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OBJECTIVES: The aim was to examine exposure-response relations between occupational hand exposures and carpal tunnel syndrome (CTS) and to compare the relation between surgery-treated and non-surgery-treated CTS. The secondary aim was to study sex-specific differences in exposure-response relations. METHODS: We conducted a nationwide register-based cohort study of all persons born in Denmark (1945-1994). During follow-up (2010-2013), we identified first-time events of CTS. Occupational hand exposure estimates the year before each follow-up year were obtained by linking individual occupational codes with a job exposure matrix. We used multivariable logistic regression equivalent to discrete survival analysis based on sex and surgery. The excess fraction of cases was calculated. RESULTS: For both sexes, exposure-response relations were found for all occupational hand exposures. Among men, we found ORadj of 3.6 (95% CI 3.2 to 3.8) for hand-related force, 2.9 (95% CI 2.5 to 3.2) for repetitive hand movements, 3.8 (95% CI 2.7 to 5.2) for non-neutral hand posture and 2.5 (95% CI 2.2 to 2.7) for hand-arm vibration in the highest exposure groups. For combined exposure (hand load), ORadj was 3.5 (95% CI 3.1 to 4.0). Slightly higher ORsadj were generally found for surgery-treated CTS compared with non-surgery-treated CTS for both sexes. When comparing sex, somewhat higher ORsadj were found among men. The excess fraction was 42%. CONCLUSIONS: Occupational hand exposures carried a 3-5-fold increased risk of CTS with slightly higher risks for surgery-treated compared with non-surgery-treated CTS. Even though CTS occurs more frequently among women, somewhat higher exposure-response relations were found for men compared with women. In the general working population, a substantial fraction of first-time CTS could be related to occupational hand exposures.
Assuntos
Síndrome do Túnel Carpal , Mãos , Doenças Profissionais , Exposição Ocupacional , Humanos , Síndrome do Túnel Carpal/epidemiologia , Síndrome do Túnel Carpal/etiologia , Dinamarca/epidemiologia , Masculino , Feminino , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Adulto , Pessoa de Meia-Idade , Estudos de Coortes , Fatores Sexuais , Modelos Logísticos , Fatores de Risco , Sistema de Registros , Vibração/efeitos adversos , Transtornos Traumáticos Cumulativos/epidemiologia , Transtornos Traumáticos Cumulativos/etiologia , Postura , Síndrome da Vibração do Segmento Mão-Braço/epidemiologia , Síndrome da Vibração do Segmento Mão-Braço/etiologia , IdosoRESUMO
OBJECTIVES: To evaluate if occupational mechanical exposures are associated with an increased risk of surgery for varicose veins (VV) in the lower extremities. METHODS: We conducted a longitudinal study of persons from the Musculoskeletal Research Database at the Danish Ramazzini Centre who were 18-65â years old when they provided baseline questionnaire data during 1993-2004. Exposure estimates were obtained from a job exposure matrix based on expert ratings. The register information on first-time surgery for VV was retrieved. We used Cox regression analyses. RESULTS: During 416,317 person-years of follow-up among 38,036 persons, 851 first-time operations for VV occurred. Using standing/walking <4â h/day and uncommon lifting as references, exposure-response relationships with risk of surgery were found for men. For women, the risk increased too, but without clear exposure-response patterns. The adjusted HRs for ≥6â h/day spent standing/walking were 3.17 (95% CI 2.06 to 4.89) and 2.34 (95% CI 1.72 to 3.19) for men and women, respectively. For high lifting exposures (≥1000â kg/day), the adjusted HRs were 3.95 (95% CI 2.32 to 6.73) for men and 2.54 (95% CI 1.95 to 3.31) for women. Other risk factors were increasing age for men and parity for women. Minimal leisure-time physical activity, a high body mass index and smoking were not associated with increased risk. CONCLUSIONS: The results suggested an increased risk of surgery for VV in relation to prolonged standing/walking and heavy lifting and a preventive potential of more than 60% of all cases in exposed occupations.
Assuntos
Remoção , Extremidade Inferior , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Postura , Varizes/etiologia , Caminhada , Adolescente , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/cirurgia , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Varizes/cirurgia , Adulto JovemRESUMO
During spring 2021, AZD1222 and BNT162b2 were used as prime and BNT162b2 as booster COVID-19 vaccines in Denmark. We obtained self-reported information on systemic reactogenicity day-by-day during two weeks for 2862 healthcare workers vaccinated with heterologous AZD1222 + BNT162b2 or homologous BNT162b2 + BNT162b2 regimens and compared prevalences of symptoms with unvaccinated healthcare workers. We found comparable systemic reactogenicity during the first week in the two vaccine regimens and no reactogenicity during the second week. Most of the symptoms returned to a level equal to the control population four days after booster vaccination.
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OBJECTIVE: Evaluate incidence rates (IRs) of carpal tunnel syndrome (CTS) as sentinels to identify job groups with high hand-wrist exposures. METHODS: A nationwide register-based cohort study of all born in Denmark. During follow-up 2010 to 2013, we identified first-time CTS diagnoses. We established job groups, calculated sex-specific age-standardized IRs (SIRs) per job group. We linked occupational codes with a job exposure matrix, calculated mean hand load estimate per job group, and plotted hand load against the SIRs. RESULTS: We followed 1,171,580 men and 1,137,854 women for 4,046,851 and 3,994,987 person-years; identified 4405 cases among men, 7858 among women; obtained crude IRs of 10.9 and 19.7 per 10,000 person-years. For both sexes, there was a positive association between SIRs and hand load. CONCLUSIONS: Higher SIRs pointed to job groups with higher hand load. Elevated SIRs of CTS may serve as sentinels of harmful hand activities.
Assuntos
Síndrome do Túnel Carpal/epidemiologia , Mãos/fisiopatologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Adolescente , Adulto , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/fisiopatologia , Exposição Ocupacional/análise , Fatores de Risco , Adulto JovemRESUMO
Objectives The aim of this study was to evaluate the development of impaired median nerve function in relation to hand-intensive seasonal work. We hypothesized that at end-season, median nerve conduction would be impaired and then recover within weeks. Methods Using nerve conduction studies (NCS), we examined median nerve conduction before, during, and after engaging in 22 days of mink skinning. For a subgroup, we used goniometry and surface electromyography to characterize occupational mechanical exposures. Questionnaire information on symptoms, disability, and lifestyle factors was obtained. Results The study comprised 11 male mink skinners with normal median nerve conduction at pre-season (mean age 35.7 years, mean number of seasons with skinning 8.9 years). Mink skinning was characterized by a median angle of wrist flexion/extension of 16º extension, a median velocity of wrist flexion/extension of 22 °/s, and force exertions of 11% of maximal voluntary electrical activity. At end-season, mean distal motor latency (DML) had increased 0.41 ms (P<0.001), mean sensory nerve conduction velocity (SNCV) digit 2 had decreased 6.3 m/s (P=0.004), and mean SNCV digit 3 had decreased 6.2 m/s (P=0.01); 9 mink skinners had decreases in nerve conduction, 5 fulfilled electrodiagnostic criteria and 4 fulfilled electrodiagnostic and clinical criteria (a positive Katz hand diagram) for carpal tunnel syndrome (CTS). Three to six weeks post-season, the changes had reverted to normal. Symptom and disability scores showed corresponding changes. Conclusions In this natural experiment, impaired median nerve conduction developed during 22 days of repetitive industrial work with moderate wrist postures and limited force exertion. Recovery occurred within 3-6 weeks post-season.