Application of MAPO (Movement and Assistance of Hospitalized Patients) method in hospitals and nursing homes: frequency of manual patient handling-part 2.

This study examines the evolution of MAPO method for estimating the frequency of overloading tasks in healthcare workers during different shifts. The data presented were collected from 51 in-patient wards (25 hospitals and 26 nursing homes), and 917 workers: the frequency of MPH tasks is a complementary value to the MAPO exposure level, which is useful to implement a prevention plan targeted towards the reduction of overloading tasks. Based on the frequency of manual patient handling, it appears that the afternoon shift is at greatest risk, with tasks liable to cause overloading occurring within a frequency range of 70-85 per worker. The study analyzes different pieces of equipment and their relative percentages of use, concluding that, overall, they are underutilised (especially minor aids and height-adjustable beds). Practitioner summary: The organisational data collected in hospitals and nursing homes confirms the availability of patient handling aids and equipment, but also indicates that they are underutilised with respect to the frequency of overloading tasks.

[Manual lifting and manual transport: risk assessment and prevalence of work-related diseases in construction companies in Basilicata]. / Movimentazione manuale dei carichi e trasporto manuale: valutazione del rischio e prevalenza di patologie correlate nelle imprese edili lucane.

BACKGROUND: The Basilicata Regional Headquarters of the Italian Institute for Insurance against Occupational Accidents and Disease (INAIL) and the Basilicata association of small building enterprises (Edilcassa di Basilicata) promoted a research project to assess the risk of manual lifting and manual transport in construction enterprises in the Basilicata Region and estimate the prevalence of related diseases. METHODS: Manual lifting risk assessment was performed by calculating the VLI of 204 working days in as many building workers. Manual transport risk assessment was carried out comparing the weights transported (on the 204 days tested) with the reference values of the "Snoock and Ciriello" tables. RESULTS: Manual Ifting risk was present on 195 of the 204 days, with an average value of VLI equal to 2.1 (min 0.4, max 8.5), with higher values in the restructuring sector (VLI average of 2.3, min 0.4, max 8.5), and no significant differences between the different tasks. Manual transport risk was present on 129 of the 204 days, with average values of 1.2 (min 0.2, max 3.3), with no significant differences between the different tasks analyzed For both risks additional factors were present that were not analyzed by the methods of assessment used (for manual lifting: 8.8% of the geometries in the critical area; for manual transport: 39% of transport on shoulders, 42.5% on a route with uneven surface and 31.9% on a sloping route), so it is likely that the actual risk is greater than that indicated by the synthetic indices of exposure. The medical questionnaire showed from the case histories that 148 out of 546 subjects were positive for the threshold forpain or discomfort in the lumbosacral spine area and 99 out of 546 subjects reported suffering from an already diagnosed herniated spinal disk. Only 18% of osteoarticular diseases was reported to the Insurance Institute, al though there was widespread awareness that the diseases in question might be related to work. Diseases of the spine were responsible for 1.9% of absenteeism, equal to 30-40% of total absenteeism ofworkers enrolled in "Edilcassa di Basilicata". CONCLUSIONS: The method used provides a solid basis for evaluating the two risks in the construction industry, where employment is subject to extreme organizational, environmental and structural (machines, tools, operators involved) variability. Employment in the construction industry involves significant exposure to the two risks, counting for 30-40% of total absenteeism in this sector.

[Screening of patient manual handling risk using the MAPO method]. / Screening del rischio da movimentazione manuale pazienti con metodo MAPO.

BACKGROUND: International standards draw attention to the steps that risk assessment should follow to first identify hazards, then proceed to risk evaluation and lastly, if necessary, risk assessment. The same logic also applies to risk assessment of manual patient handling. OBJECTIVES: To check appropriateness of approach to "risk evaluation" of manual patient handling using MAPO, a cross sectional study was carried out aimed at checking the relationship between this new risk assessment model (MAPO screening) and occurrence of acute low back pain. METHODS: After proper training the MAPO screening method was used to assess risk of manual handling of patients in 31 wards, covering 411 exposed subjects employed in geriatric hospitals belonging to the UNEBA (National Union Institutions and Social Welfare Initiatives) of the Veneto Region. At the same time health data were collected on the occurrence of low back pain episodes during the last year both in the group of exposed subjects and in an external reference group (237 subjects). Risk and clinical assessment data were verified and checked by the EPM research unit. Logistic analysis was used as a method to evaluate the relationship between MAPO screening risk index and acute low back pain. RESULTS: Investigating the relationship between acute low back pain episodes and levels of MAPO screening index, carried out only on exposed subjects who reported working for at least 30 hours per week (N=178), showed definitely positive trends: for MAPO screening index of exposure levels between 1.51 and 5, OR were double (OR=2.22; IC 95% 0.88-5.63) whereas for index levels exceeding 5, OR were about 4 (OR=3.77; IC 95% 1.33-10.74). These results did not show significant differences when correcting the analysis for confounding factors such as gender and age classes. CONCLUSIONS: The results of the study indicate that the proposed method, "MAPO screening", can be a useful tool to estimate risk due to manual handling of patients and can also be used to test the efficacy of preventive measures.

[Survey on musculoskeletal disorders in a group of 2755 construction workers in the province of Bergamo]. / Rilevazione dei disturbi muscoloscheletrici in un gruppo di 2755 artigiani edili nella provincia di Bergamo.

BACKGROUND: In the past ten years European and Italian statistics reported a significant increase in work-related musculoskeletal disorders, which also covered the construction industry. OBJECTIVES: To verify this issue, the EPM Research Unit, in collaboration with the Small Craft Industries Territorial Joint Committee in Bergamo (CPTA), undertook a research project on muscular-skeletal disorders. METHODS: The health survey was carried out by an ad hoc trained staff. RESULTS: Between November 2009 and September 2010, data on 2755 subjects were obtained. The entire sample and the group of masons were investigated and both exhibited high prevalence of upper limb disorders and high prevalence of degenerative diseases (herniated disc). CONCLUSIONS: Active research needs to be included in the protocol of health surveillance, of upper limb and spinal MSDs. The data also highlight the need for biomechanical overload exposure data aimed at reconstructing risk profiles and at identifying the technological and organizational solutions to eliminate this particular risk.

[Preliminary results of a health survey of muscular-skeletal disorders in a group of 2247 small building trades in the Province of Bergamo]. / Primi risultati di un'indagine sanitaria sui disturbi muscolo-scheletrici in un gruppo di 2247 artigiani edili nella provincia di Bergamo.

BACKGROUND: In the past ten years European and Italian statistics reported a significant increase in work-related musculoskeletal disorders, which also covered the construction industry. OBJECTIVES: To verify this issue, the EPM Research Unit, in collaboration with the Small Craft Industries Territorial Joint Committee in Bergamo (CPTA), undertook a research project on muscular-skeletal disorders with special reference to the lumbar spine and upper limbs. METHODS: The health survey was carried out by an ad hoc trained staff RESULTS: Between November 2009 and July 2010, data on 2247 subjects doing a variety of jobs were obtained, more than 50% of whom were masons. The entire sample and the group of masons were investigated and both exhibited a prevalence of upper limb disorders that was definitely higher than in the reference group of non-exposed subjects. Regarding the lumbar spine, the most significant evidence was the high prevalence of degenerative diseases (herniated disc), while subjective disorders appeared to be lower than in the reference groups. These data are influenced by the healthy worker effect, which is extremely marked in this industrial sector, as well as by the economic crisis that led to many workers having to leave. CONCLUSIONS: Active research needs to be included in the protocol of health surveillance (with appropriate clinical protocol), of upper limb and spinal MSDs. The data also highlight the need for biomechanical overload exposure data aimed at reconstructing risk profiles (from biomechanical overload)for each job and at simplifying risk assessment requirements according to present legislation but above all at identifying the technological and organizational solutions to eliminate this particular risk.

[Epidemiological study of UL-WMSDs in 2022 VDU workers]. / Indagine epidemiologica sulle patologie e sui disturbi muscoloscheletrici degli arti superiori in un gruppo di 2022 videoterminalisti.

BACKGROUND: The literature dealing with the health effects of VDU work identified right from the beginning a group of MSDs, mainly affecting the cervicobrachial region, so that VDU work could be considered a risk factor due to biomechanical overload of the upper limbs, OBJECTIVES: The aim of the study was to assess the prevalence of symptoms and diseases of VDU workers. METHODS: A cohort of 2022 workers (1125 males and 897 females) working at VDUs for a duration of time equal to or exceeding 20 hours per week, including insurance and bank employees (no desk activity), was submitted to clinical and functional assessment of the cervical spine and upper limbs following a structured protocol (case history, clinical and instrumental examinations), as used by occupational physicians, in order to identify "anamnestic cases" and diagnose upper limb biomechanical overload diseases. Besides medical data, a series of data was also collected in order to obtain details of the work task: time schedule, duration of VDU use, organizational autonomy, data entry method. RESULTS: The prevalence of subjects with UL-WMSDs was 1.9% for males and 5.8% for females, and basically similar to that found in non-exposed working populations. However, there did seem to be a correlation between cervical disorders and computer use, only for females. CONCLUSIONS: In the sample studied no association was shown between VDU work and onset of upper limb diseases, which was confirmed even considering the different exposure variables. Analysis of"anamnestic cases" made by comparison with non-exposed populations, confirmed the lack of association between upper limb diseases and VDU work.

Digestive endoscopy and risk of upper limb biomechanical overload.

BACKGROUND: For several years the literature has reported a high prevalence of upper limb musculoskeletal disorders among medical staff carrying out digestive endoscopy. OBJECTIVES: The EPM research unit, in cooperation with the Italian Society of Digestive Endoscopy (SIED) and with the patronage of the Italian Society of Ergonomics (SIE), undertook research that would permit assessment of upper limb biomechanical overload using the OCRA method during gastroscopy and colonoscopy and, via a pilot study, collect health data on 179 workers employed in endoscopy services. RESULTS: Risk analysis showed slight exposure levels for the arm bearing the instrument and a medium-to-high exposure for the other arm. However, the study of diseases in this sample showed a higher prevalence than in the reference population not exposed to risk for the upper limbs and in particular in the hand-wrist area. CONCLUSIONS: Risk analysis highlighted possible ergonomic measures that would be easy to implement and which would significantly reduce the risk.

[Upper-limb work-related musculoskeletal disorders (UL-WMSDs) and latency of effect]. / Movimenti ripetuti degli arti superiori: considerazioni sul tempo di latenza degli effetti.

BACKGROUND: Trends in work-related upper limb musculoskeletal disorders appear to be in constant increase in industrialized countries. In Europe claims and compensation for these disorders have significantly increased. OBJECTIVE: The aim of this study was to investigate the temporal relationship between the beginning of occupational exposure to repetitive movements and exertions of upper limbs, assessed through the OCRA index, and the manifestation of the disorders. METHODS: Clinical and questionnaire information about 557 cases of UL-WMSDs in the upholstered furniture industry were analyzed in order to investigate the mean latency period of the disorders and to verify to what extent different levels of exposure influence the latency time. RESULTS AND CONCLUSIONS: The latency of UL-WMSDs is influenced by the level of exposure to risk, measured by means of the OCRA index. Shorter latency times were found for wrist/hand tendonitis, with a mean latency time of 5.4 years and with a greater sensitivity to the level of exposure assessed with the OCRA index value. This might support a sort of predictive value with reference to other UL-WMSDs with longer latency. Probably a latency period of 12 years may be suggested as the cut-off limit to assess a causal relationship between tendon or canalicular WMISDs and occupational exposure to repetitive movements and exertions of upper limbs.

[Upper limb work-related musculoskeletal disorders (UL-WMSDs): a retrospective cohort study in three large factories of the upholstered furniture industry]. / Patologia da sovraccarico biomeccanico degli arti superiori: studio retrospettivo di coorte in tre grandi aziende del mobile imbottito.

BACKGROUND: The epidemiological evidence of work-related musculoskeletal disorders (UL-WMSDs) due to repetitive strain and movements in the various industries has been collected in the literature mainly through cross-sectional surveys. In particular there are no contributions so far regarding the upholstered furniture industry with a longitudinal design. OBJECTIVES: The aim of the study was to evaluate the incidence rate of WMSDs such as hand-wrist and shoulder tendonitis, carpal tunnel syndrome, and epicondylitis in exposed workers of three large companies of the upholstered furniture industry in a large geographic area of southern Italy. METHODS: The OCRA method, recommended by international standard ISO 11228-3 and EN 1005-5, was used for risk assessment. The following work tasks were considered:.filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. A total population of 5,278 subjects (exposed n=2927, controls n=2351) was investigated. The person/year at risk parameters were calculated from 1 January 2000, or from the date of engagement if later, until the first diagnosis of WMSD or, in absence of disorders, until the end of the study, i.e. 31 December 2004. Disorders occurring after the first were not considered. A multiple regression analysis was used to evaluate relationships between rates. RESULTS AND CONCLUSIONS: Incidence rates correlated with risk classes of the OCRA index. An incidence rate of WMSDs higher than 1.2 cases per 100 person/year may be considered as a threshold value to suspect an occupational exposure to repetitive strain and movements warranting further investigation. The analysis of single factors did not show a greater predisposition of the female gender, with the single exception of the carpal tunnel syndrome (RR 2.92; 95% CI 1.57-5.43). Shoulder disorders affected mainly male leather-cutting operators (RR 4.97; 95% CI 2.03-12.16) and among all the factors influencing risk (frequency, force, posture, additional risk factors, pauses) posture seems to play a significant role.

MAPO index for risk assessment of patient manual handling in hospital wards: a validation study.

Manual handling of disabled patients - as regards movement - is one of the major factors affecting acute low back pain of exposed nursing staff. In the absence of quantitative methods assessing this kind of risk, the Research Unit Ergonomics of Posture and Movement of Milan developed in 1997 a risk assessment method called Movement and Assistance of Hospital Patients (MAPO), which is applicable in hospital wards.A first study conducted in 1999 allowed the identification of three levels of MAPO index corresponding with increasing probabilities of being affected by acute low back pain. In accordance with the well-known traffic light model, for MAPO index values between 0 and 1.5 the risk is considered to be absent or negligible. For values between 1.51 and 5.00 the risk is considered to be moderate. For values exceeding 5.00 the risk is considered to be high. In view of the limitations of the previous study, the results needed confirmation and so, in 2000-2001, another cross-sectional study was carried out, which included 191 hospital wards for acute and chronic patients and 2603 exposed subjects. This paper presents the analytical results of the association between the MAPO index and acute low back pain in this new data sample. The agreement between results of the two studies indicates that the MAPO index can be used as a risk index, although with some caution, as detailed in the paper. It can assess the risk exposure level of patient manual handling in wards and can be a useful tool for planning effective preventive actions to reduce the risk of work-related musculoskeletal disorders in health-care workers looking after disabled patients.

[Criteria for classification of upper limb work-related musculo-skeletal disorders due to biomechanical overload in occupational health. Consensus document by an Italian Working Group]. / Criteri per la trattazione e la classificazione di casi di malattia da sovraccarico biomeccanico degli arti superiori nell'ambito della medicina del lavoro. Documento di consenso di un gruppo di lavoro nazionale.

BACKGROUND AND OBJECTIVE: In a preliminary consensus document the authors proposed criteria and methods to identify upper limb work-related MSDs due to biomechanical overload. With this document they intend to define severity according to shared models and procedures so as to fit behaviours to diagnostic procedures and their medical-legal assessment. This becomes especially important in view of Ministerial Decree of April 27 2004 fixing the new lists of diseases having a possible work-related origin that must be reported by law in accordance with art. 139 of law n. 1124, and also on account of the impact of such diseases which, for the first time in Italy, are regulated by law. CONTENTS: The working group, which included INAIL and ISPESL experts and was fully supported by SIMFER (Italian Society of Physical Medicine and Rehabilitation) and SINC (Italian Society of Clinical Neurophysiology), defined a general clinical procedure (anamnesis, objective examination and instrumental assessment) regarding each portion of the concerned upper limb (shoulder, elbow and wrist/hand). Once the presence and characteristics of anatomic and functional damages are established, the results allow a classification scheme to be proposed of upper limb diseases (tendon disorders and entrapment neuropathy) divided into 6 increasing severity stages: initial, medium, medium-severe, severe and extremely severe. Special attention was paid to two instrumental examinations that proved to be of great clinical interest, at least in occupational health: echography of soft tissues (in appendix) and electroneurography for entrapment neuropathy. The limitations of this proposal are discussed but the main goal was achieved: to standardize terms and provide homogeneous criteria to achieve classification of upper limb damage due to biomechanical overload for increasing severity levels. The working group research activity is part of a research project funded by ISPESL.

[Musculoskeletal conditions of the upper and lower limbs as an occupational disease: what kind and under what conditions. Consensus document of a national working-group. ISPESL]. / Le affezioni muscolo-scheletriche degli arti superiori e inferiori come patologie professionali: quali e a quali condizioni. Documento di Consenso di un gruppo di lavoro nazionale. ISPESL.

BACKGROUND AND OBJECTIVES: In via of the progressive emergence in Italy of work-related musculoskeletal disorders, the EPM Research Unit decided to set up a national working group with the aim of producing a Consensus Document including methods and criteria as an initial attempt towards managing such diseases as true "listed" work-related diseases as is already done in the other European Union countries. The working group includes experts from INAIL, ISPESL, welfare assistance institutions, local prevention and health protection services: The group's research activity was included in ISPESL's funded research plan. CONTENTS: The Consensus Document includes a review of epidemiologic issues reported in the international literature, comments on the application of current legislation, observations on the guilt profiles of employers and occupational physicians, as well as medical-legal issues. The document proposes an analytical list of musculoskeletal disorders of upper (and lower) limbs and the operational criteria for identification of working activities involving a risk from upper limb biomechanical overload. In this case, more than on other occasions, it was realized how difficult it is to adopt consolidated task/risk/damage matrices since the same task may or may not be at risk depending both on the way the task is done and on the technical aspects (lines, work parts, procedures, tools) and organization (rate, rotas, breaks). CONCLUSIONS: For the specific aims of the present document, it is possible to identify, though not exhaustively and with some limitations, a series of jobs and working conditions where the risk may be reasonably presumed and for which it is possible to adopt a list system (at least as regards "significant exposure"). The document also includes a chapter on health surveillance recommendations for the occupational physician.

[The occupational risks and pathologies due to the manual lifting of patients in Italian legislation]. / I rischi e le patologie professionali da movimentazione manuale dei pazienti nella legislazione Italiana.

Current Italian legislation establishes all necessary details of intervention procedures aimed at elimination or substantial reduction of risk due to manual lifting of patients. Chapter V of Law No 626/94, which was a thoroughly innovative step in the field of safety, hygiene and prevention at the workplace, in 3 articles and one annex incorporated Community Directive 269/90 into Italian legislation. The model to approach manual load handling, whose definition can in all respects be transferred to health facilities where load means patients who are not self-sufficient in movement, sets out a precise strategy of actions. The first action is automation of the "production process", which is inapplicable in the health care sector; the second action is to provide "aids", which is perfectly applicable to the health care sector. A further action foreseen by the regulations that should be taken into consideration in addressing the problem of manual patient handling from the point of view of prevention is found in the Law (Presidential Decree) of 14/1/97 concerning criteria of accreditation of health facilities, which also refers to the regulations contained in Law 626/94. As regards the insurance coverage of acute or chronic impairment due to manual handling of loads/patients, these aspects are still not contemplated in any regulations. This contradiction became even more evident with the introduction of Law No 626/94 where in Chapter V reference is made to "dorsal-lumbar lesions". Although these lesions are recognized legally in the acute form (accidents), there are also degenerative diseases with chronic development, and the latter are not given any protection apart from the theoretical recognition contained in the Constitutional Court Sentence 179/88. It is to be hoped that the review process of the list of compensable occupational diseases will address this problem, too, so that it can be solved as soon as possible.

[The assessment of the risk due to the manual lifting of patients: the initial descriptive and analytical results on exposure levels]. / Valutazione del rischio da movimentazione manuale di pazienti: primi risultati descrittivi e analitici sui livelli di esposizione.

The paper reports the results of risk evaluation of patient lifting or moving obtained from a multicentre study on 216 wards, for both acute hospital patients and in geriatric residences. In all situations the exposure to patient lifting was assessed using a concise index (MAPO). Analysis of the results showed that only 9% of the workers could be considered as exposed to negligible risk (MAPO Index = 0-1.5); of these 95.7% worked in hospital wards and only 4.3% in geriatric wards. A further confirmation of the higher level of exposure of workers in long-term hospitalization was that 42.3% were exposed to elevated levels (MAPO Index > 5) compared with 27.7% observed in hospital ward workers. The mean values of the exposure index were 6.8 for hospital wards and 9.64 for geriatric residences and, although much higher in the latter, both categories showed high exposure. In the orthopaedic departments of the hospitals the values were higher than in the geriatric wards (MAPO Index = 10.1); medical and surgical departments showed values similar to the mean values observed in the geriatric wards. These high values were due to: severe shortage of equipment life lifting devices (95.5%) and minor aids (99.5%), partial inadequacy of the working environment (69.2%), poor training and information (96.1% lacking); only the supply of wheelchairs was adequate (65.8%). All of which points to an almost generalized non-observance of the regulations listed under Chapter V of Law No. 626/94. However, the proposed method of evaluation allows anyone who has to carry out prevention and improvement measures to identify priority criteria specifically aimed at the individual factors taken into consideration. By simulating an intervention for improvement aimed at equipment and training, 96% of the wards would be included in the negligible exposure class (MAPO Index 0-1.5).

[Initial epidemiological data on the clinical effects in health workers employed in the manual lifting of patients in wards]. / Primi dati epidemiologici sugli effetti clinici negli operatori sanitari addetti alla movimentazione manuale di pazienti nei reparti di degenza.

An investigation was carried out by teams from various centres coordinated by the EPM (Ergonomics of Posture and Movement) Research Unit on 54 different hospitals in various regions of northern and central Italy. The teams examined a total of 3341 health workers whose job involved manual handling of patients (553 male and 2788 females, 1568 working in hospitals and 1773 in geriatric residences). Numerous meetings were held to ensure that the methods of assessing the exposure indexes and spinal impairment were identical in the various teams. The final data were processed centrally at the EPM Research Unit. The sample analyzed may be considered as representative of the situation in hospitals in Italy, at least for northern and central Italy. The mean age was 36 years, mean length of service in the department 6 years and mean length of job duration not exceeding 10 years; staff turnover was high. Physical examination revealed that 8.4% of the workers had had at least one episode of acute low back pain in the previous 12 months: i.e., 4 times the values of the reference groups. Also in the case of clinical-functional spondyloarthropathies of the lumbosacral spine, in the females there was a significantly higher prevalence than in the reference groups. All disorders were more severe in sectors more at risk, i.e., old peoples homes, rehabilitation centres, orthopaedic and surgical departments, and in any case higher in old peoples homes and geriatric residences. The initial data concerning the ratio between presence of spinal disease and risk index were also positive.

[The application of a synthetic index of exposure in the manual lifting of patients: the initial validation experiences]. / L'applicazione dell'indice sintetico di esposizione nella movimentazione manuale pazienti: prime esperienze di validazione.

Via a multicentre study coordinated by the EPM research group carried out in 216 wards in a total of 56 hospitals, old peoples homes and geriatric departments, it was possible to quantify exposure to patient handling (classified in 4 classes: 0-1.5 negligible, 1.51-5 slight to average, 5.01-10 average to high, > 10 elevated), and at the same time identify the damage to the lumbosacral spine thus caused. Both assessment of exposure and identification of health impairment were carried out using homogeneous methods. Subjects with work seniority in the job of less than 6 months and subjects who had been transferred because of back trouble were excluded from the study. It was therefore possible to carry out two types of study to assess the association between exposure and impairment. In study A, covering 3021 subjects, an analysis was performed of the association between exposure index, positive response to the anamnestic threshold for lumbosacral disorders and acute low back pain using the method of logistic analysis to obtain the prevalence odds ratios. In study B, covering 418 subjects, the analysis of association was performed on the incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain, assuming that exposure in the wards had remained constant. The technique used was Poisson regression, thereby calculating the relative incidence rate ratios. Both for PORs and IRRs the reference group consisted of the exposure class judged as negligible (exposure index 0-1.5). The results showed that the PORs calculated for positive lumbar threshold were significant for increasing exposure classes with a positive trend for the second and third exposure class but not for the last, presumably due to a healthy worker selection effect. Neither in Study A nor in Study B were any associations observed between exposure and acute low back pain occurring in the previous 12 months: this may be due to the fact that the impairment indicator does not appear to be appropriate in terms of latency period. A different result was obtained in Study B which showed a good association between exposure and incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain according to department. The IRRs showed a positive trend both for acute episodes (IRR: 1.932, 2.439, 2.847) and for acute plus pharmacologically controlled acute episodes (1.798, 1.830, 4.523). On the basis of these results, even with the caution required for the reasons explained in the text, it seems to be possible to identify three grades of exposure which correspond to increasing probability of impairment of the lumbosacral region of the spine: the first where risk seems negligible corresponds to an exposure level between 0 and 1.5. The second, where the episodes of low back pain may occur with an incidence 3.8 times greater, corresponds to an exposure level between 1.51 and 5, and the third corresponds to exposure levels exceeding 5, where the episodes of low back pain may occur with an incidence up to 5.6 times greater than expected.

[Worker turnover because of spinal pathologies in the wards and outpatient clinics of the hospitals of Leno and Manerbo, Brescia]. / Il turn-over, per patologie del rachide, dei lavoratori nei reparti di degenza e negli ambulatori degli ospedali di Leno e Manerbio (BS).

A total of 306 employees of the hospitals of the Leno/Manerbio health area underwent clinical and anamnestic examination in order to ascertain the existence of degenerative diseases of the spine associated with "manual handling of loads" risk. The prevalences obtained for positive anamnestic threshold concerning the lumbosacral spine, the trend of total acute low back pain and of low back pain in the last year showed lower values compared to the entire national group and in any case lower or only slightly above the values for the reference group of non-exposed subjects. Therefore, in order to assess the real prevalences of disorders due to incorrect load handling in hospital environments, it is important to assess the presence of associated disorders of the spine also and especially in outpatients departments. In fact, unsuitable or unfit staff had recently been transferred from the wards to outpatients departments. 56 workers from outpatients departments underwent physical-anamnestic examination: 16 workers (4.5% of the entire group under study) from average-to-high risk wards were identified as suffering from degenerative disorders of the lumbosacral spine. Therefore the prevalence of unfit subjects from hospital wards, cancelling the effect of the turnover factor on outpatients departments, led to an almost twofold total frequency, which rose from 6.9% to 11.4%.

[Acute lumbago due to the manual lifting of patients in wards: prevalence and incidence data]. / La lombalgia acuta da movimentazione manuale di pazienti nei reparti di degenza: dati di prevalenza e incidenza.

The aim of the study was to measure the occurrence (prevalence and incidence) of episodes of acute low back pain (definite effect) in a wide sample of health workers assisting disabled patients. A questionnaire was used for the study both of true acute low back pain and of episodes of ingravescent low back pain controlled pharmacologically at the onset. The questionnaire identified overall acute and pharmacologically controlled episodes occurring in the previous 12 months, both in the course of work and over the whole life of the subject. Appropriately trained operators administered the questionnaire to 551 subjects; 481 valid answer cards were obtained from 372 females and 109 males working in medical, orthopaedic and geriatric departments. 75.4% of the sample had high exposure index levels for patient lifting. The prevalence of true acute low back pain was 9% in males and 11% in females referred to the previous 12 months. Taking acute true and pharmacologically controlled low back pain together the prevalences rose to 13.8% for males and 26.9% in females. Data from the reference populations showed that acute low back pain did not exceed 3% on average in the previous year. Since work seniority in the hospital wards was known, the incidences were calculated, giving 7.9% in females and 5.29% in males for acute low back pain, and 19% in females and 3.49% in males for pharmacologically controlled low back pain. Considering the number of episodes in 100 workers/year, acute low back pain alone reached prevalences of 13-14%. This therefore appears to confirm the positive ratio between episodes of low back pain and duties involving assistance to disabled patients.

The occurrence of musculoskeletal alterations in worker populations not exposed to repetitive tasks of the upper limbs.

A total of 749 workers (males: 139 aged between 15 and 35 years, and 171 aged > 35 years; females: 176 aged between 15 and 35 years, and 263 aged > 35 years) performing tasks not at risk for work-related musculoskeletal disorders of the upper limbs (WMSDs) underwent a clinical examination using a standardized method. The 'anamnestic cases' were defined on the basis of pain or paraesthesia present for at least 1 week during the previous 12 months, or appearing at least once a month, and not subsequent to acute trauma. The anamnestic cases among the males amounted to 4.4% (age 15-35 years) and 12.3% (age > 35 years); among the females, 4.6% (age 15-35 years) and 14.2% (age > 35 years). Of the 1498 limbs examined, the prevalent diseases reported were: suspect narrow chest syndrome: 0.3% among the males > 35 years, 0.6% among the females aged 15-35 years, 1% among the females > 35 years; scapulo-humeral periarthritis: 0.3% among the males aged > 35 years, 0.3% among the females aged 15-35 years, 1.3% among the females aged > 35 years; lateral epicondylitis: 0.3% among the males aged > 35 years, 0.2% among the females aged > 35 years; trapeziometacarpal arthrosis: 0.8% among the females aged > 35 years; wrist-hand tendinitis: 0.9% among the males aged > 35 years, 0.9% among the females aged 15-35 years; carpal tunnel syndrome: 2.5% among the females aged > 35 years. No disorders were detected outside the age ranges indicated. Several workers reported more than one disorder. The number of workers with at least one WMSD was: males 0% in the 15-35 years age range, 3.5% in the > 35 years age range; females 2.3% in the 15-35 years age range, 7.2% in the > 35 year age range; 3.9% of the total sample population. The prevalences were on average quite low, particularly among the older workers, hence the authors recommend that even minimal prevalences detected in particular work environments should not be underestimated.

Criteria for the reintegration in the workforce of workers with musculoskeletal disorders of the upper limbs, based on preliminary practical experience.

This paper presents a preliminary study on the return to the workforce of employees with WMSDs of the upper limbs, and their reallocation to jobs with 'low exposure'. The study, which is still underway, involves a large engineering firm and includes some 100 workers affected by WMSDs. The trial involved: providing a definition of the criteria for characterizing 'accommodating' jobs (i.e. frequency of action < 20 actions/min; virtual absence of other risk factors such as force, awkward posture, inadequate pauses, etc.); effectively identifying jobs meeting such criteria (or jobs which, with minimal modifications, could be made suitable); classifying WMSD workers according to the type and severity of the disorder; matching WMSD workers with the jobs best suited to them; specific training for the workers and their supervisors; carrying out a follow-up of the return of WMSD workers to the workforce in organizational terms (i.e. the need for further modifications to equipment or procedures) and clinical terms (i.e. symptom patterns, acceptability of the condition). The preliminary results, 6-12 months after the start of the trial, are extremely encouraging, and show that when workers return to the workforce in jobs that fully meet defined criteria, a significant prevalence of 'improvements' are reported among the workers involved. The investigation will need to be extended but it already shows quite convincingly that it is possible for workers with what can be described as a 'reduced working capacity' to remain 'productive' (albeit in jobs featuring a lower exposure potential than the acceptable threshold for 'healthy' workers).