Work environment and neck and shoulder pain: the influence of exposure time. Results from a population based case-control study.

OBJECTIVES: To study associations between long term and short term exposure to different work environmental conditions and the incidence of neck or shoulder pain. The results were obtained as part of the MUSIC-Norrtälje study, which is a population based case-control study conducted in Sweden in 1993-7. METHODS: The cases were people from the study base who sought medical care or treatment for neck or shoulder pain. Information on physical and psychosocial conditions in the work environment, currently and 5 years ago, and lifestyle factors, was obtained by self administered questionnaires from 310 cases and 1277 randomly selected referents. RESULTS: Associations between both physical and psychosocial exposures in the work environment and seeking care for neck or shoulder pain were found. The risk patterns differed for the sexes, and risk ratios exceeding 1.5 were more often found among women than among men. Generally, subjects who had experienced a recent increase of exposure were more likely (relative risk (RR) 2.1-3.7) to seek care than those who had been exposed long term (RR 1.5-1.8). Among women, an increased amount of visual display terminal (VDT) work, work above shoulder level, and reduced opportunities to acquire new knowledge, and among men, an increased amount of seated work were associated with neck or shoulder pain. This might indicate short induction periods for neck or shoulder pain for these exposures. However, for repetitive work with the hands and hindrance at work among women, and possibly also local vibrations among men, the induction periods seem to be longer. Interactive effects between factors, both at work and in the family, were found, but only among women. CONCLUSIONS: Associations between some exposures in the work environment and seeking care for neck or shoulder pain were found. The high RRs for short term exposure might indicate that for many factors the induction period for neck or shoulder pain is short.

Interview versus questionnaire for assessing physical loads in the population-based MUSIC-Norrtälje Study.

BACKGROUND: MUSIC-Norrtälje study is a case-referent study, the aim of which is to find risk and health factors for low back and neck/shoulder disorders. In this part of the study, the interview technique and the self-administered questionnaire used for assessment of physical loads are described and the inter-method reliability of parts of the self-administered questionnaire is estimated. The distribution of exposure levels in a general population is also described. METHODS: The study period was three years from November 1993 to November 1996, and the study subjects totaled 2,480 persons (813 female and 610 male referents, 380 female and 315 male low back cases, 252 female and 106 male neck/shoulder cases). The interview concerned "a typical working day" during the preceding 12 months and comprised assessment of energy expenditure, work postures, and manual materials handling for work and leisure time, including regular sport activities. The self-administered questionnaire comprised 18 questions, each covering 5 different points of time: right now, 5, 10, 15, 20 years ago. The answers to eight of the questions about current conditions were compared to corresponding interview responses. The interview was considered as the "gold standard." RESULTS: Ninety-eight percent of the subjects completed the interview without any great difficulties. According to the interview, the distributions of different exposure levels were generally positively skewed, i.e., the frequency of highly exposed subjects was low in the study base. The correlation between interview and questionnaire responses among the referents was high for time spent "sitting at work" (r = 0.82), "VDU work" (r = 0.87), and work related "motor vehicle driving" (r = 0.80). The correlation was moderate for work-related "hands above shoulder level" (rs = 0.63), and "hands below knee level (trunk flexion)" (rs = 0.66). The correlation was lower for leisure time activities such as "domestic work" (r = 0.55), "time for own activities" (r = 0.39), and "sitting during leisure time" (r = 0.38). Subjects seeking care for low back or neck/shoulder disorder estimated equally correctly or not, as had the referents. However, non-differential misclassification was present in all questions, which will attenuate observed estimates of the relative risk. CONCLUSIONS: Even though interview data are preferable, questionnaire data may be useful for assessing well-defined work tasks and for "sitting at work."

Musculoskeletal symptoms and job strain among nursing personnel: a study over a three year period.

OBJECTIVES: To examine the variation of symptoms from the neck, shoulders, and back over a three year period among female nursing personnel and the relation between job strain and musculoskeletal symptoms. METHODS: At a county hospital the female nursing personnel answered a questionnaire at baseline and then once a year over a period of three years. There were 565, 553, 562, and 419 subjects who answered the questionnaire at the first, second, third, and fourth survey, respectively. Of the study group, 285 nursing personnel answered the questionnaire on four occasions. Ongoing symptoms of the neck, shoulders, and back were assessed by means of a 10 point (0-9) scale with the verbal end points "no symptoms" and "very intense symptoms." Cases were defined as nursing personnel reporting ongoing symptoms, score > 6, from at least one of the body regions. For assessments of job strain, a Swedish version of Karasek and Theorell's model was used. RESULTS: Of the 285 subjects, 13% were defined as cases at all four assessments, and 46% varied between cases and not cases during the study period. In the repeated cross sectional surveys the estimated rate ratio (RR) for being a case was between 1.1 and 1.5 when comparing the group with job strain and the group without job strain. For the combination of job strain and perceived high physical exertion the estimated RR was between 1.5 and 2.1. When the potential risk factors were assessed one, two, or three years before the assessment of symptoms the estimated RR for becoming a case was between 1.4 and 2.2 when comparing the group with job strain and the group without job strain. CONCLUSION: Almost half of the healthcare workers varied between being a case and not, over a three year period. The analysis indicated that job strain is a risk factor for musculoskeletal symptoms and that the risk is higher when it is combined with perceived high physical exertion.

Interview protocols and ergonomics checklist for analysing overexertion back accidents among nursing personnel.

No documented strategy, including preventive strategies, for systematic investigation of overexertion back accidents among nursing personnel has yet been published. One aim of the present study was to develop standardized instruments for the systematic investigation of back accidents among nursing personnel in order to develop preventive strategies. Another aim was to produce a screening tool that could easily be used for identifying potential overexertion back accident hazards. Two structured interview protocols were developed, one for the injured person and one for the supervisor. An ergonomics checklist was designed for the most important spaces according to accident statistics: patient's room, corridor, toilet, and also one for 'other space', eg X-ray and treatment rooms. The instruments were developed by frequent discussions and adjustments in a task force of researchers and occupational health personnel. The protocols were tested in two steps before a final version was established. The construct validity and interobserver reliability of the checklist were tested by ten ergonomists, who checked a patient's room, a toilet and a corridor with some known hazards. The constructed validity agreement was 90% in 19 of 26 items in the checklist. The interobserver reliability had the same figures as the validity for all items in the checklist. The interview protocols and checklist appear to be suitable for systematic investigation of overexertion back accidents.

Human experimental MIBK exposure: effects on heart rate, performance, and symptoms.

Heart rate, performance, and symptoms were studied in six female and six male volunteers, aged 19 to 47 years, during experimental 2-hr exposures to 10 and to 200 mg/m3 of methyl isobutyl ketone (MIBK). No effects from exposure on performance of a reaction time task or an arithmetic test could be demonstrated, and no consistent effects on heart rate were found. Subjects reported significantly more symptoms from the central nervous system, e.g., fatigue, due to the exposure. There was also an indication of an increase in ratings of irritation to the airways. A reduction of the threshold limit value (TLV) of 205 mg/m3 for MIBK exposure presently indicated by the American Conference of Governmental Industrial Hygienists, is therefore recommended.

Toxicokinetics of toluene and urinary excretion of hippuric acid after human exposure to 2H8-toluene.

Nine male volunteers were exposed to 2H8-toluene (200 mg/m3 for two hours during a workload of 50 W) via inspiratory air with the aid of a breathing valve and mouthpiece. Labelled toluene was used to differentiate between hippuric acid originating from exposure to toluene and hippuric acid normally excreted in urine. The total uptake of toluene was 2.2 (standard deviation (SD) 0.2) mmol, or 50% of the amount inhaled. Four hours after the end of exposure 1.4 (SD 0.3) mmol or 65% of the total uptake had been excreted in urine as 2H-hippuric acid and 20 hours after the end of exposure the cumulative excretion of 2H-hippuric acid was 1.8 (SD 0.3) mmol, or 78% of the total uptake. By contrast the cumulative excretion of labelled plus unlabelled hippuric acid exceeded the total uptake of toluene already after four hours. The excretion rate of 2H-hippuric acid was highest, about 5 mumol/min, during exposure and the SD between the subjects was low. The background concentrations of unlabelled hippuric acid in urine were high, however, and there were large differences between subjects. These findings confirm earlier indications that for low exposure, urinary hippuric acid concentration cannot be used for biological monitoring of exposure to toluene.

Uptake, distribution and elimination of alpha-pinene in man after exposure by inhalation.

The toxicokinetics of alpha-pinene were studied in human volunteers exposed by inhalation (2 h, 50 W) in an exposure chamber on four occasions. The exposures were about 10, 225, and 450 mg/m3 (+)-alpha-pinene and 450 mg/m3 (-)-alpha-pinene. The relative pulmonary uptake was about 60% for the higher exposures, and total uptake increased linearly with increasing exposure. The total blood clearance was high, about 1.11.h-1.kg-1. After the exposure was terminated, less than 0.001% of the total uptake was eliminated unchanged in the urine and about 8% in exhaled air. A long half-time in poorly perfused tissues indicates a high affinity to adipose tissues. There was a statistically significant exposure-response relationship among five subjects who experienced irritation. Short-time exposure to alpha-pinene did not give rise to acute changes in lung function 20 min after the exposure.

Influence of paracetamol and acetylsalicylic acid on the toxicokinetics of toluene.

To study the influence of paracetamol and acetylsalicylic acid on the toxicokinetics of toluene, 2 groups of 10 male volunteers were exposed to toluene vapor (3.25 mmol/m3, 4 hr) at two different exposure occasions: toluene alone and toluene + analgesics. Solvent concentrations in blood and hippuric acid concentrations in urine were measured during the exposure period and 3 hr after exposure. The concentration of toluene in blood increased after ingestion of paracetamol or acetylsalicylic acid, as compared to the control exposure. The ingestion of paracetamol significantly increased the area under the blood concentration versus time curve (P less than 0.05) and the apparent blood clearance was significantly reduced (P less than 0.05) after ingestion of paracetamol but not after ingestion of acetylsalicylic acid. No statistically significant differences in the urinary excretion of hippuric acid were found.

Liquid/air partition coefficients of four terpenes.

The liquid/air partition coefficients of four common terpenes, alpha-pinene, beta-pinene, 3-carene, and limonene, have been determined in vitro using head space technique. The liquids used were water, human blood, and olive oil. alpha-Pinene, beta-pinene, and 3-carene were practically insoluble in water and limonene was slightly soluble; all were readily dissolved in olive oil. The oil/air partition coefficients ranged from 2900 to 5700 in the order alpha-pinene, beta-pinene, 3-carene, and limonene. The blood/air partition coefficients ranged from 15 to 42 in the same order as for oil/air.