Programmed health surveillance and detection of emerging diseases in occupational health: contribution of the French national occupational disease surveillance and prevention network (RNV3P).

OBJECTIVE: The French national occupational disease surveillance and prevention network (RNV3P) includes the 30 occupational disease consultation centres in university hospitals to which patients are referred for potentially work-related diseases, and an occupational health service. The aim of this work is to demonstrate the contribution of RNV3P to national health surveillance. METHODS: Data from consultations are recorded in standardised occupational health reports and coded using international or national classifications. Programmed health surveillance is carried out through annual follow-up of annual referrals to experts for pre-selected disease-exposure associations, as well as incidence estimations for the well characterised working population followed by the occupational health service. Hypotheses on new emerging diseases are generated using statistical methods employed in pharmacosurveillance and by modelling as an exposome to analyse multiple exposures. RESULTS: 58,777 occupational health reports were collected and analysed from 2001 to 2007. Referrals to the 30 university hospital centres increased significantly for asbestos-related diseases, mood disorders and adjustment disorders related to psychological and organisational demands, and for elbow and shoulder disorders related to manual handling. Referrals significantly decreased for asthma and for rhinitis related to exposure to organic dusts (vegetable or animal) or chemicals, except for cosmetics and cleaning products. Estimation of incidences by the occupational health services showed different patterns in different sectors of activity. The methods for detecting emerging diseases are presented and illustrated using the example of systemic sclerosis, identifying new exposures and new sectors of activity to be investigated. CONCLUSION: The RNV3P collects data from two complementary samples: 30 university hospital centres (workers or former workers) and an occupational health service (current workers). This dual approach is useful for surveillance and for hypothesis generation on new emerging disease-exposure associations.

The dynamic course of musculoskeletal disorders in an assembly line factory.

OBJECTIVES: To describe the course of employee-individual clinical status with respect to upper limb musculoskeletal disorders (UL-MSDs), epidemiological surveillance of UL-MSDs was implemented for three consecutive years at a household appliance assembly company. METHODS: A standardized clinical examination guide was used to survey UL-MSDs of employees seen in annual consultation. Recorded data included eight specific UL-MSDs as well as the main sociodemographic characteristics of employees. Univariate and multivariate analysis were performed. Significance was defined as P<0.05. All statistical analysis were performed with Statgraphics (version 5.1) software. RESULTS: During three consecutive years, 459 employees were seen in the occupational medicine consultation. The annual prevalence of UL-MSD cases was 20.2% in 2000, 21.7% in 2001 and 24.0% in 2002. In fact, this relative stability conceals significant renewal of the population suffering from UL-MSDs with time, illustrated by both a high rate of annual incidence of cases (9.8 and 13.5% in 2001 and 2002, respectively) and a high rate of annual recoveries (37.0 and 44.3% in 2001 and 2002, respectively). CONCLUSION: Factors governing variation in individual clinical status of employees with respect to UL-MSDs and their interactions remain little known and open up interesting research prospects.

Incidence of Stress and Psychosocial Factors on Musculoskeletal Disorders in CAD and Data Entry.

A comparative study concerning the incidence of psychosocial factors and stress on musculoskeletal disorders (MSD) was conducted on 30 males carrying out a computer-aided design (CAD) task and on 26 females carrying out a data entry task. Both populations completed a questionnaire concerning complaints of MSD, stress symptoms, psychosocial factors and working life. This study showed that the work context was more favourable to the data entry task operators than to the CAD task operators. In addition, there were relationships in CAD and in data entry between complaints of MSD and stress variables as well as between anguish and psychosocial factors. This field study has shown the importance of stress and of the work context in the occurrence of MSD in computer work.

Biomechanical stresses in computer-aided design and in data entry.

A study of the risk factors of musculoskeletal disorders (MSDs) of the upper limbs was carried out on 2 populations, 1 performing a computer-aided design (CAD) task and the other performing a data entry task. A questionnaire on MSD complaints and working life was completed by a sample of each population. Biomechanical measurements of the forces, the angles, and the repetitiveness of movements of the upper limbs were carried out on some operators in each sample. It emerged that complaints of the upper limbs seem to be linked to the use of input devices. The grip forces exerted when using the keyboard and mouse were higher in CAD than in data entry.

Integration of ergonomics into hand tool design: principle and presentation of an example.

The development of ergonomic tools responds to health protection needs on the part of workers, especially the work related musculoskeletal disorders of the upper limbs and to the development of ergonomic tools to take into account the needs of the factories. Only an ergonomic design process can enable tool manufacturers to meet these requirements. Three factors are involved: integration of ergonomics into the design process, definition of the different ergonomic stages involved, and finally knowledge of the different factors involved in hand tool design. This document examines these 3 elements in more detail and presents briefly a project of research whose main purpose is to integrate ergonomic criteria into a design process.

Work-related musculoskeletal disorders of the upper limb.

Work-related musculoskeletal disorders of the upper limb (WRMSDs-UL) account for over two-thirds of all occupational disorders recognized in France. This broad term encompasses a vast array of disorders whose development is facilitated by environmental factors present at the workplace. Numerous epidemiological studies have established the key role of occupational activities in the genesis of WRMSDs-UL. This role is mediated by biomechanical factors (repetitive motion, strenuous effort, extreme joint postures) and/or psychosocial factors. Biological plausibility supports the epidemiological data. The high incidence of WRMSDs-UL indicates a need for greater emphasis on prevention.