctive features of work-related low-back pain.

Occupational mononeuropathies in industry.

Peripheral nerve injuries have the potential to cause significant disability and can be commonly associated with recreational and occupational activities. Acute nerve injuries are mainly related to violent trauma, while repeated mechanical trauma due to external forces or repetitive motions can produce chronic nerve compression injury. This chapter will present a narrative review of the existing evidence of the association between peripheral compressive nerve disorders and work-related risk factors. Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the general population and in working populations employed in manual repetitive and forceful activities. The work-relatedness of CTS is essentially based on epidemiologic evidence and the results of experimental studies showing the capability of repetitive wrist extreme postures, associated with hand-wrist forceful exertions, to increase the pressure inside the carpal tunnel and to compress the median nerve. Assembly industry, food processing and packaging, hand-arm vibrating tools, and jobs involving high-repetition, high-force tasks put workers at risk for CTS. Less strong evidence exists of the association between ulnar elbow neuropathy and manual tasks or repetitive stretch on squatting and peroneal nerve neuropathy at the fibular head. Very few reports are available about the association between occupation and other compressive peripheral nerve injuries.

Upper-extremity and neck disorders associated with keyboard and mouse use.

Musculoskeletal disorders are frequently related to computer use in the workplace. The aim of this chapter is to provide an overview of the evidence in the literature concerning the putative association between neck, shoulder, and upper-limb disorders and occupational exposure to use of a computer and its devices. We searched the scientific literature via PubMed, using specific search strategies, including substrings tailored to retrieve papers about: (1) occupational etiology; (2) computer use; and (3) different upper-limb disorders. We intended to include, in our evaluation, systematic reviews and relevant, informative papers published later on. We were able to retrieve 11 systematic reviews and 11 informative studies regarding neck, shoulder, and upper-limb disorders. There is limited/insufficient and/or inconsistent evidence indicating that computer work may be associated to neck, shoulder, or distal arm complaints. There is sufficient evidence indicating no association between carpal tunnel syndrome and computer work. There are no studies regarding the use of computers and some neck, shoulder, and upper-limb diseases, such as tennis elbow and trigger finger. Applying the general principles of ergonomics to computer work is probably the correct strategy to pursue, with the aim of maintaining office workers' well-being.

Micronuclei and chromosome aberrations in subjects occupationally exposed to antineoplastic drugs: a multicentric approach.

OBJECTIVES: Recently published works showed that occupational exposure to antineoplastic drugs (ANPD) is still frequent in hospital settings, despite significant safety policy improvements. The aim of this study was to assess the current level of occupational exposure to ANPD and any potentially associated cytogenetic damages in hospital nurses routinely handling ANPD. METHODS: Occupationally ANPD-exposed (n = 71) and ANPD-unexposed (n = 77; control) nurses were recruited on a voluntary basis from five hospitals in Northern and Central Italy. Evaluation of surface contamination and dermal exposure to ANPD was assessed by determining cyclophosphamide (CP) on selected surfaces (wipes) and on exposed nurses' clothes (pads). The concentration of unmetabolized CP­as a biomarker of internal dose­was measured in end-shift urine samples. Biomonitoring of genotoxic effects (i.e., biological effect monitoring) was conducted by analyzing micronuclei (MN) and chromosome aberrations (CA) in peripheral blood lymphocytes. Genetic polymorphisms for enzymes involved in metabolic detoxification (i.e., glutathione S-transferases) were analyzed as well. RESULTS: We observed a significant increase in MN frequency (5.30 ± 2.99 and 3.29 ± 1.97; mean values ± standard deviation; p < 0.0001) in exposed nurses versus controls, as well as in CA detection (3.30 ± 2.05 and 1.84 ± 1.67; p < 0.0001), exposed subjects versus controls. Our results provide evidence that, despite safety controlled conditions, ANPD handling still represents a considerable genotoxic risk for occupationally exposed personnel. CONCLUSIONS: Because both MN and CA have been described as being predictive of group-increased cancer risk, our findings point to a need for improving specific safety procedures in handling and administering ANPD.

Bilateral hearing loss after dichloromethane poisoning: a case report.

Dichloromethane is a widely used organic solvent. Occupational exposure to dichloromethane is frequent and can result in both acute and chronic toxicity, affecting mostly the central nervous system, directly or through its metabolite, carbon monoxide. The effects of dichloromethane on the peripheral nervous system are debated. Here we report the case of a 37-year-old woman who was accidentally exposed to dichloromethane. In the days following the incident she experienced bilateral hypoacusis. Hearing loss regressed after 25 days treatment with hyperbaric oxygen. This is the first report of sudden hearing loss after acute exposure to dichloromethane, suggesting a possible toxic effect of this solvent on the auditory system.

[Occupational risks in grocery stores]. / Rischi da lavoro nella grande distribuzione.

AIM: This work provides an overview of the spectrum of possible occupational risk factors in the retail grocery store/supermarket workplace. METHOD: Literature on this theme, obtained consulting PubMed database and Google Scholar, was checked. We also exjlore results from the National bInstitute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA). RESULTs: Contacts with objects, use of dangerous equipment (cutter, food slicer) and falls to the same level (slips, trips and falls) are the mainly described workplace hazards. Exposure to chemical (flour dust, components of detergents or disinfectants, volatile organic compounds and contact with nickel) and physical agents (cold exposure, nonionizing radiation and whole bpdy vibration) are reported by many authors. Relations between biomechanical and ergonomic risk factors and musculoskeletal disorders represent the main subjects of study. Few studies are found about biological agents (particularly among butchers). Data regarding psychosocial risks factors in this setting are still limited. CONCLUSIONS: Musculoskeletal disorders continue to be the most recurrent health problem between the grocery store workers (particularly low back pain and carpal tunnel syndrome among cashiers). Many technical documents and international Srecommendations are present to prevent these kinds of disorders. Psychosocial risk factors and risk of workplace violence should deserve further investigation.

[Risk assessment comparison of biomechanical overloading of the musculoskeletal system: 10 years' applied experience]. / Metodi di valutazione del rischio da sovraccarico biomeccanico all'apparato muscolo scheletrico a confronto: esperienza applicativa di dieci anni.

UNLABELLED: Risk assessment for upper extremity work related muscoloskeletal disorders by applying six methods of ergonomic: a ten years experience. The objective of this research was to verify and validate the multiple step method suggested by SIMLII guidelines and to compare results obtained by use of these methods: Washington State Standard, OCRA, HAL, RULA, OREGE and STRAIN INDEX. METHODS: 598 workstations for a total of 1800 analysis by different methods were considered, by adopting the following multiple step procedure: prelinminary evaluation by Washington State method and OCRA checklist in all the working stations, RULA or HAL as first level evaluation, OREGE or SI as second level evaluation. RESULTS: The preliminary evaluation resulted negative (risk absent) in the 75% of examined work stations and by using checklist OCRA optimal-acceptable condition was found in 58% by HAL in 92% of analysis, by RULA in 100%, by OREGE in 64%; by SI in 70% of examined working positions. We observed similar evaluation of strain among methods and main differences have been observed in posture and frequency assessment. DISCUSSION AND CONCLUSION: The preliminary evaluation by State of Washington method appears to be an adequate instrument for identify the working condition at risk. All the adopted methods were in a good agreement in two estreme situations: high risk or absent risk, expecially in absent risk conditions. Level of accordance varied on the basis of their rationale and of the role of their different components so SIML indications about the critical use of biouzechanical methods and about the possible use of more than one of them (considering working chlaracteristics) have been confirmed.