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1.  A Conceptual Model On Musculoskeletal Disorders For Occupational Health Practitioners 
PMCID: PMC4096869  PMID: 24549992
Musculoskeletal Disorders; MSD; models; Occupational; Practitioners
2.  Does Obesity Modify the Relationship between Exposure to Occupational Factors and Musculoskeletal Pain in Men? Results from the GAZEL Cohort Study 
PLoS ONE  2014;9(10):e109633.
To analyze relationships between physical occupational exposures, post-retirement shoulder/knee pain, and obesity.
9 415 male participants (aged 63–73 in 2012) from the French GAZEL cohort answered self-administered questionnaires in 2006 and 2012. Occupational exposures retrospectively assessed in 2006 included arm elevation and squatting (never, <10 years, ≥10 years). “Severe” shoulder and knee pain were defined as ≥5 on an 8-point scale. BMI was self-reported.
Mean BMI was 26.59 kg/m2 +/−3.5 in 2012. Long-term occupational exposure to arm elevation and squatting predicted severe shoulder and knee pain after retirement. Obesity (BMI≥30 kg/m2) was a risk factor for severe shoulder pain (adjusted OR 1.28; 95% CI 1.03, 1.90). Overweight (adjusted OR 1.71; 1.28,2.29) and obesity (adjusted OR 3.21; 1.90,5.41) were risk factors for severe knee pain. In stratified models, associations between long-term squatting and severe knee pain varied by BMI.
Obesity plays a role in relationships between occupational exposures and musculoskeletal pain. Further prospective studies should use BMI in analyses of musculoskeletal pain and occupational factors, and continue to clarify this relationship.
PMCID: PMC4201453  PMID: 25330397
3.  Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study 
Although previous studies have related occupational exposure and epicondylitis, the evidence is moderate, and mostly based on cross-sectional studies. Suspected physical exposures were tested over a three year period in a large longitudinal cohort study of workers in the United States.
In a population-based study including a variety of industries, 1107 newly employed workers were examined; only workers without elbow symptoms at baseline were included. Baseline questionnaires collected information on personal characteristics and self-reported physical work exposures and psychosocial measures for the current or most recent job at 6 months. Epicondylitis (lateral and medial) was the main outcome, assessed at 36 months based on symptoms and physical examination (palpation or provocation test). Logistic models included the most relevant associated variables.
Of 699 workers tested after 36 months who did not have elbow symptoms at baseline, 48 suffered from medial or lateral epicondylitis (6.9%), with 34 cases of lateral epicondylitis (4.9%), 30 cases of medial epicondylitis (4.3%), and 16 workers who had both. After adjusting for age, lack of social support, and obesity, consistent associations were observed between self-reported wrist bending/twisting and forearm twisting/rotating/screwing motion and future cases of medial or lateral epicondylitis (odds ratios 2.8 [1.2;6.2] and 3.6 [1.2;11.0] respectively in men and women).
Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial epicondylitis in a large longitudinal study, although other studies are needed to better specify the exposures involved.
PMCID: PMC4059355  PMID: 23825198
epicondylitis; observational study; occupational; risk factor; epidemiology
4.  Natural history and predictors of long-term pain and function among workers with hand symptoms 
To evaluate predictors of hand symptoms and functional impairment after three years of follow-up among workers with different types of hand symptoms including carpal tunnel syndrome (CTS). Functional status and job limitations were also analyzed as key secondary objectives.
Cohort design of 3-years duration
Working population-based study
1107 newly employed workers without a pre-existing diagnosis of CTS. Subjects were categorized into four groups at baseline examination: no hand symptoms, any hand symptoms but not CTS (recurring symptoms in hands, wrist or fingers without neuropathic symptoms), any hand symptoms of CTS (neuropathic symptoms in the fingers and normal nerve conduction study), or confirmed CTS (CTS symptoms and abnormal nerve conduction study). Among workers with hand pain at baseline, subject and job characteristics were assessed as prognostic factors for outcomes, using bivariate and multivariate regression models.
Not applicable
Main outcome measure
The primary outcome assessed by questionnaire at 3 years was “severe hand pain” in the past 30 days.
At baseline, 155 workers (17.5% of 888 followed workers) reported hand symptoms, 21 had confirmed CTS. Presence of hand pain at baseline was a strong predictor of future hand pain and job impairment. Subjects with confirmed CTS at baseline were more likely to report severe hand pain, (adjusted prevalence ratios 1.98 [1.11 – 3.52]) and functional status impairment (adjusted prevalence ratios 3.37 [1.01 – 11.29]) than workers with other hand pain. Among subjects meeting our case definition for CTS at baseline, only 4 (19.1%) reported seeing a physician in the 3 year period.
Hand symptoms persisted among many workers after 3 year follow-up, especially among those with CTS, yet few symptomatic workers had seen a physician.
PMCID: PMC3695071  PMID: 23416766
hand; pain; Carpal Tunnel Syndrome; functional status; work
5.  Occupational asthma and occupational rhinitis: the united airways disease model revisited 
Whereas accumulating evidence indicates close associations between rhinitis and asthma, little is known about the relationships between occupational rhinitis (OR) and occupational asthma (OA). This study analyses the prevalence of OR associated with OA, globally and according to the various causal agents, and investigates the temporal relationships between these two conditions.
Data on incident cases of OA (2008–2010) were collected through the French national occupational disease surveillance and prevention network, using a standardized form including information on occupation, causal agents, presence of OR, and respective dates of occurrence of rhinitis and asthma.
Among the 596 reported OA cases with latency period, 555 could be attributed to identified agents: high molecular weight (HMW) agents (n=174); low molecular weight (LMW) agents (n=381). Overall, OR was associated with OA in 324 (58.4%) cases. The frequency of association was significantly higher for HMW agents than for LMW agents (72.2% vs 51.5%, p<0.001). OR occurred before OA significantly more frequently for HMW agents than for LMW agents (p<0.01).
These results show that OR is frequently associated with OA, especially when HMW agents are involved. They are consistent with the hypothesis that OR, in conjunction with OA, is more likely to be caused by sensitizers that cause disease via IgE-mediated mechanisms and suggest that symptoms of OR should be taken into account in the medical surveillance of workers exposed to HMW agents.
PMCID: PMC3908889  PMID: 23390199
Adult; Air Pollutants, Occupational; adverse effects; chemistry; Asthma, Occupational; epidemiology; etiology; Female; France; epidemiology; Humans; Incidence; Male; Middle Aged; Molecular Weight; Occupational Diseases; epidemiology; etiology; Occupations; statistics & numerical data; Odds Ratio; Prevalence; Rhinitis; epidemiology; etiology; occupational asthma; occupational rhinitis; high molecular weight; low molecular weight
6.  Initial evaluation of patients reporting a work-related stress or bullying 
PMCID: PMC3984140  PMID: 23222476
Bullying; psychology; Humans; Mental Disorders; diagnosis; etiology; Occupational Diseases; diagnosis; etiology; Referral and Consultation; Stress, Psychological; diagnosis; etiology
7.  A "T-index" for the evaluation of teaching performance of medical university staff? 
Medical Teacher  2013;35(5):425.
PMCID: PMC3984142  PMID: 23464898
Employee Performance Appraisal; methods; Faculty, Medical; Humans; Teaching
9.  Can a single-item measure assess physical load at work? An analysis from the GAZEL cohort 
Assessment of workplace physical load is highly resource-intensive. This study tested whether a single-item measure asking individuals about perceived physical strain (PPS) at work was an acceptable proxy for physical load.
The study was conducted in a subset of GAZEL cohort (n=2612) undergoing assessment of exposure to 38 occupational biomechanical constraints (representing eight domains) in 1994. Test-retest reliability analyses compared PPS in 1994 and 1995. Validity analyses compared PPS in 1994 to concurrent strains assessed in the more extensive measure.
The measure showed adequate test-retest reliability. Within and across domains of physical load, linear relationships (p<0.0001) existed between n exposures and PPS. Domains considered more strenuous (carrying loads, pulling objects) showed the highest PPS.
PPS approximates physical load in absence of detailed measures. PPS could be used in non-occupational epidemiologic studies.
PMCID: PMC3907304  PMID: 22481211
Analysis of Variance; Cohort Studies; Female; France; Humans; Male; Physical Exertion; Reproducibility of Results; Self Report; Workload
10.  Association among work exposure, alcohol intake, smoking and Dupuytren's disease in a large cohort study (GAZEL) 
BMJ Open  2014;4(1):e004214.
In view of the debate of factors in Dupuytren’s disease, we aimed to describe its relationship with certain occupational factors, alcohol intake and smoking.
The French GAZEL cohort (employees of Electricité de France and Gaz de France).
Participants of the cohort who answered a questionnaire in 2012, that is, 13 587 participants (73.7% of the questionnaire sent). In 2007, self-assessed lifetime occupational biomechanical exposure was recorded (carrying loads, manipulating a vibrating tool and climbing stairs), as well as alcohol intake, smoking and diabetes mellitus. Analyses were performed on high alcohol intake, smoking and duration of relevant work exposure, stratified by gender.
Primary and secondary outcome measures
From a specific question on Dupuytren’s disease assessed in 2012, the outcome measures were self-reported Dupuytren’s disease (yes/no) and disabling Dupuytren’s disease (including surgery).
A total of 10 017 men and 3570 women, aged 64–73 years, were included; the mean age for men was 68 years and for women was 65 years. Among men, the following were significantly associated with Dupuytren’s disease: age (OR 1.03 (1.00; 1.06)), diabetes (OR 1.31 (1.07; 1.60)), heavy drinking (OR 1.36 (1.10; 1.69)) and over 15 years of manipulating a vibrating tool at work (OR 1.52 (1.15; 2.02)); except for diabetes, the association with these factors was stronger for disabling Dupuytren’s disease (or surgery), with OR 1.07 (1.03; 1.11), 1.71 (1.25; 2.33) and 1.98(1.34; 2.91), respectively, for age, heavy drinking and over 15 years of manipulating a vibrating tool at work. Among the 3570 women included, 160 reported Dupuytren’s disease (4.5%). The number of cases in the group of women was too low to reach conclusions, although the findings seemed similar for age, diabetes and vibration exposure.
In this large French cohort study, Dupuytren’s disease in men was associated with high levels of alcohol consumption and exposure to hand-transmitted vibration. It is likely that the same applied to women.
PMCID: PMC3913034  PMID: 24477316
11.  Asbestos-related diseases in automobile mechanics 
Annals of Occupational Hygiene  2011;56(1):55-60.
Automobile mechanics have been exposed to asbestos in the past, mainly due to the presence of chrysotile asbestos in brakes and clutches. Despite the large number of automobile mechanics, little is known about the non-malignant respiratory diseases observed in this population. The aim of this retrospective multicenter study was to analyze the frequency of pleural and parenchymal abnormalities on HRCT in a population of automobile mechanics.
The study population consisted of 103 automobile mechanics with no other source of occupational exposure to asbestos, referred to three occupational health departments in the Paris area for systematic screening of asbestos–related diseases. All subjects were examined by HRCT and all images were reviewed separately by two independent readers, with further consensus in the case of disagreement. Multiple logistic regression models were constructed to investigate factors associated with pleural plaques.
Pleural plaques were observed in 5 cases (4.9%) and interstitial abnormalities consistent with asbestosis were observed in 1 case. After adjustment for age, smoking status, and a history of non-asbestos-related respiratory diseases, multiple logistic regression models showed a significant association between the duration of exposure to asbestos and pleural plaques.
The asbestos exposure experienced by automobile mechanics may lead to pleural plaques. The low prevalence of non-malignant asbestos-related diseases, using a very sensitive diagnostic tool, is in favor of a low cumulative exposure to asbestos in this population of workers.
PMCID: PMC3678990  PMID: 21965465
Adult; Asbestos; toxicity; Automobiles; Female; Humans; Logistic Models; Lung Diseases; epidemiology; radiography; Male; Mechanics; Middle Aged; Occupational Diseases; epidemiology; radiography; Occupational Exposure; adverse effects; Paris; Pleural Diseases; epidemiology; radiography; Prevalence; Retrospective Studies; Time Factors; Tomography, X-Ray Computed; methods; Young Adult; asbestos; pleural plaques; automobile mechanics; HRCT
12.  Management of acute allergic reactions by dispatching physicians in a Medical Emergency Dispatch Centre 
Emergency Medicine Journal : EMJ  2010;29(2):147-151.
Acute allergic reactions often occur in out-of-hospital settings, and some of these reactions may cause death in the short term. However, initial diagnosis, management and processing of acute allergic reactions by Medical Emergency Dispatch Centres are not documented. We sought to describe acute allergic reactions and their management by a Medical Emergency Dispatch Centre.
A prospective study was conducted from 20th August 2006 to 5th November 2006 on incoming calls for acute allergic reactions to the Medical Emergency Dispatch Centre for the Hauts de Seine (Paris West suburb, France). The agreement between initial diagnosis (made by dispatching physician) and final diagnosis (made by the physician who later examined the patient), and between initial and final severity, were evaluated using Cohen’s weighted Kappa coefficient.
210 calls were included. The diagnoses made by the dispatching physician were: in 58.1% of cases urticaria, in 23.8% angioedema, in 13.3% laryngeal edema, and in 1.9% anaphylactic shock. The agreement between initial and final diagnoses was evaluated by a kappa coefficient at 0.44 (CI 95%: 0.26–0.61) and the agreement between initial and final severity was evaluated using a kappa coefficient at 0.37 (CI 95%: 0.24–0.50).
We have highlighted only moderate agreement between the initial severity assessed by the dispatching physician and the final severity assessed by the physician later examining the patient. This demonstrates the need to develop a tool for assessing severity of acute allergic reactions for dispatching physicians in Medical Emergency Dispatch Centres.
PMCID: PMC3677740  PMID: 20961937
Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Emergency Medical Services; organization & administration; Female; France; Humans; Hypersensitivity; diagnosis; Infant; Male; Middle Aged; Physician's Role; Prospective Studies; Severity of Illness Index; Young Adult; allergy; pre-hospital; clinical assessment; severity (other)
13.  Physical Examination Has a Low Yield in Screening for Carpal Tunnel Syndrome 
Physical examination is often used to screen workers for carpal tunnel syndrome (CTS). In a population of newly-hired workers, we evaluated the yield of such screening.
Our study population included 1108 newly-hired workers in diverse industries. Baseline data included a symptom questionnaire, physical exam, and bilateral nerve conduction testing of the median and ulnar nerves; individual results were not shared with the employer. We tested three outcomes: symptoms of CTS, abnormal median nerve conduction, and a case definition of CTS that required both symptoms and median neuropathy.
Of the exam measures used, only Semmes-Weinstein sensory testing had a sensitivity value above 31%. Positive predictive values were low, and likelihood ratios were all under 5.0 for positive testing and over 0.2 for negative testing.
Physical examination maneuvers have a low yield for the diagnosis of CTS in workplace surveillance programs and in post-offer, pre-placement screening programs.
PMCID: PMC3624757  PMID: 21154516
Carpal Tunnel Syndrome; Post-offer pre-placement examinations; physical examination; screening; clinical epidemiology
14.  Heavy manual work, exposure to vibration and Dupuytren's disease? Results of a surveillance program for musculoskeletal disorders 
In view of the debate about occupational factors in Dupuytren’s disease, the aim of this study was to describe the prevalence of the disease in men and its relationship with work exposure, and especially to distinguish heavy manual work with and without significant use of vibrating tools by using data from a surveillance program for musculoskeletal disorders.
This cross-sectional study was conducted in France between 2002 and 2004. Dupuytren’s disease was diagnosed clinically by one of the 83 occupational physicians involved in the program. Exposure in relation to work status and occupational risk factors was assessed with a self-administered questionnaire, and was categorized according to vibration exposure (defined as use of vibrating tools ≥2h/day), heavy manual work without vibration exposure [defined as use of hand tools ≥2h/day (use of vibrating tools ≥2h/day excluded) and Borg scale ≥15/20] and no form of such exposure. Bivariate and multivariate associations using logistic models were recorded in men and also in those with over 10 years at the same job.
Of the 2,161 men, 1.3% (n=27) suffered from Dupuytren’s disease (mean age 47.1+/−6.7 years). Heavy manual work without vibration exposure was significantly associated with the disease (adjusted odds ratio - aOR- 3.9[1.3;11.5]) adjusted on age and diabetes), as was the use of vibrating tools (aOR 5.1[2.1;12.2]). These associations remained significant among subjects with over 10 years at the same job, with increases in aOR of 6.1[1.5;25.0] and 10.7[3.4;34.6], respectively.
Despite the limited number of cases, occupational exposure, including both vibration exposure and heavy manual work without significant vibration exposure, was associated with Dupuytren’s disease.
PMCID: PMC3815440  PMID: 22213840
Adult; Cross-Sectional Studies; Dupuytren Contracture; diagnosis; epidemiology; etiology; France; epidemiology; Humans; Logistic Models; Male; Middle Aged; Occupational Diseases; etiology; Occupational Exposure; adverse effects; Occupations; Population Surveillance; Prevalence; Questionnaires; Risk Factors; Vibration; adverse effects; Work; Dupuytren contracture; observational study; occupational factor; manual work; vibration exposure
15.  Performance of Simplified Scoring Systems for Hand Diagrams in Carpal Tunnel Syndrome Screening 
The Journal of hand surgery  2011;37(1):10-17.
Katz et al have published a standardized scoring system of hand diagrams for carpal tunnel syndrome. The purpose of this study was to quantitatively evaluate alternative scoring of the hand diagram for detection of carpal tunnel syndrome.
In a prospective study of 1107 workers, 221 workers with hand symptoms completed hand diagrams and electrodiagnostic testing for carpal tunnel syndrome. Scoring algorithms for the hand diagrams included the Katz rating; a median nerve digit score (0–2) with a maximum of 2 symptomatic digits of thumb, index, and long; and isolated digit scores (0–1) of thumb, index, or long. Intraclass correlation coefficients quantified inter-rater reliability. Sensitivity, specificity, and logistic regression analyses evaluated scoring systems performances ability to predict abnormal median nerve conduction.
One hundred ten (50%) subjects illustrated symptoms within the median nerve distribution. All scoring systems demonstrated substantial inter-rater reliability. “Classic” or “probable” Katz scores, median nerve digit score of 2, and positive long finger scores were significantly associated with abnormal median nerve distal sensory latency and median-ulnar difference. Abnormal distal motor latency was significantly associated with the median nerve digit score of 2 and positive long finger scores. Increasing Katz scores from “possible” to “probable” and “classic” were not associated with greater odds of electrodiagnostic abnormality. Positive long finger scores performed at least as well as the most rigorous scoring by Katz.
Symptoms diagramed within the median nerve distribution are associated with abnormal nerve conduction among workers. The median nerve digit score and the long finger score offer increased ease of use compared to the Katz method while maintaining similar performance characteristics. The long finger appears best suited for isolated digit scoring to predict abnormal median nerve conduction in a working population.
PMCID: PMC3438892  PMID: 21975100
Carpal tunnel syndrome; Hand diagram; screening; scoring
16.  Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact 
Thoracic outlet syndrome is a controversial cause of neck and shoulder pain due to complex mechanisms involving muscular dysfunction and nerve compression. Although management of thoracic outlet syndrome must be based on a multidisciplinary approach, physicians and occupational therapist should be familiar with the principles of diagnosis and treatment.
Method, results and conclusion
The purpose of this article is to review the definitions, diagnosis and management of this syndrome. A particular emphasis was described on the links between the workplace and the individual in the pathogenesis, prevalence in the workforce and the course of this disease.
PMCID: PMC3526474  PMID: 21193950
Diagnosis, Differential; Humans; Occupational Diseases; diagnosis; etiology; therapy; Prevalence; Risk Factors; Thoracic Outlet Syndrome; diagnosis; etiology; therapy; Thoracic outlet syndrome; rehabilitation; diagnosis; occupational disease
17.  Snow in Paris: efficient cooperation in a hospital 
PMCID: PMC3413615  PMID: 21409789
Attitude of Health Personnel; Cooperative Behavior; Disaster Planning; organization & administration; Hospital Administration; Humans; Paris; Snow
18.  Prevalence of multisite musculoskeletal symptoms: a French cross-sectional working population-based study 
The musculoskeletal disorders in working population represent one of the most worrying work-related health issues at the present time and although the very great majority of available data on the subject focus on musculoskeletal disorders defined by anatomical site, a growing number of studies indicate the low prevalence of disorders strictly confined to a specific anatomical site. The objective of this study was to describe the prevalence and characteristics of multisite musculoskeletal symptoms (multisite MS) in a large French working population.
This study was performed on surveillance data of the cross-sectional survey (2002–2005) conducted by a network of occupational physicians in the working population of the Loire Valley region (from 20 to 59 years old). Data concerning MS were collected in the waiting room of the occupational physicians by means of the self-administrated standardized NORDIC questionnaire.
The study population comprised 3,710 workers (2,162 men (58%) and 1,548 women (42%)) with a mean age of 38.4 years (standard deviation: 10.4 years). The prevalence of MS during the past 12 months was 83.8% with 95% confidence interval of [82.8-85.3] for men and 83.9% [82.0-85.7] for women. The prevalence of subacute MS (lasting at least 30 days) over the past 12 months was 32.8% [30.9-34.8] for men and 37.3% [34.9-39.7] for women. Two-thirds of workers reported MS in more than one anatomical site and about 20% reported MS lasting at least 30 days in more than one anatomical site. The anatomical sites most frequently associated with other MS were the upper back, hip, elbow and neck. The majority of these multisite MS were widespread, involving at least two of the three anatomical regions (upper limb, axial region and lower limb).
The frequency and extent of multisite MS reported by workers are considerable. Further research must be conducted in this field in order to provide a better understanding of the characteristics and determinants of these multisite MS.
PMCID: PMC3495201  PMID: 22818516
19.  Prevention of musculoskeletal disorders in workers: classification and health surveillance – statements of the Scientific Committee on Musculoskeletal Disorders of the International Commission on Occupational Health 
The underlying purpose of this commentary and position paper is to achieve evidence-based recommendations on prevention of work-related musculoskeletal disorders (MSDs). Such prevention can take different forms (primary, secondary and tertiary), occur at different levels (i.e. in a clinical setting, at the workplace, at national level) and involve several types of activities. Members of the Scientific Committee (SC) on MSDs of the International Commission on Occupational Health (ICOH) and other interested scientists and members of the public recently discussed the scientific and clinical future of prevention of (work-related) MSDs during five round-table sessions at two ICOH conferences (in Cape Town, South Africa, in 2009, and in Angers, France, in 2010). Approximately 50 researchers participated in each of the sessions. More specifically, the sessions aimed to discuss new developments since 1996 in measures and classification systems used both in research and in practice, and agree on future needs in the field.
The discussion focused on three questions: At what degree of severity does musculoskeletal ill health, and do health problems related to MSDs, in an individual worker or in a group of workers justify preventive action in occupational health? What reliable and valid instruments do we have in research to distinguish ‘normal musculoskeletal symptoms’ from ‘serious musculoskeletal symptoms’ in workers? What measures or classification system of musculoskeletal health will we need in the near future to address musculoskeletal health and related work ability?
Four new, agreed-upon statements were extrapolated from the discussions: 1. Musculoskeletal discomfort that is at risk of worsening with work activities, and that affects work ability or quality of life, needs to be identified. 2. We need to know our options of actions before identifying workers at risk (providing evidence-based medicine and applying the principle of best practice). 3. Classification systems and measures must include aspects such as the severity, frequency, and intensity of pain, as well as measures of impairment of functioning, which can help in prevention, treatment and prognosis. 4. We need to be aware of economic and/or socio-cultural consequences of classification systems and measures.
PMCID: PMC3437218  PMID: 22721454
Occupation; Epidemiology; Prevention; Aetiology; Expert opinion; Occupational health; Public health; Rheumatology; Rehabilitation; Orthopaedics
20.  Renal failure and occupational exposure to organic solvents: what work-up should be performed? 
The etiological work-up of a disease with an occupational component, such as renal failure associated with exposure to organic solvents, may include several complementary investigations. We discussed certain elements of the aetiological work-up in the light of a clinical case, particularly the individual and collective advantages and disadvantages of this work-up. Further investigations would not have provided the patient with any individual or collective benefit and were therefore not performed, while other investigations (environmental studies, screening of fellow workers) may provide collective rather than individual benefits, but must be decided by a multidisciplinary approach. A multidisciplinary study (general practitioner, nephrologist, occupational health physician and specialist in toxicology) is necessary to discuss the appropriate aetiological work-up, taking into account the individual and collective benefit-risk balance.
PMCID: PMC3320581  PMID: 21337187
Occupational disease; Kidney disease (Failure); (Organic)Solvent; (Etiologic diagnosis)
21.  Comparison of research case definitions for carpal tunnel syndrome 
The aim of our study was to assess agreement between different case definitions of carpal tunnel syndrome (CTS) for epidemiological studies.
We performed a literature search for papers suggesting case definitions for use in epidemiological studies of CTS. Using data elements based on symptom questionnaires, hand diagrams, physical examinations and nerve conduction studies collected from 1107 newly-hired workers, each subject in the study was classified according to each of the case definitions selected from the literature. We compared each case definition to every other case definition, using the Kappa statistic to measure pairwise agreement on whether each subject met the case definition.
We found six unique papers in a twenty year period suggesting a case definition of CTS for use in population-based studies. We extracted seven case definitions. Definitions included different parameters: symptoms only, symptoms and physical examination, symptoms and either physical examination or median nerve conduction study, symptoms and nerve conduction study. When applied to our study population, the prevalence of CTS using different case definitions ranged from 2.5% to 11.0%. The percentage of misclassification was between 1 to 10%, with generally acceptable levels of agreement (Kappa values ranged from 0.30 to 0.85).
Different case definitions resulted in widely varying prevalences of CTS. Agreement between case definitions was generally good, particularly between those that required very specific symptoms or the combination of symptoms and physical examination or nerve conduction. The agreement observed between different case definitions suggests that the results can be compared across different research studies of risk factors for CTS.
PMCID: PMC3317883  PMID: 21301789
median neuropathy; population study; nerve conduction studies; screening
23.  Attributable risk of carpal tunnel syndrome according to industry and occupation in a general population 
Arthritis and Rheumatism  2008;59(9):1341-1348.
An epidemiological surveillance network for carpal tunnel syndrome (CTS) was set up in the general population of a French region to assess the attributable fraction of CTS according to work in high risk industries and occupations.
Cases of CTS occurring among patients aged 20 to 59 living in the Maine and Loire region were included prospectively from 2002 to 2004. Medical and occupation history was gathered by mailed questionnaire for 815 women and 20 men. Age-adjusted relative risks of CTS and the attributable fractions of CTS to work among exposed persons (AFE) were computed in relation to industry sectors and occupation categories.
Twenty-one industry sectors and eight occupational categories for women, and ten sectors and six occupational categories for men were characterized by a significant excess risk of CTS. High values of AFE were observed in the manufacturing (from 42 to 93% for both genders), construction (66 for men) and personal service industries (66 for women), and trade and commerce (49% for women) sectors. High values of AFE were observed in female lower grade white-collar occupations (from 43 to 67%), and male (from 60 to 74%) and female (from 48 to 88%) blue-collar occupations.
The attributable fractions of CTS among workers employed in industry sectors and occupation categories identified at high risk of CTS varied between 36 and 93%
PMCID: PMC3192399  PMID: 18759264
Adult; Carpal Tunnel Syndrome; epidemiology; Employment; statistics & numerical data; Female; France; epidemiology; Humans; Incidence; Male; Middle Aged; Occupational Diseases; epidemiology; Odds Ratio; Questionnaires; Risk Factors; Attributable risk fraction; Carpal tunnel syndrome; Industry; Occupation; Work; Work-related.
24.  Risk factors for upper-extremity musculoskeletal disorders in the working population 
Arthritis and Rheumatism  2009;61(10):1425-1434.
The study aimed to assess the relative importance of personal and occupational risk factors for upper-extremity musculoskeletal disorders (UEMSDs) in the working population.
A total of 3,710 workers (58% of men) participating in a surveillance program of MSDs in a French region in 2002–2005 were included. UEMSDs were diagnosed by 83 trained occupational physicians performing a standardized physical examination. Personal factors and work exposure were assessed by a self-administered questionnaire. Statistical associations between MSDs, personal and occupational factors were analyzed using logistic regression modeling.
A total of 472 workers suffered from at least one UEMSD. The risk of UEMSDs increased with age for both genders (P<0.001) (O.R. up to 4.9 in men and 5.0 and in women) and in cases of prior history of UEMSDs (OR 3.1 and 5.0, P<0.001). In men, UEMSDs were associated with obesity (OR 2.2, P=0.014), high level of physical demand (OR 2.0, P<0.001), high repetitiveness of the task (OR 1.5, P=0.027), postures with the arms at or above shoulder level (OR 1.7, P=0.009) or with full elbow flexion (OR 1.6, P=0.006), and high psychological demand (O.R. 1.5, P=0.005). In women, UEMSDs were associated with diabetes mellitus (O.R. 4.9, P=0.001), postures with extreme wrist bending (OR 2.0, P<0.001), use of vibrating hand tools (O.R. 2.2, P=0.025) and low level of decision authority (OR 1.4, P=0.042).
The study showed that personal and work-related physical and psychosocial factors were strongly associated with clinically-diagnosed UEMSDs.
PMCID: PMC3189514  PMID: 19790112
Musculoskeletal disorders; upper extremity; risk factors; personal factors; physical exposure; psychosocial factors; work; Adult; Employment; Female; Humans; Male; Middle Aged; Musculoskeletal Diseases; diagnosis; epidemiology; etiology; Occupational Diseases; diagnosis; epidemiology; etiology; Risk Factors; Safety Management; Upper Extremity; pathology; physiopathology
25.  What was the patient's occupation? 
PMCID: PMC3180008  PMID: 20661075
Arthralgia; etiology; radiography; Dancing; Female; Foot Joints; radiography; Humans; Metatarsal Bones; radiography; Middle Aged; Occupational Diseases; etiology; radiography; Osteoarthritis; etiology; radiography; Tomography, X-Ray Computed

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