The French Musculoskeletal Disorders Surveillance Program: Pays de la Loire network.

OBJECTIVES: An epidemiological surveillance system for work-related musculoskeletal disorders (MSDs) was implemented in 2002 in France's Pays de la Loire region to assess the incidence and prevalence of MSDs in the general and working populations, identify levels of exposure to occupational risk factors and investigate the proportion of cases attributable to work exposure. METHODS: The program combines (1) surveillance of sentinel health events in the general population (carpal tunnel syndrome (CTS) was the sentinel event for upper limb MSDs), (2) assessment of the prevalence of the main upper limb MSDs and their risk factors in the workplace based on a network of occupational physicians and (3) registration of the notification of work-related diseases (WRDs). RESULTS: 1168 incident cases of CTS were included over a 3 year period. The estimated incidence of CTS was 1.00 per 1000 person-years in those aged 20-59 years (0.60 in men and 1.40 in women). The incidence rate was higher in employed than unemployed persons in the year of diagnosis (0.6 per 1000 vs 0.3 in men and 1.7 vs 0.8 in women). The occupational physician network noted high prevalence rates: 11% of men and 15% of women had at least one of the six main upper limb clinically-diagnosed MSDs. The WRD survey showed that MSDs represented 65% of notified WRDs. CONCLUSION: The Pays de la Loire program plays a significant role in informing the authorities and the public about the state of current MSDs. It is planned to extend it to a routine national surveillance program.

[Exposure to psychosocial stressors at work in the Pays de la Loire region in 2002]. / Exposition au stress psychosocial chez les salariés des Pays de la Loire en 2002.

OBJECTIVE: An epidemiological surveillance system of work-related musculoskeletal disorders of the upper limb (MSDs) was implemented in 2002 in the Pays de la Loire region to assess the prevalence of the MSDs and their biomechanical and psychosocial risk factors in the working population. We will report here only the results concerning the exposure to psychosocial stress in the work environment. According to the Karasek "demand-autonomy" model, high psychological work demands may increase risk of ill health, particularly if there is a low level of decision latitude for the employees and low social support by the hierarchy or colleagues. METHODS: In 2002, 68 out a total of 400 occupational physicians volunteered to participate in the surveillance program and included 1 495 workers (895 men, 600 women) representative of the region's workforce. Work history and work environment were assessed by a self-administered questionnaire before the compulsory annual visit of occupational physicians. Exposure to psychosocial stress at work was assessed with the Job Content Questionnaire (JCQ) developed by Karasek. The three scales of decision latitude, social support and psychological demands were calculated using Karasek's recommendations. RESULTS: The mean scores of psychological demands, decision latitude and social support were 69.3 +/- 12.7; 22.3 +/- 3.2; 24.0 +/- 3.5, respectively. No differences were observed according to gender and age. A third of the workers were exposed to high psychological demands at work and most of them (61%) had little decision latitude to cope with work constraints. About 28% of workers suffered from a lack of social support from their colleagues or supervisors. Overall, about 17% of workers were exposed to a situation of "Job strain" (ie a combination of a high level of psychological demands and a low level of decision latitude) and 7% were exposed to a situation of "Job strain" with social isolation ("Job strain" with low social support). The situations of "Job strain", associated or not with a low level of social support, were particularly frequent in industries with taylorized work organisation, like the food industry and automobile industry, and in services characterised by strong merchant constrains, such as trade and cleaning services, for example. The frequency of "Job strain", with or without social isolation, was almost double in temporary workers. DISCUSSION: This study confirms that in a representative sample of workers, the exposure to occupational stress is not limited to managers and professionals, but concerns also a large number of employees and blue-collar workers of the public and private sectors. In general, the strongly qualified occupations are characterised by a high level of psychological demands, but individuals have large decision latitude to cope, which allows them to develop their capacities. The less qualified occupations are generally less confronted with a high level of mental demands than the managers and professionals. However, these individuals do not have enough decision latitude to cope with psychological demands which could lead to a high level of "Job strain", notably in the case of lack of social support from the supervisors and the colleagues. CONCLUSION: The study shows that the exposure to occupational stress is not limited to managers and professionals, but also concerns numerous employees and blue-collar workers. The determinants of work strain differ depending on occupations and this should be taken into consideration when implementing prevention programs for stress at work.

Risk factors for Raynaud's phenomenon among workers in poultry slaughterhouses and canning factories.

BACKGROUND: Apart from the use of vibrating tools, little is known about risk factors for Raynaud's phenomenon. However, it has been hypothesized that this disorder may have a multifactorial aetiology, involving potential causal or triggering factors which can be found in the workplace. The objective of the study is to identify individual and occupational risk factors of Raynaud's phenomenon in a population of workers not exposed to vibration, but exposed to cold. METHODS: The survey was carried out in 1987-1988 in 17 poultry slaughterhouses and six canning factories and included 1474 employees. Data were collected at the annual visit to the occupational health physician. Finger sensitivity to cold and Raynaud's phenomenon were identified from a list of symptoms occurring from exposure to cold. The role of potential risk factors was assessed using multiple logistic regression. RESULTS: A high prevalence of symptoms of finger sensitivity to cold was observed. Raynaud's phenomenon was more common in women than in men, was related to family history of the disease but not to smoking or alcohol consumption. After controlling for non-occupational factors, the following working conditions appeared as risk factors for Raynaud's phenomenon: use of plastic gloves, less than four rest breaks, breaks in an unheated place, continual repetition of the same series of operations, exertion of the arm or hand and being able to think of something else while working. CONCLUSION: The study showed that a number of working conditions were associated with an increased risk of Raynaud's phenomenon and finger sensitivity to cold. Changes in working conditions might reduce the risk of this disorder in the food processing industry.

Risk factors of early menopause in two generations of gainfully employed French women.

OBJECTIVES: Numerous studies have been focused on the detection of factors which can act on the age of menopause. Little is known about the factors related to the occurrence of an early menopause. Some factors such as occupational work factors and generational effects have not been taken into account as yet. METHODS: We examined the risk factors of early natural menopause (before age 45) in a large random sample of gainfully employed French women born in the years 1938 (n = 1743) and 1943 (n = 1959). The subjects were selected from files of an occupational physician. A woman was considered to be post-menopausal when at least 12 consecutive months had passed without menstruation at the time of the survey. Subjects were questioned and examined during their annual visit by the occupational physician. Occupational history, working conditions, living conditions, smoking habits and reproductive history were explored. RESULTS: The prevalence of early natural menopause, before age 45, was higher in the generation of 1938 (5.3%) than in that of 1943 (3.3%) with P < 0.01. After multivariate regressions, significant relationships existed statistically between the occurrence of early natural menopause and marital status, educational level, age at first childbirth and breast-feeding of children. CONCLUSIONS: Our results show important generation effects. There was no evidence of a significant relationship between early natural menopause at 45 years of age and factors relative to heavy physical work conditions.

Work status after workers' compensation claims for upper limb musculoskeletal disorders.

AIM: To provide information on employment status after workers' compensation (WC) claims for musculoskeletal disorders of the limbs (MSDs). METHODS: Two-year follow up of the workers who filed a WC claim for MSDs in 1996 in the Pays de la Loire region. Of the 701 eligible workers, 514 workers (70%) participated. Information was requested by means of a mailed questionnaire about the characteristics of the MSDs and job status at the time of the WC claim and two years later. RESULTS: Two years after the WC claim, 65% of the claimants had returned to work in the same company, often without any ergonomic improvement, 12% had retired or had left employment voluntarily, and 18% had been dismissed. The risk of dismissal was associated with three factors: being older than 45 years, having two or more MSDs at claim, and working in the cleaning services sector.

[Age, work and spinal pain]. / Age, travail et douleurs rachidiennes.

BACKGROUND: To examine whether the relationship between age and musculoskeletal disorders in the spine is specific to one localization (cervical, dorsal, lumbar) or due to the accumulation of lesions with age. METHODS: Data were gathered from the ESTEV study among a randomly selected sample of 21,378 French workers, followed by 390 occupational physicians during the year 1990. The subjects, males or females, were born in 1938, 1943, 1948, 1953. Participation rate (88%) did not depend on age and sex. Data were collected during annual medical examination for medical variables, and using standardized self questionnaires for occupational exposures and work constraints for actual or past jobs. RESULTS: Data on musculo-skeletal disorders, defined as pains during the last 6 months before examination, were recorded by occupational physician. Each painful localization was associated with the main factors described in the literature, particularly heavy physical work factors and psycho-social factors of work. There was no interaction between age and any of these. At the opposite, in male as female subjects, there was a statistically significant interaction between age, multiple exposures to heavy physical work factors and the frequency of multiple localizations of pain in the spine. CONCLUSION: Results suggest that accumulation of pain in the different localizations of the spine might account for accelerated aging process of the musculo-skeletal structure of the spine which can reflect effects of environmental work factors.

Work-related factors associated with age at natural menopause in a generation of French gainfully employed women.

This study's purpose was to identify occupational factors that may influence the age at natural menopause in a random sample of gainfully employed French women born in 1938 (n=1,594). Occupational physicians selected the subjects from their files and interviewed them during their annual visits in 1990 and 1995. The authors used Kaplan-Meier survival curves to estimate median age at menopause (52 years) and multiple Cox models to estimate associations among women's characteristics, occupational factors, and age at menopause separately within two strata distinguished by a self-reported history of depression. Among women without such a history, earlier menopause was associated with smoking more than 10 cigarettes per day in 1990 (p<0.001), a high-strain job (p=0.01) in 1990, and difficult schedules before 1990 (p=0.03). Later menopause was associated with higher educational status (p=0.003) and repetitive work in 1990 (p=0.005). Among women with a history of depression, a later menopause was associated with having at least one child (p<0.001) and menarche later than the age of 13 years (p=0.004). Earlier menopause was associated with a high job control in 1990 (p=0.03) and high school education (p<0.01). These results suggest that certain physical job stressors may be related to age at menopause.

Hematological findings among styrene-exposed workers in the reinforced plastics industry.

A cross-sectional survey of hematological parameters was carried out among 221 workers exposed to styrene in the reinforced plastics industry and 104 controls. Styrene exposure was assessed in both groups by monitoring urinary excretion of styrene metabolites (i.e. mandelic and phenylglyoxylic acids) in post-shift urinary samples collected over five consecutive days. Blood tests were performed with the same counter for all subjects. Information on factors liable to affect hematological parameters was collected from personal questionnaires completed by the workers. Urinary excretion of styrene metabolites varied from 15 to 3740 mg/g creatinine. Exposed subjects exhibited significantly lower mean values of neutrophils and mean corpuscular hemoglobin concentration (MCHC) than controls, and significantly higher mean values for monocytes and mean corpuscular volume. A dose-effect relationship was found for MCHC which decreased with urinary metabolite concentrations. These results remained statistically significant for all parameters after adjustment for age, sex, tobacco and alcohol consumption, place of residence (rural or urban) and time of blood sampling (morning or afternoon) with the exception of neutrophils whose relationship with exposure was essentially explained by smoking. These results are suggestive of a direct effect of styrene-exposure--in the range considered--on the statistical distribution of some hematological parameters.

Risk factors for high blood pressure among workers in French poultry slaughterhouses and canneries.

The aim of the present study is to examine the relationship between the working conditions of employees in the food industry and blood pressure. An epidemiological survey was conducted between 1987 and 1988 in 17 poultry slaughterhouses and 6 canneries in the French regions of 'Bretagne' and 'Pays de Loire'. One thousand, four hundred and seventy-four workers were included in the study. Data was collected in the course of the medical visit organized annually for employees. Mean diastolic (DBP) and systolic blood pressure (SBP) were analyzed separately for male and female workers. The results indicate a significant relationship between blood pressure, and age and obesity. Amongst the various features of working condition studies, loud noise and the number of work breaks were found to be associated with heightened mean values of DBP or SBP in men only. Type and size of the factory was found to be associated with blood pressure readings for both sexes. A number of working conditions giving rise to heightened mental strain were found to be related to a lowering in mean blood pressure: for example, irregular work finishing times for men and production-line work for women. A discussion of these results reveals the complexity of the relationships which exist between physical and environmental factors in this type of setting and blood pressure of employees.

Chronic neck and shoulder pain, age, and working conditions: longitudinal results from a large random sample in France.

AIMS: To analyse the effects of age and occupational factors on both the incidence and the disappearance of chronic neck and shoulder pain after a five year follow up period. METHODS: A prospective longitudinal investigation (ESTEV) was carried out in 1990 and 1995 in seven regions of France. A random sample of male and female workers born in 1938, 1943, 1948, and 1953 was selected from the occupational physicians' files. In 1990, 21 378 subjects were interviewed (88% of those contacted), and 87% were interviewed again in 1995. Chronic neck and shoulder pain satisfying specific criteria, and psychosocial working conditions were investigated by a structured self administered questionnaire and a clinical examination. RESULTS: Prevalence (men 7.8%, women 14.8% in 1990) and incidence (men 7.3%, women 12.5% for the period 1990-95) of chronic neck and shoulder pain increased with age, and were more frequent among women than men in every birth cohort. The disappearance rate of chronic neck and shoulder pain decreased with age. Some adverse working conditions (repetitive work under time constraints, awkward work for men, repetitive work for women) contributed to the development of these disorders, independently of age. Psychosocial factors seemed to play a role in both the development and disappearance of chronic neck and shoulder pain. Data did not show specific interactions between age and working conditions. CONCLUSIONS: The aging of the workforce appears to contribute to the widespread concern about chronic neck and shoulder pain. A better understanding of work activity regulation of older workers can open up new preventive prospects.

Carpal tunnel syndrome and work organisation in repetitive work: a cross sectional study in France. Study Group on Repetitive Work.

OBJECTIVES: To study the determinants of signs of carpal tunnel syndrome (CTS) in repetitive industrial work, with special attention to occupational constraints at group level and management practices of the companies. METHOD: A cross sectional study was conducted in three sectors: assembly line; clothing and shoe industry; food industry. A total of 1210 workers in repetitive work, from 53 different companies, was compared with a control group of 337 workers. Constraints at the workplace were partly self declared, and partly assessed by the occupational physicians in charge of the employees of the company. The definition of CTS was based on a standardised clinical examination. RESULTS: CTS was associated with repetitive work, especially packaging. It was more frequent among subjects who declared psychological and psychosomatic problems and those with a body mass index > or = 27. Dissatisfaction with work, lack of job control, short cycle time, and having to press repeatedly with the hand were associated with the syndrome. An odds ratio (OR) of 2.24 was found for "just in time" production. CONCLUSION: The results emphasise the complexity of the determinants of CTS, the role of psychosocial factors at work and the potentially negative effects of some practices of the companies aimed at enhancing their competitiveness.

Conformity of Workers' and Occupational Health Physicians' Descriptions of Working Conditions.

To determine whether workers, describing their own work, and occupational physicians, describing typical workstations, would report the same working conditions, and whether the relationships between health status and working conditions described by these two sources would be similar. An epidemiologic survey was carried out in 1987-88 in 17 poultry slaughterhouses and six canneries in France. The data were collected in two ways: workers described their own working conditions, and occupational physicians described the working conditions at workstations in the same factories. The study included 507 workers who worked at fixed workstations that had been described by the 24 occupational physicians. Health data were obtained from the workers by the physicians during their annual visits. The agreement between workers and physicians in the descriptions of seven working conditions was analyzed. On the whole, the prevalences of exposures to the seven selected working conditions estimated by the two sources were similar. Nevertheless, the observed agreement was not necessarily high. When agreement existed about specific working conditions, the relationships observed between those conditions and workers' health were generally similar for the two sources. This result was stronger for physical health problems than for mental health problems. When both sources agreed that the worker was being exposed to a risk factor, the risk estimation was higher compared with the cases of discordant judgment. This study confirms the usefulness of information provided by experts but also the necessity to interview workers themselves about their working conditions.