Risk factors for hand-wrist disorders in repetitive work.

OBJECTIVES: To identify the risk of hand-wrist disorders related to repetitive movements, use of hand force and wrist position in repetitive monotonous work. METHODS: Using questionnaires and physical examinations, the prevalence and incidence of hand-wrist pain and possible extensor tendonitis (wrist pain and palpation tenderness) were determined in 3123 employees in 19 industrial settings. With the use of questionnaires and video recordings of homogenous work tasks number of wrist movements, hand force requirements and wrist position were analysed as risk factors for hand-wrist disorders, controlling for potential personal and psychosocial confounders. All participants were re-examined three times during a follow-up period of three years. RESULTS: Force but not repetition and position was related to hand-wrist pain and possible tendonitis in the baseline analyses showing an exposure-response pattern. Odds ratios for the risk of hand pain was 1.7 (95% CI 1.3 to 2.2) and for possible tendonitis 1.9 (95% CI 1.1 to 3.3). There was no significant interaction between the ergonomic factors. In the follow-up analyses force remained a risk factor for hand pain (OR 1.4, 95% CI 1.1 to 1.8) and for possible tendonitis (OR 2.9, 95% CI 1.3 to 6.8). Repetition was also a risk factor for the onset of hand-wrist pain (OR 1.6, 95% CI 1.2 to 2.3). CONCLUSIONS: Increasing levels of force were associated with prevalent and incident hand-wrist pain and possible extensor tendonitis. The results for repetition were less consistent. Working with the hand in a non-neutral position could not be identified as a risk factor.

Clustering of cardiovascular risk factors. time trends during 28 years.

OBJECTIVES: To assess the development in frequency and clustering of hypertension, hypercholesterolaemia, high body mass index (BMI), physical inactivity and tobacco smoking in the period 1964-1992, and to evaluate any sex and age differences. DESIGN: Five cross-sectional investigations on cardiovascular risk factors performed in 1964, 1978, 1982-1984, 1986-1987 and 1991-1992 comprising random samples in a suburban area of Copenhagen, Denmark. Physical activity during leisure time and smoking habits were assessed by self-administered questionnaire. Blood pressure, weight, height and serum total cholesterol were measured according to WHO standards. RESULTS: A total of 8644 persons aged 30, 40, 50 and 60 years participated with an equal number of men and women. Women had fewer risk factors than men and younger persons had fewer risk factors than older persons. In the period 1964-1992 there was a decreasing number of risk factors. The 50 year olds show a sex difference in the period 1982-1992, whereas there was no sex difference among the 60 year olds. Tobacco smoking was the most common risk factor. BMI > 27.5 has become more and more frequent throughout the period, especially in men. The BMI has conquered third place in all age groups. The association of BMI > 27.5 and sedentary leisure time physical activity has become the most frequent. CONCLUSION: Clustering among risk factors decreased over time in both sexes. The association of elevated BMI and sedentary leisure time activity may contribute to the rising frequency of chronic disease such as diabetes mellitus and cardiovascular disease.

The influence of hormone replacement therapy on the aging-related change in cognitive performance. Analysis based on a Danish cohort study.

OBJECTIVE: A maintenance and/or improvement of cognitive performance with postmenopausal hormone replacement therapy (HRT) is biological plausible. The objectives of this study were to analyze the impact of HRT on aging-related changes in cognitive performances, and to assess whether women who choose HRT have better cognitive performance prior to HRT. METHODS: Data derives from a longitudinal sub-cohort of women participating in a large survey of the general adult population-The Danish MONICA (MONItoring CArdiovascular risk factors) Study. Main variables for analyses come from neuropsychological examination consisting of 28 cognitive parameters collected in 1982-1983 and again in 1993-1994, by a computer-aided test technique, the Cognitive Function Scanner((R)). The final analyses comprised 126 'never users', 40 'current users' at follow-up, and 30 'future users' of HRT (women who started HRT during the observation period subsequent to baseline registration). RESULTS: 'Current users' of HRT at follow-up showed a less pronounced decline in cognitive performance compared to 'never users' in one of six parameters for concentration ability and two of eight parameters for visuomotor function. 'Future users' of HRT had better cognitive performance at baseline compared to 'never users' in long-term visual memory, concentration, and reaction time. 'Future users' of HRT were more precise but spent more time in the tests for visuomotor function than 'never users'. CONCLUSION: HRT-treated women show a postponed aging-related decline in cognitive functioning, partly in concentration and partly in visuomotor function. However, women who choose HRT have better cognitive performance prior to the treatment.

Work-related knee disorders in floor layers and carpenters.

Previous studies indicate an increased prevalence of knee disorders in some occupations possibly related to kneeling working positions. The purpose of the present study was to examine the relationship among knee-straining work, self-reported knee-complaints, and physical signs of knee disorders. The duration of knee-straining work was estimated from videotapes of representative work tasks. Floor layers (n = 133), carpenters (n = 506), and compositors (n = 327) aged 26 to 72 years without previous acute knee traumas were examined in a cross-sectional study by questionnaire. A stratified random sample of the questionnaire responders; 67 floor layers, 127 carpenters, and 101 compositors had independent double examinations for physical signs of knee disorders. The videotapes showed that knee-straining work constituted 56% of working time for floor layers, 26% for carpenters, and none for compositors. The prevalences of self-reported knee-complaints were positively associated with the amount of knee-straining work and were significantly different for the three trades. Floor layers and carpenters who were presently working in their trade had a higher prevalence of knee complaints than floor layers and carpenters who had left their trade. Age, seniority, weight, body mass index, smoking, and knee-straining sports activity had no significant effects. The clinical study showed a positive association for knee-straining work, hyperkeratosis, and bursitis. A similar pattern was found for signs of intraarticular knee disorders by one physician but not by another. The reproducibility of these signs was low. More studies are needed to define clinically important knee disorders for epidemiological studies.

Radiographic knee osteoarthritis in floorlayers and carpenters.

OBJECTIVES: The aim of the present study was to examine the relationship between knee-straining work and radiological findings of knee osteoarthritis and to study the relation between radiological findings and self-reported knee complaints and clinical signs of knee osteoarthritis. METHODS: The material consisted of 133 floorlayers, 506 carpenters, and 327 compositors, 26-72 years of age, who had completed a questionnaire and reported no previous knee trauma. A stratified sample of these questionnaire respondents, 50 floorlayers, 51 carpenters, and 49 compositors, were radiologically examined for knee osteoarthritis by 2 radiologists. The X-ray films were independently assessed by 2 radiologists and blinded with respect to knee complaints, trade, and age. RESULTS: The radiological investigation showed estimated prevalences of knee-osteoarthritis (grades 2-4) for 14% of the floorlayers, 8% of the carpenters, and 6% of the compositors (not significantly different). For the subjects > or =50 years of age the estimated prevalences of the combination of radiological grades 2-4 for knee osteoarthritis and knee complaints during the last 12 months were 29% [95% confidence interval (95% CI) 17-44%], 9% (95% CI 1-26%), and 1% (95% CI 1-10%) for the floorlayers, carpenters, and compositors, respectively. Radiological grades 2-4 were mainly found for subjects above the age of 50 years, subjects with knee complaints, and floorlayers. Radiological knee osteoarthritis was positively associated with self-reported knee complaints and with clinical signs of intraarticular and retropatellar crepitation. CONCLUSIONS: The data suggest that work in which a considerable amount of time is spent in knee-straining positions may be a risk factor for the development of knee osteoarthritis above the age of 50 years.