Upper extremity musculoskeletal disorders and work exposures among railroad maintenance-of-way workers.

BACKGROUND: Our objective was to examine occupational risk factors for musculoskeletal disorders of the shoulders, elbows, wrists, and hands among railroad maintenance-of-way (MOW) workers. Little systematic research on musculoskeletal disorders has been conducted in this occupational group. METHODS: In total, 3995 active members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a standardized survey focusing on disorders caused by hand-transmitted vibration. We computed adjusted prevalence ratios (aPRs) using Poisson regression for shoulder, elbow, carpal tunnel syndrome, and vibration white finger musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, potential second job, and spare time vehicle vibration exposure, and other work exposures. RESULTS: Among active male BMWED members, we found associations between >5.2 years (vs. 0.0-0.7 years) duration of full-time equivalent power tool use and shoulder pain (aPR = 2.01; 95% confidence interval [CI], 1.43-2.85), elbow pain (aPR = 2.88; 95% CI, 1.86-4.46), vibration white finger symptoms (aPR = 2.49; 95% CI, 1.06-5.85), hand/wrist pain (aPR = 2.40; 95% CI, 1.74-3.32), finger numbness or tingling (aPR = 1.86; 95% CI, 1.38-2.50) and self-reported carpal tunnel syndrome diagnosis (aPR = 2.16; 95% CI, 1.24-3.77). Associations were not consistent across outcomes for the duration of non-powered hand tool use and "repeated lifting, pushing, pulling, or bending." Positive gradients were observed for most outcomes. CONCLUSIONS: Hand-arm vibration and some other biomechanical exposures were associated with shoulder, elbow, wrist, hand, and finger symptoms. Prevention programs should address occupational risk factors for upper extremity musculoskeletal disorders among MOW workers.

Powered-hand tools and vibration-related disorders in US-railway maintenance-of-way workers.

Maintenance-of-way workers in North America who construct railroad tracks utilize specialized powered-hand tools, which lead to hand-transmitted vibration exposure. In this study, the maintenance-of-way workers were surveyed about neuro-musculoskeletal disorders, powered-hand tools and work practices. Information about vibration emission data of trade specific powered-hand tools for the North American and European Union markets was searched online to obtain respective user information of manufacturer and compared to non-commercial international data banks. The survey showed that maintenance-of-way workers frequently reported typical hand-transmitted vibration-related symptoms, and appear to be at a risk for neuro-musculoskeletal disorders of the upper extremity. Of all of the powered-hand tools used by this trade, 88% of the selected tools exceeded a=5 m/s2 and were above vibration magnitudes of common tools of other comparable industries. This may create a risk if these tools are used throughout an 8-h work day and management of vibration exposure may be needed. In the North-American market, limited or no vibration emission data is available from manufacturers or distributors. Vibration emission information for powered-hand tools, including vibration emission levels (in m/s2), uncertainty factor K, and the applied testing standard/norm may assist employers, users and occupational health providers to better assess, compare and manage risk.

Occupational risk factors for musculoskeletal disorders among railroad maintenance-of-way workers.

BACKGROUND: Our objective was to examine occupational risk factors for musculoskeletal disorders of the neck, back, and knee among railroad maintenance-of-way (MOW) workers. METHODS: Four thousand eight-hundred sixteen active, retired, and disabled members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a survey. We computed adjusted prevalence ratios (aPRs) using Poisson regression for neck, back, and knee musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, and potential second job and spare time vehicle vibration exposure. RESULTS: Among active male BMWED members, we found associations between use of high-vibration vehicles and neck pain (aPR = 1.47, 95% confidence interval (CI): 1.07-2.03) and knee pain (aPR = 1.38, 95% CI: 1.04-1.82) for more than 1.9 years (vs 0) of full-time equivalent use; but not back pain. Back pain radiating below the knee (sciatica indicator) was associated with high-vibration vehicle use greater than 0.4 and less than 1.9 years (aPR = 1.58, 95% CI: 1.15-2.18). We also found significant associations between often or always lifting, pushing, pulling, or bending on the job (vs seldom or never) and neck pain (aPR = 2.43, 95% CI: 1.20-4.90), back pain (aPR = 1.94, 95% CI: 1.24-3.03), the sciatica indicator (aPR = 5.18, 95% CI: 1.28-20.95), and knee pain (aPR = 2.84, 95% CI: 1.47-5.51), along with positive gradients in the outcome by exposure time. CONCLUSIONS: Biomechanical work exposures, including force and nonneutral postures, were associated with neck, lower back, and knee pain. Whole-body vibration, as measured by the duration of use of high-vibration vehicles, was associated with neck pain, knee pain, and sciatica. Prevention programs should address occupational risk factors for musculoskeletal disorders among MOW workers.

Work Exposures and Musculoskeletal Disorders Among Railroad Maintenance-of-Way Workers.

OBJECTIVE: The aim of this study was to measure musculoskeletal disorders and occupational risk factors among railroad maintenance-of-way (MOW) workers. METHODS: Four thousand eight hundred sixteen active, retired, and disabled members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a survey. RESULTS: Compared with U.S. employed men, adjusting for age, race, and region, active male MOW workers were more likely to report "repeated lifting, pushing, pulling, or bending" at work (74.6% vs 46.9%), not enough staff (88.1% vs 65.2%), and a diagnosis of carpal tunnel syndrome (7.9% vs 3.6%). They were less likely to report management priority on workplace health and safety (59.37% vs 94.8%), ability to make job decisions on their own (68.4% vs 87.7%), and supervisor support (60.3% vs 90.8%) (all comparisons, P < 0.001). CONCLUSION: Prevention programs should address risk of musculoskeletal disorders and occupational hazards faced by MOW workers.

Whole-body vibration-related health disorders in occupational medicine--an international comparison.

Workers with whole-body vibration (WBV) exposure are likely to report non-specific health complaints. Health and safety providers may not recognise such occupational injuries and may be unfamiliar with appropriate exposure assessment and prevention. This is a review of clinical studies, medical evidence, differential diagnostic evaluation protocols, surveillance programmes, national and international standards, and interventions recommendations utilising PubMed and other online resources. In summary, several studies show a clear trend: with increasing duration and intensity of occupational WBV exposure, primarily musculoskeletal or neurological disorders of the spine occur. Other organ damage has also been reported. In some European Union countries, spinal injury caused by WBV is recognised as an occupational disease and may be compensable. The WBV-related injury diagnosis includes a review of the work history, exposure assessment and differential diagnostic evaluation. WBV health surveillance should assess health status of WBV-exposed workers and address preventive measures. PRACTITIONER SUMMARY: Workers with whole-body vibration exposure report a variety of physical disorders. Health and safety providers may not recognise such injuries, or may be unfamiliar with exposure assessment and prevention. This review addresses health issues, exposure assessment and an international review of compensation criteria, trends and prevention efforts.

Review of health hazards and prevention measures for response and recovery workers and volunteers after natural disasters, flooding, and water damage: mold and dampness.

Health problems and illnesses encountered by unprotected workers, first-responders, home-owners, and volunteers in recovery and restoration of moldy indoor environments after hurricanes, typhoons, tropical storms, and flooding damage are a growing concern for healthcare providers and disaster medicine throughout the world. Damp building materials, particularly cellulose-containing substrates, are prone to fungal (mold) and bacterial infestation. During remediation and demolition work, the airborne concentrations of such microbes and their by-products can rise significantly and result in an exposure risk. Symptoms reported by unprotected workers and volunteers may relate to reactions of the airways, skin, mucous membranes, or internal organs. Dampness-related fungi are primarily associated with allergies, respiratory symptoms or diseases such as dermatitis, rhinosinusitis, bronchitis, and asthma, as well as changes of the immunological system. Also, cognitive, endocrine, or rheumatological changes have been reported. Based on the consensus among experts at a recent scientific conference and a literature review, it is generally recommended to avoid and minimize unnecessary fungal exposure and use appropriate personal protective equipment (PPE) in disaster response and recovery work. Mycologists recommend addressing any moisture or water intrusion rapidly, since significant mold growth can occur within 48 h. Systematic source removal, cleaning with "soap and water," and "bulk removal" followed by high-efficiency particulate air vacuuming is recommended in most cases; use of "biocides" should be avoided in occupied areas. Public health agencies recommend use of adequate respiratory, skin, and eye protection. Workers can be protected against these diseases by use of dust control measures and appropriate personal protective equipment. At a minimum, a facial dust mask such as the National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirator should be used for mold remediation jobs. For any large-scale projects, trained remediation workers who have medical clearance and use proper personal protection (PPE) should be employed.

Vibration and shock exposure of maintenance-of-way vehicles in the railroad industry.

The aim of this study is to investigate and compare vibration and shock measurements of maintenance-of-way vehicles used in the railroad industry for track maintenance and construction. Following international standards (i.e., ISO 2631-1: 1997) and professional guidelines the frequency weighted root-mean-square (r.m.s.) acceleration for each measurement axis, the vector sum, the seat effective amplitude transmissibility (SEAT), the crest factor (CF), the maximum transient vibration value (MTVV), the vibration dose value (VDV), the ratio and the newly proposed shock risk estimation factor 'R' for spinal injury according to ISO 2631-5:2004 were measured and calculated for seven different maintenance-of-way vehicles during revenue service. Furthermore, a proposed alternative spinal injury prediction method, the VibRisk model, which incorporates different typical driver postures and operator physical characteristics was included for comparison with the ISO 2631-5 risk prediction. The results of the vibration exposure measurements depended on vehicle type, track/surface conditions and seat properties, with the tamper and bulldozer showing the highest r.m.s. vibration values. The vector sum (a(v)) results ranged from 0.37 to 0.99 (m/s(2)). Five of seven track maintenance vehicles would exceed the current Whole-body Vibration ACGIH-TLV(®) guideline for an 8 h exposure duration in the vertical axis recommended by the American Conference of Governmental Industrial Hygienists (ACGIH). The measured CF, MTVV/a(w) and VDV/(a(w)·T(1/4)) ratios were at or above the critical ratios in the majority of measurements given by the ISO 2631-1 (1997) and American industry guidelines by the American Conference of Governmental Industrial Hygienists (ACGIH-TLV). Comparing both prediction models for vibration shock risk for parts of the lumbar spine, different risk predictions and inconsistencies were found. The VibRisk model generally suggests different and higher risk of vertebral endplate failure for individual lumbar levels, whereas the ISO 2631-5 model indicated generally lower risks and did not differentiate between different disk levels and driver posture. Epidemiological studies validating the different shock risk models are lacking. Work modifications and adequate suspension seats would be beneficial for prevention of harmful exposure to vibration and shocks.

Cognitive impairment associated with toxigenic fungal exposure: a response to two critiques.

Fox, Greiffenstein, and Lees-Haley (2005) and McCaffrey and Yantz (2005) criticized our 2004 article that reported neuropsychological evidence of cognitive impairment in a sample of individuals exposed to toxic molds who complained of cognitive difficulties (Gordon et al., 2004). They critiqued the study's justification, design, analyses, and conclusions and characterized it as poor epidemiology. This article is a rebuttal to their comments. It documents that both sets of negative comments are based on frequent inaccuracies, mischaracterizations of our findings, and red herrings. Furthermore, they failed to refute the implications of the study's main findings.

Cognitive impairment associated with toxigenic fungal exposure: a replication and extension of previous findings.

In this study, neuropsychological data and symptom reports from 31 individuals exposed to toxic mold were examined. Most participants were found to have reduced cognitive functioning in multiple domains, with memory and executive functions the most commonly affected areas. Rates of dysfunction were significantly greater than chance on more than half of the tests. Number of cognitive impairments was found to be related to depression, although few neuropsychological test scores were correlated with depression. Results also indicated that symptom report of the mold-exposed participants was not significantly different from that of matched groups of 65 persons with mild traumatic brain injury (TBI) and 26 individuals with moderate TBI. The mold-exposed participants reported significantly more symptoms than 47 people with no disability. This study adds to a growing body of literature (e.g., Baldo, Ahmad, & Ruff, 2002; Gordon, Johanning, & Haddad, 1999) relating exposure to mycotoxins to cognitive dysfunction.

Indoor moisture and mold-related health problems.

Moisture, microbial and in particular mold related indoor exposure and health problems in homes, offices, and public buildings (Kindergartens, schools, library, and hospitals) have been gaining recognition as one of the most common indoor environmental health issues. Proper recognition of microbial related health problems and the differential diagnosis of sick building syndrome (SBS) or building related illness (BRI) are important for early and effective exposure intervention, treatment, referral and prevention of more serious illness.

Whole-body vibration exposure study in U.S. railroad locomotives--an ergonomic risk assessment.

Whole-body vibration exposure of locomotive engineers and the vibration attenuation of seats in 22 U.S. locomotives (built between 1959 and 2000) was studied during normal revenue service and following international measurement guidelines. Triaxial vibration measurements (duration mean 155 min, range 84-383 min) on the seat and on the floor were compared. In addition to the basic vibration evaluation (aw rms), the vector sum (av), the maximum transient vibration value (MTVV/aw), the vibration dose value (VDV/(aw T1/4)), and the vibration seat effective transmissibility factor (SEAT) were calculated. The power spectral densities are also reported. The mean basic vibration level (aw rms) was for the fore-aft axis x = 0.18 m/sec2, the lateral axis y = 0.28 m/sec2, and the vertical axis z = 0.32 m/sec2. The mean vector sum was 0.59 m/sec2 (range 0.27 to 1.44). The crest factors were generally at or above 9 in the horizontal and vertical axis. The mean MTVV/aw was 5.3 (x), 5.1 (y), and 4.8 (z), and the VDV/(aw T1/4) values ranged from 1.32 to 2.3 (x-axis), 1.33 to 1.7 (y-axis), and 1.38 to 1.86 (z-axis), generally indicating high levels of shocks. The mean seat transmissibility factor (SEAT) was 1.4 (x) and 1.2 (y) and 1 (z), demonstrating a general ineffectiveness of any of the seat suspension systems. In conclusion, these data indicate that locomotive rides are characterized by relatively high shock content (acceleration peaks) of the vibration signal in all directions. Locomotive vertical and lateral vibrations are similar, which appears to be characteristic for rail vehicles compared with many road/off-road vehicles. Tested locomotive cab seats currently in use (new or old) appear inadequate to reduce potentially harmful vibration and shocks transmitted to the seated operator, and older seats particularly lack basic ergonomic features regarding adjustability and postural support.