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1.  Dupuytren’s contracture and occupational exposure to hand-transmitted vibration 
Aims
The relation between Dupuytren’s contracture and occupational exposure to hand-transmitted vibration (HTV) has frequently been debated. We explored associations in a representative national sample of workers with well-characterised exposure to HTV.
Methods
We mailed a questionnaire to 21,201 subjects aged 16 – 64 years, selected at random from the age-sex registers of 34 general practices in Great Britain and to 993 subjects chosen randomly from military pay records, asking about occupational exposure to 39 sources of HTV and about fixed flexion contracture of the little or ring finger. Analysis was restricted to men at work in the previous week. Estimates were made of average daily vibration dose (A(8) r.m.s.) over that week. Associations with Dupuytren’s contracture were estimated by Poisson regression, both for lifetime exposure to HTV and for exposures in the past week >A(8) of 2.8 ms−2 r.m.s.. Estimates of relative risk (Prevalence Ratio (PR)) were adjusted for age, smoking status, social class and certain manual activities at work.
Results
In all 4,969 eligible male respondents supplied full information on the study variables. These included 72 men with Dupuytren’s contracture, 2,287 with occupational exposure to HTV, and 409 with A(8)>2.8 ms−2 in the past week. PRs for occupational exposure to HTV were elevated 1.5-fold. For men with an A(8)>2.8 ms−2 in the past week, the adjusted PR was 2.85 (95% confidence interval 1.37 to 5.97).
Conclusions
Our findings suggest that risk of Dupuytren’s contracture is more than doubled in men with high levels of weekly exposure to HTV.
doi:10.1136/oemed-2013-101981
PMCID: PMC3963601  PMID: 24449599
2.  Optimising case definitions of upper limb disorder for aetiological research and prevention – a review 
Background
Experts disagree about the optimal classification of upper limb disorders (ULDs). To explore whether differences in associations with occupational risk factors offer a basis for choosing between case definitions in aetiological research and surveillance, we analysed previously published research.
Methods
Eligible reports (those with estimates of relative risk (RR) for >1 case definition relative to identical exposures were identified from systematic reviews of ULD and occupation and by hand-searching five peer-review journals published between January 1990 and June 2010. We abstracted details by anatomical site of the case and exposure definitions employed and paired estimates of RR, for alternative case definitions with identical occupational exposures. Pairs of case definitions were typically nested, a stricter definition being a subset of a simpler version. Differences in RR between paired definitions were expressed as the ratio of RRs, using that for the simpler definition as the denominator.
Results
We found 21 reports, yielding 320 pairs of RRs (82, 75 and 163 respectively at the shoulder, elbow, and distal arm). Ratios of RRs were frequently ≤1 (46%), the median ratio overall and by anatomical site being close to unity. In only 2% of comparisons did ratios reach ≥4.
Conclusion
Complex ULD case definitions (e.g. involving physical signs, more specific symptom patterns, and investigations) yield similar associations with occupational risk factors to those using simpler definitions. Thus, in population-based aetiological research and surveillance, simple case definitions should normally suffice. Data on risk factors can justifiably be pooled in meta-analyses, despite differences in case definition.
doi:10.1136/oemed-2011-100086
PMCID: PMC3427012  PMID: 22006938

Results 1-2 (2)