The TACOs (time-based assessment computerized strategy) approach to evaluating occupational working postures.

Many investigations of biomechanical overload concentrate on upper limbs and manual handling: certain jobs require an evaluation on spinal and lower limb postures. While existing methodologies adequately describe postures, they often poorly consider the organisation. This shortcoming prompted the development of TACOs for spinal and lower limb postures, using organisational factors to adjust the risk indexes. The TACOs is set out in steps: task identification, posture assessment, duration, and a final evaluation also for complex cycles. Given the complexity, tools have been devised, free downloadable, to facilitate evaluation. Studies on the TACOs reliability indicate excellent intra-observer and moderate interobserver agreement. TACOs, defining the task as a measurement unit, offers the advantage of assessing postures more easily and, considering duration, provides precise evaluation of the final risk. While the method does not demonstrate predictive validity regarding related diseases, it nonetheless enables the classification of exposure levels, even in complex multitask scenarios.

The development of TACOs strategy for posture analysis stems from the need to modulate the intensity of posture risk factors in relation with duration. It estimates final exposure scores in real work through detailed preliminary organisational studies. This involves identifying tasks, assessing postures for type and duration in work period.

First results of the application of the Latin Questionnaire in comparison with populations of reference workers obtained through preliminary epidemiological studies.

Introduction: The authors proposed an application study of the Latin Questionnaire, an updated protocol to conduct the anamnestic study of work-related musculoskeletal disorders through closed questions and the introduction of a predetermined severity threshold that allows for epidemiological studies to be conducted, comparing the results of the exposed population with those of a reference population. Background: Similar protocols describing work-related musculoskeletal disorders occurring in the previous 12 months are available in the literature. For many of these, problems arise when the results must be processed collectively. Objectives: Here we present application examples, with comments on the results in terms of statistical significance of the comparison. Methods: The anamnestic study of the Latin Questionnaire is based on symptoms: discomfort, pain, and evaluation of paresthesia. Each symptom is described considering: location, duration, number of episodes, irradiation, and treatment. The model, which covers the previous 12 months, is designed to identify in the spine, upper and lower limbs: positive anamnestic case, case with minor disorders, negative case. Results: The original application examples show the scope of the disorders presented in the groups of workers exposed to known risk, in comparison with those of the reference group: the significance of the differences is estimated statistically. Conclusions: The Latin Questionnaire, also implemented in the digital format (free to download), allows for comparing the data of exposed and unexposed workers and their statistical significance easily and automatically.

Introducción: Los autores propusieron un estudio de aplicación del Cuestionario Latino, un protocolo actualizado para realizar el estudio anamnésico de los trastornos musculoesqueléticos relacionados con el trabajo a través de preguntas cerradas y la introducción de un umbral de gravedad predeterminada que permiten realizar estudios epidemiológicos comparando los resultados de la población expuesta con los de una población de referencia. Antecedentes: Se encuentran disponibles en la literatura protocolos similares que describen los trastornos musculoesqueléticos relacionados con el trabajo ocurridos en los 12 meses anteriores. Para muchos de estos surgen problemas cuando los resultados deben procesarse colectivamente. Objetivos: Aquí presentamos ejemplos de aplicación, con comentarios sobre los resultados en términos de significación estadística de la comparación. Métodos: El estudio anamnésico del Cuestionario Latino se basa en los síntomas: molestia, dolor y evaluación de parestesia. Cada síntoma se describe considerando: localización, duración, número de episodios, irradiación, tratamiento. El modelo, que cubre los 12 meses anteriores, está diseñado para identificar en la columna y en los miembros superiores e inferiores: caso anamnésico positivo, caso con trastornos menores, caso negativo. Resultados: Los ejemplos originales de aplicación muestran el alcance de los trastornos presentados en los grupos de trabajadores expuestos a un riesgo conocido, en comparación con los del grupo de referencia; la significancia de las diferencias se estima estadísticamente. Conclusiones: El Cuestionario Latino, implementado también en forma digital (de descarga gratuita), permite comparar de manera fácil y automática los datos de trabajadores expuestos y no expuestos y su significación estadística.

Latin Questionnaire: a threshold strategy for anamnestic screening of occupational musculoskeletal disorders through specific reference groups.

Introduction: Health surveillance programs conducted for both individual workers and working populations as a whole are managed by occupational health physicians and focus on disorders and diseases caused by biomechanical overload, primarily for preventive purposes. Objectives: The purpose of the paper is to update an anamnestic protocol for studying musculoskeletal disorders after more than 40 years experience of its application. The updated version has been re-named the Latin Questionnaire. The protocol enables preliminary epidemiological evaluation, by comparing results of exposed populations to those from a reference population, thanks to the introduction of a severity threshold, a concept lacking in similar questionnaires. Methods: The Latin Questionnaire is based on symptoms of discomfort, pain, and paraesthesia. Each symptom is described in terms of location, duration, number of episodes, irradiation, and treatment. The model covers present symptoms during the previous 12 months and is designed to identify positive anamnestic cases (when positive according to the threshold), cases with minor disorders, and negative cases for conditions involving the spine and upper and lower limbs. Results: The updated anamnestic model was validated again through the collaborative effort involving 37 physicians from 14 Latin countries. To enable comparisons with exposed populations, an updated reference population (4,000 unexposed workers) is presented, evaluating the percentages of subjects positive according to thresholds for spine and upper and lower limbs and the incidence of acute lower back pain, broken down by gender and age groups. Examples of application of the questionnaire are also presented. Conclusions: The Latin Questionnaire, which has also been implemented in digital form (free download), allows selection of significant anamnestic cases compared to cases with minor disorders. This strategy is indispensable for correctly conducting preliminary epidemiological studies. Example applications confirm the presence of significant differences between the percentages of subjects with positive thresholds in exposed compared to reference groups, with surpluses proportional to their levels of biomechanical overload.

Scientific basis of the OCRA method for risk assessment of biomechanical overload of upper limb, as preferred method in ISO standards on biomechanical risk factors.

We are writing in regards to Armstrong et al`s recent discussion paper (1), which addresses the scientific basis of ISO standards on biomechanical risk factors and more specifically the OCRA methodology. The paper comments on the ISO's working methods, but it will be up to the ISO to respond if it sees fit to do so. As the authors of the OCRA method, we wish to respond in a individual capacity. For several years, we have belonged to an ISO working group (ISO TC 159/SC3/WG4) advocating methods for the assessment of biomechanical overload risk; the members of the working group come from various countries and represent public authorities, social partners and researchers with particular expertise in this field. Our decision to send this letter to the editor was motivated by the following position put forth in Armstrong et al`s paper concerning the rigor of development of the ISO ergonomics standards: "The production of the ISO ergonomics standards differed substantially from the writing of evidence-based practical guidelines. According to the limited information provided in the published documents, the ISO ergonomics standards were not based on a systematic search and appraisal of available literature. It is not clear why the ISO subcommittee preferred one method of risk assessment over others. For instance, the ISO 11228-3 identified three detailed risk assessment methods for repetitive hand exertions at high frequency: OCRA (a concise index for the assessment of exposure to repetitive movements of the upper limbs) (20), ACGIH hand activity level (HAL) (21), and the Strain Index (22), but preferred the OCRA methods without providing a scientific basis or comparison (eg, intra- and inter-observer reliability, strength of association with musculoskeletal disorders (MSD), etc.) even though such comparisons are available in the literature (13, 23). As a result, some statements in ISO 11228-3 appear to be based on personal opinions and are in contrast with scientific evidence from the literature. For instance, the ISO standard includes a statement "in many epidemiological surveys it (OCRA) has shown itself to be well related with health effects (such as the occurrence of UL-WMSD [upper limb-work related MSD)]" (13). This statement was not supported by a well-designed epidemiological study in 2007 when the ISO standard was published (19). Indeed, in 2010, Takala and colleagues noted the absence of longitudinal studies on the association between the OCRA index and the risk of MSD. They also pointed out the absence of studies on the repeatability of the OCRA method (13)". (Note: the references in italic relate to the original paper). We would like to point out that the ISO standards in question (2) were actually developed by the working group, as mandated by ISO, over the period 2000‒2004.The years leading up to the publication of the standard (2005‒2007) were dedicated to the challenging task of democratically seeking the endorsement of the ISO member countries. During this time, no significant changes could be made to the basic text other than those arising from specific observations or comments from the countries. This needs to be taken into account, especially when debating the references underpinning the standard. More specifically, the standard in question (ISO 11228-3) (2) in Annex A, clearly states that the general reference model for assessing "repetitive, high frequency, low load movements of the upper limbs" is a Consensus Document, drafted and published in 2001 by the IEA-Technical Committee on Musculoskeletal Disorders, with the endorsement of the International Commission on Occupational Health (ICOH) (3). The study considered at least 14 different methods that have over time been suggested in the literature as briefly summarized in the same ISO standard (2). The recommendations set forth in this vital Consensus Document went on to become the basis for choosing the most appropriate methods to suggest to future users through the standard (OCRA; ACGIH Hand Activity Level (HAL); Strain Index), each with their respective merits and limits in compliance with the criteria set out in the Consensus Document and taking into account their applicability in the field and ability to interpret the results of the risk assessment. It is against this background, and in light of the rationale described in Annex A, that the entire group agreed that the OCRA method was to be considered as the "preferred" method, insofar as it was deemed to best match the recommendations laid out in the aforementioned Consensus Document. Furthermore the OCRA method was, at the time, the only risk assessment method supported by the results of several epidemiological, albeit cross-sectional studies, uniquely available in literature. The study was based on a very large number of cases (>5000 cases) with results both of risk evaluation of upper-limb biomechanical overload (using the OCRA method) and of musculo-skeletal clinical examination (assessing the corresponding diseases). Such studies were reported in a special issue of Ergonomics (4), in an updated paper ‒ first published in Italian (5) ‒ also in Ergonomics (6), in the books edited by Elsevier (7), and CRC Taylor & Francis (8). This risk/damage database enabled an estimation (within defined limits) of the risk of upper-limb work-related musculoskeletal disorders at a given OCRA index level. Starting from the established relation among risk indexes and percent of pathological subjects, it was possible to determine the risk limit values provided by the ISO standard (2). With reference to the alleged absence of studies on the repeatability of the OCRA method, we prefer to mention the most recent results obtained by other researchers, rather than our findings, acknowledging the good "inter-rater reliability" of the OCRA Checklist, and stating that "the OCRA Checklist inter-rater reliability scores were among the highest reported in the literature for semi-quantitative physical exposure assessment tools of the upper extremity" (9) As for the scientific base, we suggest Armstrong et al (1) could get more valuable information about the OCRA methodology looking not only to the 1996 special issue in Italian language (10) ‒ the only publication they mention dealing specifically with OCRA ‒ but to the many updated publications. Some of the most relevant publications in English (as suggested by the publisher) are mentioned in the references here below. Many other publications and manuals in English, Italian, Spanish and Portuguese are available but not reported here due to limitation of space. A complete list of our publications can be found on our website: www.epmresearch.org, where some of the articles are available for download. Simple tools (Excel spreadsheets) for carrying out risk assessments by OCRA can also be freely downloaded from the same website. The validity and usability of OCRA methodology can also be indirectly confirmed by its extensive use around the world. For example, a recent search on ScienceDirect (www.sciencedirect.com/science/journals/all/full-text-access) has recently shown that more than 477 works dealing with OCRA hae been published by different authors in indexed journals to date. In conclusion, we recommend the authors of the discussion paper (1) deepen their analysis of the OCRA methodology [beyond the only cited old 1996 paper (10)] before expressing definite conclusions about the scientific value of the OCRA methodology and about the entire ISO standard-setting system. Our team is always happy to engage with the scientific community and end users of studies on biomechanical overload, as we have also done within the ISO for many years now. ISO working groups arguably offer valuable opportunities to come together at the international level and table discussions between researchers and users. We are researchers who have devoted our life's work to prevention, and intend to continue striving towards that goal, with everyone's help and without bickering, bias, vested interests, or professional rivalry. The health and well-being of workers is all we have ever cared about. We have always been ready to cooperate with those who share this vital objective. References 1. Armstrong T J, Burdorf I A, Descatha A, Farioli A, Graf M, Horie S, Marras W S, Potvin J R, Rempel D, Spatari G, Takala E P, Verbeek J, Violante FS. Scientific basis of ISO standards on biomechanical risk factors. Scand J Work Environ Health ‒ online first. https://doi.org/10.5271/sjweh.3718 2. ISO. ISO 11228-3. Ergonomics - Manual handling - Handling of low loads at high frequency. ISO, 2007. Geneva, Switzerland. 3. Colombini D, Occhipinti E, Delleman D, Fallentin N, Kilbom A, Grieco A. Exposure assessment of upper limb repetitive movements: a consensus document in W. Karwowski International Encyclopaedia of Ergonomics and Human Factors, New York: Taylor & Francis, 2001. 4. Colombini D, Grieco A, Occhipinti E. Occupational musculoskeletal disorders of the upper limbs due to mechanical overload. Ergonomics. Special issue;1998:41(9). 5. Occhipinti, E., Colombini, D. Metodo OCRA: aggiornamento dei valori di riferimento e dei modelli di previsione dell'occorrenza di UL-WMSDs nelle popolazioni lavorative esposte a movimenti e sforzi ripetuti degli arti superiori. [The OCRA method: update of UL-WMSDs reference values and prediction models of occurrence in working populations exposed to repetitive movements and strains of the upper limbs]. La Medicina del Lavoro, 2004. 95;4:305-319 6. Occhipinti E, Colombini D. Updating reference values and predictive models of the OCRA method in the risk assessment of work-related musculoskeletal disorders of the upper limbs. Ergonomics; 2007,50(11):1727-1739. https://doi.org/10.1080/00140130701674331 7. Colombini D, Occhipinti E, Grieco A. Risk assessment and management ofrepetitive movements and exertions of upper limbs. Amsterdam: Elsevier Science, 2002. 8. Colombini D, Occhipinti E. Risk analysis and management of repetitive actions: a guide for applying the OCRA system (occupational repetitive actions). New York: CRC press, 2016. 9. Paulsen R, Gallu T, Gilkey D, Reiser R, Murgia L, Rosecrance J. The inter-rater reliability of Strain Index and OCRA Checklist task assessments in cheese processing. Applied Ergonomics. 2015;51,199-204. https://doi.org/10.1016/j.apergo.2015.04.019 10. Occhipinti E, Colombini D. Proposal of a concise index for the evaluation of the exposure to repetitive movements of the upper extremity (OCRA index)]. Med Lav. Special issue, 1996 Nov-Dec; 87(6): 526-548.

Variable Lifting Index (VLI): A New Method for Evaluating Variable Lifting Tasks.

OBJECTIVE: We seek to develop a new approach for analyzing the physical demands of highly variable lifting tasks through an adaptation of the Revised NIOSH (National Institute for Occupational Safety and Health) Lifting Equation (RNLE) into a Variable Lifting Index (VLI). BACKGROUND: There are many jobs that contain individual lifts that vary from lift to lift due to the task requirements. The NIOSH Lifting Equation is not suitable in its present form to analyze variable lifting tasks. METHOD: In extending the prior work on the VLI, two procedures are presented to allow users to analyze variable lifting tasks. One approach involves the sampling of lifting tasks performed by a worker over a shift and the calculation of the Frequency Independent Lift Index (FILI) for each sampled lift and the aggregation of the FILI values into six categories. The Composite Lift Index (CLI) equation is used with lifting index (LI) category frequency data to calculate the VLI. The second approach employs a detailed systematic collection of lifting task data from production and/or organizational sources. The data are organized into simplified task parameter categories and further aggregated into six FILI categories, which also use the CLI equation to calculate the VLI. RESULTS: The two procedures will allow practitioners to systematically employ the VLI method to a variety of work situations where highly variable lifting tasks are performed. CONCLUSIONS: The scientific basis for the VLI procedure is similar to that for the CLI originally presented by NIOSH; however, the VLI method remains to be validated. APPLICATION: The VLI method allows an analyst to assess highly variable manual lifting jobs in which the task characteristics vary from lift to lift during a shift.

IEA/WHO toolkit for WMSDs prevention: criteria and practical tools for a step by step approach.

When studying WMSDs, several determinants and their interrelationship are considered as relevant. Hence the necessity of an "holistic" approach to prevention, especially when preparing technical rules and strategic plans. There is a strong request, from OSH agencies and operators, for developing "simple" tools for risk assessment and management. In this context WHO asked IEA to develop a "Toolkit for WMSD prevention". The paper presents one of the main contribution to this WHO project, focused on selecting tools at different level for hazard identification, risk estimation and management. Proposals are based on two essential criteria: Acting on a step-by-step approach; Taking into account the presence of multiple influencing factors. The proposals consider: A Basic Step devoted to hazard identification by operative "key-enter" questions, that can be operated also by non-experts. A First Step, (quick assessment), for identifying 3 possible conditions: acceptable; high risk present; more detailed analysis (via tools presented at second step) necessary. This step can be operated by non-experts with only some specific training. A Second Step, where recognized (i.e. from international standards or guidelines) tools for risk estimation are used. This step can be operated only by persons with some specific training.

A simple tool for preliminary hazard identification and quick assessment in craftwork and small/medium enterprises (SME).

During the last Congress of the International Ergonomics Association (IEA), Beijing, August 2009, an international group was founded aimed at developing a "toolkit for MSD prevention" within IEA and in collaboration with World Health Organization (WHO). Possible users of toolkits are: members of health and safety committees, health and safety representatives, line supervisors; labor inspectors; health workers implementing basic occupational health services; occupational health and safety specialists.According to ISO standard 11228 series and the new Draft CD ISO 12259-2009: Application document guides for the potential user, a computer software ( in Excel®) was create dealing with hazard "mapping" in handicraft The proposed methodology, using specific key enters and quick assessment criteria, allows a simple ergonomics hazard identification and risk estimation. Thus it makes possible to decide for which professional hazards a more exhaustive risk assessment will be necessary and which professional consultant should be involved (occupational physician, safety engineer, industrial hygienist, etc.).

Hazard identification and pre-map with a simple specific tool: synthesis of application experience in handicrafts in various productive sectors.

In August 2009, an international group was founded with the task of developing a "toolkit for MSD prevention" under the IEA and in collaboration with the World Health Organization.According to the ISO standard 11228 series and the new Draft ISO TR 12259 "Application document guides for the potential user", our group developed a preliminary "mapping" methodology of occupational hazards in the craft industry, supported by software (Excel®, free download on: www.epmresearch.org).The possible users of toolkits are: members of health and safety committees; health and safety representatives; line supervisors; foremen; workers; government representatives; health workers providing basic occupational health services; occupational health and safety specialists.The proposed methodology, using specific key enters and quick assessment criteria, allows a simple ergonomics hazards identification and risk estimation to be made. It is thus possible to decide for which occupational hazards a more exhaustive risk assessment will be necessary and which occupational consultant should be involved (occupational physician, safety engineer, industrial hygienist, etc.).The methodology has been applied in different situations of small and medium craftsmanship Italian enterprises: leather goods, food, technical dental work, production of artistic ceramics and stained glass, beekeeping activities. The results are synthetically reported and discussed in this paper.

Biomechanical overload in multiple tasks with weekly and annual cycle: practical experiences in the field of cleaning and packaging of fruit.

The OCRA method is the reference method chosen in ISO (ISO 11228-3) and CEN (EN 1005-5) standards regarding risk assessment and management of upper limbs repetitive movements and exertions. The method consists of two specific tools (OCRA index and OCRA checklist). In this paper special attention will be devoted to the procedures for the analysis of multiple repetitive tasks.When computing the OCRA index (checklist score) considering the presence of more than one repetitive task, a "traditional" procedure has been previously proposed. This approach, whose results could be defined as "time weighted average", seems to be appropriate when considering rotations among tasks that are performed almost once every hour. On the contrary, when rotation among repetitive tasks is less frequent the "time weighted average" approach could result into an underestimation of the exposure level. For those scenarios an alternative approach is based on a concept that the most stressful task is the minimum starting point. A peculiar procedure allows to exactly estimate the resulting index within this range of minimum to maximum values. It is possible to apply this approach also for job rotation with weekly or monthly or annual cycle typical of agriculture, supermarket, cleaning sectors. This paper shows criteria and results in two working situation: cleaning (weekly cycle) and packaging of fruit (annual cycle).

[From complexity to simplification: contribution of the EPM Research Unit to producing a toolkit for risk assessment and management of biomechanical overload and WMSDs prevention]. / Dalla complessità alla semplificazione: il contributo dell'Unità di Ricerca EPM ad un toolkit per la valutazione e gestione del rischio da sovraccarico meccanico e la prevenzione dei WMDSs.

BACKGROUND: When studying musculoskeletal disorders and their connection with working conditions (WMSDs), several factors of different nature (mechanical, organizational, psychophysical, individual) and their interrelationship have been considered important in general models for epidemiologic surveys and risk assessment and management. Hence the necessity of a "holistic" (that is to say complex, global, multifactorial and interdisciplinary) approach to MSD prevention, especially when establishing technical norms, guidelines and strategic plans of action at national or international level. On the other hand, considering the widespread presence of these factors and WMSDs in many working contexts, there is a great demand by OSH agencies and operators to develop "simple" tools for risk assessment and management, usable also by non-experts in both developed and developing countries. OBJECTIVES: Both these needs are perfectly justified but are also to a certain extent in conflict. How can we address the problem, i.e., simplify complexity? METHODS AND CRITERIA: The proposals are based on two essential criteria: 1) Act on a step-by-step approach using basic tools first and more complex tools only when necessary. 2) Take into account the complexity and the presence of multiple influencing factors at every step (even if with different degrees of in-depth analysis). The proposals are mainly developed within the framework of an IEA-WHO collaboration initiative for a "Toolkit for MSD prevention" but they are also derived from other converging issues (i.e. ISO application document of LSO series 11228 on manual handling). RESULTS: The proposals consider: 1) A Basic Step devoted to preliminary occupational hazard identification and priority check by operative "key enter" questions (at this step all potential hazards--including those influencing WMSDs--should be considered). This step also can be carried out by non-experts with limited training. 2) First Step, focused on WMSDs risk factors, consisting of a "quick assessment" and mainly addressed to identifying 3 possible conditions: acceptable/no consequences; high risk present/redesign urgently needed; a more detailed analysis (via tools proposed in second step) is necessary. This step can also be carried out by non-experts with only limited training. 3) Second Step, where recognized tools (i.e. from international standards or guidelines) for risk (of WMSDs) estimation are used as a consequence of the first step outcome. Examples of such tools are "adaptations" of the Revised NIOSH Lifting Equation, Liberty Mutual Psychophysical Tables, OCRA Checklist, etc. These tools should be able to adequately take account of most of the influencing factors. For some particular working sectors (i.e. agriculture) these tools need to be specifically adapted. For particular working sectors a database could be envisaged where the most common tasks (with their "variants") are "intrinsically" evaluated by experts and could provide non-experts with the relevant knowledge to be applied to the specific work context. This step can be carried out only by persons with some sort of specific training.

[Development of simple tools for risk identification and prevention of WMSDs (work related muscular-skeletal disorders): application experience in small and craft industries]. / Sviluppo di strumenti valutativi semplici per la individuazione delle sorgenti di rischio lavorativo e la prevenzione dei disturbi muscolo scheletrici: esperienze di applicazione nel lavoro artigianale e nella piccola impresa.

When studying WMSDs, multiple factors of different nature (mechanical, organizational, psychosocial, individual) and their interrelationship are considered relevant; consequently, the need for a "holistic" approach to MSD prevention was established. However, in recent years, considering the widespread presence of WMSDs in various work contexts there is a strong demand from OSH agencies and operators to develop "simple" tools for risk assessment and management, usable also by non-experts both in developed and developing countries, and in particular in craft industries and SME (small-medium enterprises). The World Health Organization (WHO) promoted the development of "toolkits" for different occupational risks and diseases; in outlining a toolkit (for WMSDs prevention), WHO defines this as "a set of practical risk assessment procedures and related management guidance documents, including advice on simple risk control options". The "Ergonomics of Posture and Movement" Research Unit (EPM) is very much involved in the WHO project for developing a "toolkit for MSD prevention" (as well as in similar issues promoted by ISO or UE); attention was consequently focused on craft industries, small enterprises and "difficult" work sectors (i.e. agriculture, fisheries, construction). In these sectors simple tools, procedures and software were developed and applied, that could facilitate WMSDs risk assessment and management. This issue of "La Medicina del Lavoro" is entirely devoted to selected papers regarding the above proposals and experience, especially in craft industries. The opening paper is a basic methodological contribution presenting a procedure and a tool (with relative software) that is useful for the identification of a number of occupational risks by means of special "key-enters"; the same tool, with special regard to WMSDs, defines criteria for a "quick risk assessment" which is mainly aimed at identifying 3 possible conditions: Acceptable (no remedial actions needed); High risk present (redesign is urgently needed); More detailed analysis is necessary, using proper tools for risk estimation (derived from recognized literature, international standards and/or guidelines) A series of practical applications in different craft industry contexts are then presented: the selection of the papers took into account that, apart from producing specific results on "risk mapping", they gave a detailed analysis of production cycles" in work sectors that are often "neglected" in OSH literature. Other application experience in similar work contexts using a quite similar approach will, for reasons of space, be reported in future volumes of this journal. Finally, in the web sites of the journal (http://www.lamedicinadellavoro. it/) and of the EPM Research Unit (http.//www.epmresearch.org), the reader will find (only on-line) papers and information regarding updates on the use of the "OCRA Checklist" that is now also proposed in a simpler version (OCRA mini-checklist) that can be applied specially in the sectors considered here and whenever production is "variable".

[A preliminary mapping methodology for occupational hazards and biomechanical risk evaluation: presentation of a simple, computerized tool kit for ergonomic hazards identification and risk assessment]. / La pre-mappatura dei disagi e dei pericoli professionali e la valutazione e gestione del rischio da sovraccarico biomeccanico: presentazione di uno strumento di analisi semplice e informatizzato (toolkit) e delle sue modalità di utilizzo.

BACKGROUND AND OBJECTIVES: During the last Congress of the International Ergonomics Association (IEA), Beijing, August 2009, an international group was founded with the task of developing a "toolkit for MSD prevention" under the IEA and in collaboration with the World Health Organization. The possible users of toolkits are: members of health and safety committees; health and safety representatives; line supervisors; foremen; workers; government representatives; health workers providing basic occupational health services; occupational health and safety specialists. METHODS: According to the ISO standard 11228 series and the new Draft CD ISO 12259-2009: Application document guides for the potential user, our group developed a preliminary "mapping" methodology of occupational hazards in the craft industry, supported by software (Excel). RESULTS AND CONCLUSION: The proposed methodology, using specific key enters and quick assessment criteria, allows a simple ergonomics hazards identification and risk estimation to be made. It is thus possible to decide for which occupational hazards a more exhaustive risk assessment will be necessary and which occupational consultant should be involved (occupational physician, safety engineer, industrial hygienist, etc.).

[Use of premapping of risks data sheet in artistic ceramics industries]. / Utilizzo della scheda di premappatura dei pericoli nel comparto delle ceramiche artistiche.

BACKGROUND: In 2006 there were more than 10,000 people working in artistic ceramics industries in Italy. The jobs in these industries that attracted most attention were work at the potter's wheel and decorating. OBJECTIVES: To test the premapping of risks data sheet in these enterprises. METHODS: We tested the data sheet in 3 craft industries: one was mainly artistic, one had a semi-industrial setting and in the third jobs were non-specific. RESULTS: In the semi-industrial craft industry the risks for potter's wheel workers were higher due to the repetitive movements required and to work organization aimed at achieving maximum productivity. CONCLUSIONS: The premapping of risks data sheet is a very sensitive tool. It can sometimes overestimate the risks, but in this way identifies situations that call for more in-depth analysis using tools that comply with international standards.

[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.

[Evaluation of work-related biomechanical overload: techniques for the acquisition and analysis of surface EMG signal]. / Tecniche di acquisizione ed analisi del segnale elettromiografico per lo studio del sovraccarico biomeccanico occupazionale.

OBJECTIVES: The aim of this research was to obtain information concerning muscle fatigue and muscle activation levels by measuring quantitative parameters through the surface electromyographic signal, and use such information to integrate the OCRA (Occupational Repetitive Actions) method for risk assessment of upper limb biomechanical overload Along with the main risk factors associated with the development of work-related upper limb musculoskeletal disorders (UL WMSDs) like posture, movement, frequency of action and organizational factors, this method also takes into account the muscular effort. Unlike the other risk factors that can be directly measured during inspections on farms, muscular effort is currently estimated only via a subjective assessment scale (Borg CR-10 scale). METHODS: A new apparatus and new procedures were implemented for synchronized EMG and video acquisition, which guarantee a high degree of inter- and intra-subject repeatability, and an ad hoc software for data elaboration was developed They have been specifically designed for "on the field" applications. The methodology was first tested in the laboratory on a group of 12 healthy subjects, studying a repetitive task, running in two different ways, (high/low OCRA index) and interspersed with isometric tests for an indirect measurement of dynamic fatigue. The methodology was then tested in a working environment to compare the muscular effort required during the use of different types of tools for pruning. RESULTS: Results of the laboratory protocol showed onset of fatigue for Anterior Deltoid, Middle Deltoid and Brachial Triceps muscles only for the high-risk index mode, as demonstrated by the significance of the Bonferroni tests (p < 0.05) on MDF (Median Frequency) calculated from isometric tests. They also showed significant differences in terms of higher level of muscle activation, and thus required force, in the case of high OCRA index work task compared to the one at low risk (Wilcoxon, p < 0.05) for all analysed muscle groups with regard to 10th, 50th and 90th percentile of the APDF (Amplitude Probability Distribution Function). These results clearly defined the differences of subjectively perceived effort. The results of field" application showed that the tested protocol was also easily exportable to a real working environment and that the numerical parameters extracted from the EMG signal can be a useful tool for evaluating effort levels of different muscles of the upper limb and for comparing different work tools, through effort indexes referred to single muscles. CONCLUSIONS: It can therefore be concluded that by integrating the information about the 'FORCE' factor in the OCRA method, the calculated parameters may provide objective information useful in analyzing and designing ergonomic tools and workplaces.

[Risk assessment of work-related upper limb musculoskeletal disorders in thirty factories in the upholstered furniture industry]. / Valutazione del rischio da movimenti e sforzi ripetuti degli arti superiori in trenta aziende del comparto del mobile imbottito.

BACKGROUND: One of the most common procedures for risk assessment of upper limb work-related musculoskeletal disorders (UL-WMSDs) in Italy is the OCRA synthetic index, which is recommended as the preferred method in the ISO standard 11228-3. OBJECTIVE: The aim of the survey was to assess the risk of UL-WMSDs due to repetitive strain and movements in thirty factories of the sofa industry located in a large geographic area of southern Italy. METHODS: The most characteristic working tasks of the manufacturing process were studied: filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. The single tasks were carried out almost exclusively manually, with features of a handicraft approach. Data were collected through questionnaires and video tape recordings in each factory. The mean value of the OCRA index of every group of factories was calculated by weighting the values of the index of each single task group with the number of the workers. RESULTS: Figures obtained in the different factories showed values of the OCRA index ranging between 4 and 15. A 2,9 OCRA value was attributed to a low exposure group. CONCLUSIONS: Even though the work tasks analyzed were characterized by long duration of the manufacturing cycle (between 5 and 60 min), a particular but rigorous application of the OCRA procedures made it possible for a detailed risk assessment to be made for each of the working groups analysed.

[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.

[Ocra Method: development of a new procedure for analysis of multiple tasks subject to infrequent rotation]. / Metodo Ocra: messa a punto di una nuova procedura per l'analisi di compiti multipli con rotazioni infrequenti.

In the Ocra methods (Ocra index and Ocra Checklist), when computing the final indices (Ocra index or checklist score), in the case of more than one repetitive task a "traditional" procedure was already proposed, the results of which could be defined as "time-weighted average". This approach appears to be appropriate when considering rotations among tasks that are performed very frequently, for instance almost once every hour (or for shorter periods). However, when rotation among repetitive tasks is less frequent (i.e. once every 1 1/2 or more hours), the "time-weighted average" approach could result in an underestimation of the exposure level (as it practically flattens peaks of high exposures). For those scenarios an alternative approach based on the "most stressful task as minimum" might be more realistic. This latter approach has already been included in the NIOSH approach for multiple sequential lifting tasks and, given the recent availability in the Ocra method of more detailed duration multipliers (practically one different Du(M) for each different step of one hour of duration of the repetitive task), it is now possible to define a particular procedure to compute the complex Ocra Multitask Index (cOCRA) and the complex Checklist Score (cCHESCO) for the analysis of two or more repetitive tasks when rotations are infrequent (rotations every 1 1/2 hours or more). The result of this approach will be at least equal to the index of the most stressful task considered for its individual daily duration and at the most equal to the index of the most stressful task when it is (only theoretically) considered as lasting for the overall daily duration of all examined repetitive tasks. The procedure is based on the following formula: Complex Ocra Multitask Index = Ocra(1(Dum1) + (Delta ocra1xK) where 1,2,3,...,N = repetitive tasks ordered by ocra index values (1 = highest; N = lowest) computed considering respective real duration multipliers (Dum(i)). ocra1 = ocra index of task, considering Dum(1). Dum(i) = duration multiplier for task(i) real duration. Dum(tot) = duration multiplier for total duration of all repetitive tasks. delta ocra1 = highest ocra index among N tasks considering Dum(tot) (ocra(i max)) - ocra index of task1 considering Dum1. K = (ocra(1 max)*FT1) + (ocra(2 max)*FT2) + ... + (ocra (N)*FT(N)) over (ocra(i max)). ocral,Nm(1,N MAX) = index of tasks 1 to Ncons idering Dum,, (tot)7=Fr(i) c tion of Time (values from 0 to 1) of task; wi(i)h respect to the total repetitive time.

Preventing upper limb work-related musculoskeletal disorders (UL-WMSDS): new approaches in job (re)design and current trends in standardization.

In industrialized countries, upper limb work-related musculoskeletal disorders (UL-WMSDs) are the most common form of occupational diseases. They are generating a growing population of workers with reduced working capacity. The link between these pathologies and different aspects of work organization has been convincingly proven. Recent experiences in Europe supporting the combination of traditional work design methods used in manufacturing companies with ergonomics methods are reported briefly, with special focus on the use of the occupational repetitive action (OCRA) method for risk assessment and management of manual repetitive tasks. The combined approach strives to achieve the goal of maintaining a satisfactory level of productivity while respecting ergonomics criteria and, definitely, workers' health. New ergonomics standards provide for interaction between job and machinery designers and ergonomists in the design of work processes and workplaces. These standards generally refer only to the healthy adult working population and do not always provide criteria for protecting particular working populations, such as that represented by workers affected by UL-WMSDs. The results of preliminary studies concerning productive re-employment of workers with UL-WMSDs allow the introduction of some criteria for implementing current ergonomics standards in this connection. One aim of this paper is to summarize experiences of close cooperation between ergonomists, machinery designers and job designers to guarantee productivity and the prevention of musculoskeletal disorders. A second aim is to examine current ergonomics standards in the field of manual physical work (designed for healthy workers) and to suggest preliminary criteria for their implementation taking into account the capabilities and needs of specific sub-groups of the working population.