Development and Validation of a Job Exposure Matrix for Physical Risk Factors in Low Back Pain

Objectives

The aim was to construct and validate a gender-specific job exposure matrix (JEM) for physical exposures to be used in epidemiological studies of low back pain (LBP).

Materials and Methods

We utilized two large Finnish population surveys, one to construct the JEM and another to test matrix validity. The exposure axis of the matrix included exposures relevant to LBP (heavy physical work, heavy lifting, awkward trunk posture and whole body vibration) and exposures that increase the biomechanical load on the low back (arm elevation) or those that in combination with other known risk factors could be related to LBP (kneeling or squatting). Job titles with similar work tasks and exposures were grouped. Exposure information was based on face-to-face interviews. Validity of the matrix was explored by comparing the JEM (group-based) binary measures with individual-based measures. The predictive validity of the matrix against LBP was evaluated by comparing the associations of the group-based (JEM) exposures with those of individual-based exposures.

Results

The matrix includes 348 job titles, representing 81% of all Finnish job titles in the early 2000s. The specificity of the constructed matrix was good, especially in women. The validity measured with kappa-statistic ranged from good to poor, being fair for most exposures. In men, all group-based (JEM) exposures were statistically significantly associated with one-month prevalence of LBP. In women, four out of six group-based exposures showed an association with LBP.

Conclusions

The gender-specific JEM for physical exposures showed relatively high specificity without compromising sensitivity. The matrix can therefore be considered as a valid instrument for exposure assessment in large-scale epidemiological studies, when more precise but more labour-intensive methods are not feasible. Although the matrix was based on Finnish data we foresee that it could be applicable, with some modifications, in other countries with a similar level of technology.     

Lifting over an obstacle: effects of one-handed lifting and hand support on trunk kinematics and low back loading

Mechanical loading of the low back during lifting is a common cause of low back pain. In this study two-handed lifting is compared to one-handed lifting (with and without supporting the upper body with the free hand) while lifting over an obstacle. A 3-D linked segment model was combined with an EMG-assisted trunk muscle model to quantify kinematics and joint loads at the L5S1 joint. Peak total net moments (i.e., the net moment effect of all muscles and soft tissue spanning the joint) were found to be 10+/-3% lower in unsupported one-handed lifting compared to two-handed lifting, and 30+/-8% lower in supported compared to unsupported one-handed lifting. L5S1 joint forces also showed reductions, but not of the same magnitude (18+/-8% and 15+/-10%, respectively, for compression forces, and 15+/-17% and 11+/-14% respectively, for shear forces). Those reductions of low back load were mainly caused by a reduction of trunk and load moment arms relative to the L5S1 joint during peak loading, and, in the case of hand support, by a support force of about 250 N. Stretching one leg backward did not further reduce low back load estimates. Furthermore, one-handed lifting caused an 6+/-8 degrees increase in lateral flexion, a 9+/-5 degrees increase in twist and a 6+/-6 degrees decrease in flexion. Support with the free hand caused a small further increase in lumbar twisting. It is concluded that one-handed lifting, especially with hand support, reduces L5S1 loading but increases asymmetry in movements and moments about the lumbar spine.     

Mechanical demands on the lower back in patients with non-chronic low back pain during a symmetric lowering and lifting task

There is limited information in the literature related to the lower back loading in patients with LBP, particularly those with non-chronic LBP. Toward addressing such a research gap, a case-control study was conducted to explore the differences in lower back mechanical loads between a group of females (n = 19) with non-chronic, non-specific LBP and a group of asymptomatic females (n = 19). The differences in lower back mechanical loads were determined when participants completed one symmetric lowering and lifting of a 4.5 kg load at their preferred cadence. The axial, shearing, and moment components of task demand at the time of peak moment component as well as measures of peak trunk kinematics were analyzed. Patient vs. asymptomatic group performed the task with smaller peak thoracic rotation and peak lumbar flexion. While no differences in the moment component of task demand on the lower back between the patients and controls were found, the shearing (40–50 age group) and axial components of task demand were, respectively, larger and smaller in patients vs. controls. Whether alterations in lower back loads in patients with non-chronic LBP are in response to pain or preceded the pain, the long-term exposure to abnormal lower back mechanics may adversely affect spinal structure and increase the likelihood of further injury or pain. Therefore, the underlying reason(s) as well as the potential consequence(s) of such altered lower back mechanics in patients with non-chronic LBP should to be further investigated.     

Prospective cohort study of predictors of incident low back pain in nurses.

OBJECTIVE: To assess the impact of handling patients and indicators of individual susceptibility on risk of low back pain in nurses. DESIGN: Prospective cohort study with follow up by repeated self administered every three months over two years. SETTING: NHS university hospital trust. SUBJECTS: 961 female nurses who had been free from low back pain for at least one month at the time of completing a baseline questionnaire. MAIN OUTCOME MEASURES: Incidence of new low back pain during follow up and of pain leading to absence from work. RESULTS: Of 838 women who provided data suitable for analysis, 322 (38%) developed low back pain during follow up (mean 18.6 months), including 93 (11%) whose pain led to absence from work. The strongest predictor of new low back pain was earlier history of the symptom, and risk was particularly high if previous pain had lasted for over a month in total and had occurred within the 12 months before entry to the study (incidence during follow up 66%). Frequent low mood at baseline was strongly associated with subsequent absence from work for back pain (odds ratio 3.4; 95% confidence interval 1.4 to 8.2). After adjustment for earlier history of back pain and other potential confounders, risk was higher in nurses who reported frequent manual transfer of patients between bed and chair, manual repositioning of patients on the bed, and lifting patients in or out of the bath with a hoist. CONCLUSIONS: Of the indicators of individual susceptibility that were examined, only history of back trouble was sufficiently predictive to justify selective exclusion of some applicants for nursing posts. The main route to prevention of back disorders among nurses is likely to lie in improved ergonomics.     

Health conditions of bus drivers in a 6 year follow up study

The bus drivers of a public bus company, working in a fast rotating 4 shift system from 05.00 to 24.30, were examined in 1993 (230 persons) and 1999 (266 persons). The comparison between the two years showed no significant differences for all the parameters evaluated by the Standard Shiftwork Index and medical examination. In both surveys work organisation was considered "efficient-fairly good" by most workers, who were mostly satisfied with their job. Work load was rated significantly higher for "afternoon" and "morning" shifts, during which most accidents at work and "in itinere" occurred. Night sleep was reduced by 3 hours on "early" shift and about 2 hours on "morning" shifts. The most prevalent health troubles dealt with low back pain, gastritis, headache and haemorrhoids. Neuroticism was the trait more correlated with poorer health conditions, whereas shiftwork exposure appeared as a significant predictor of risk of critical Effort/Reward Imbalance and minor psychological disorders. Both extrinsic and intrinsic efforts significantly increased with age, but not reward. The comparison of the same cohort of 108 persons examined both in 1993 and in 1999 showed a significant increase of low back pain, gastrointestinal troubles, haemorrhoids and lipids disorders.     

Mortality patterns among industrial workers exposed to chloroprene and other substances. II. Mortality in relation to exposure

As part of an historical cohort study to investigate the mortality experience of industrial workers exposed to chloroprene (CD) and other substances, including vinyl chloride monomer (VC), we analyzed mortality from all cancers combined, respiratory system (RSC) and liver cancer in relation to CD and VC exposures. Subjects were 12,430 workers ever employed at one of two U.S. sites (Louisville, KY (n=5507) and Pontchartrain, LA (n=1357)) or two European sites (Maydown, Northern Ireland (n=4849) and Grenoble, France (n=717)). Historical exposures for individual workers were estimated quantitatively for CD and VC. For sites L, M, P and G, respectively, average intensity of CD exposures (median value of exposed workers in ppm) were 5.23, 0.16, 0.028 and 0.149 and median cumulative exposures (ppm years) were 18.35, 0.084, 0.133 and 1.01. For sites L and M, respectively, average intensity of VC exposures (median value of exposed workers in ppm) was 1.54 and 0.03 and median cumulative exposures (ppm years) were 1.54 and 0.094. We performed relative risk (RR) regression modeling to investigate the dependence of the internal cohort rates for all cancers combined, RSC and liver cancer on combinations of the categorical CD or VC exposure measures with adjustment for potential confounding factors. We categorized exposure measures into approximate quartiles based on the distribution of deaths from all cancers combined. We also considered 5- and 15-year lagged exposure measures and adjusted some RR models for worker pay type (white/blue collar) as a rough surrogate for lifetime smoking history. All modeling was site-specific to account for exposure heterogeneity. We also computed exposure category-specific standardized mortality ratios (SMRs) to assess absolute mortality rates. With the exception of a one statistically significant association with duration of exposure to CD and all cancers combined in plant M, we observed no evidence of a positive association with all cancers, RSC or liver cancer and exposure to CD and/or VC using both the unlagged and lagged exposure measures: duration, average intensity or cumulative exposure to CD or VC; time since first CD or VC exposure; and duration of CD exposure or time since first CD exposure in presence or absence of VC exposure. We observed elevated and statistically significantly elevated RRs for some analysis subgroups, but these were due to inordinately low death rates in the baseline categories. With the possible exception of all cancer mortality in plant G, our additional adjustment of RRs for pay type revealed no evidence of positive confounding by smoking. We conclude that exposures to CD or VC at the levels encountered in the four study sites do not elevate mortality risks from all cancers, RSC or liver cancer. This conclusion is corroborated by our analysis of general mortality patterns among the CD cohort reported in our companion paper [G. Marsh, A. Youk, J. Buchanich, M. Cunningham, N. Esmen, T. Hall, M. Phillips, Mortality patterns among industrial workers exposed to chloroprene and other substances. I. General mortality patterns, Chem.-Biol. Interact., submitted for publication].     

Position sense in the lumbar spine with torso flexion and loading

Proprioception plays an important role in appropriate sensation of spine position, movement, and stability. Previous research has demonstrated that position sense error in the lumbar spine is increased in flexed postures. This study investigated the change in position sense as a function of altered trunk flexion and moment loading independently. Reposition sense of lumbar angle in 17 subjects was assessed. Subjects were trained to assume specified lumbar angles using visual feedback. The ability of the subjects to reproduce this curvature without feedback was then assessed. This procedure was repeated for different torso flexion and moment loading conditions. These measurements demonstrated that position sense error increased significantly with the trunk flexion (40%, p < .05) but did not increase with moment load (p = .13). This increased error with flexion suggests a loss in the ability to appropriately sense and therefore control lumbar posture in flexed tasks. This loss in proprioceptive sense could lead to more variable lifting coordination and a loss in dynamic stability that could increase low back injury risk. This research suggests that it is advisable to avoid work in flexed postures.     

Lymphocyte DNA damage in elevator manufacturing workers in Guangzhou, China

AIMS: To study the effect of smoking, passive smoking, alcohol drinking, and occupational exposure to low level of benzene on DNA strand breaks in elevator manufacturing workers in Guangzhou, China. METHODS: Three hundred and fifty-nine workers (252 men and 107 women) of a modern elevator manufacturing factory, 205 were from production departments and 154 from managerial department. Information on the workers' health conditions, smoking, passive smoking, alcohol consumption and occupational exposure history was collected by personal interview. Lymphocyte DNA damage was measured by the Comet assay. RESULTS: None of the women smoked and 20.6% of the men were daily smokers. In non-smokers, the prevalence of passive smoking at work was 25% for men and 11.2% for women, and at home, 37.8 and 48.6%, respectively. Smoking significantly increased tail moment (P<0.001). Daily smokers had the largest tail moment (geometric mean, 95% CI) (0.93 microm (0.81-0.94)), followed by occasional smokers (0.76 microm (0.59-0.95)), ex-smokers (0.70 microm (0.58-0.85)), and never smokers (0.56 microm (0.53-0.60)). Tail moment increased significantly with daily tobacco consumption (cigarettes per day) (r=0.26, P<0.001) after adjusting for age, gender, occupational exposure, passive smoking, and drinking. Analysis of covariance (ANCOVA) showed that smoking (P<0.001), passive smoking at home (P=0.026), occupational exposure (P<0.001), male gender (P<0.001), and age (P=0.001) had independent effects on tail moment, whereas passive smoking at work and alcohol drinking had no significant effect. CONCLUSIONS: Smoking, passive smoking at home, male gender, age and occupational exposure independently increased lymphocyte DNA strand breaks. The presence of excess DNA damage under low level of occupational exposure to benzene or other solvents suggest that the current allowance concentrations may not be safe to prevent genotoxicity.     

Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

Objective To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care.Design Cohort study with one year follow-up.Setting Primary care clinics in Sydney, Australia.Participants An inception cohort of 973 consecutive primary care patients (mean age 43.3, 54.8% men) with non-specific low back pain of less than two weeks’ duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors.Main outcome measures Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression.Results The follow-up rate over the 12 months was more than 97%. Half of those who reduced their work status at baseline had returned to previous work status within 14 days (95% confidence interval 11 to 17 days) and 83% had returned to previous work status by three months. Disability (median recovery time 31 days, 25 to 37 days) and pain (median 58 days, 52 to 63 days) took much longer to resolve. Only 72% of participants had completely recovered 12 months after the baseline consultation. Older age, compensation cases, higher pain intensity, longer duration of low back pain before consultation, more days of reduced activity because of lower back pain before consultation, feelings of depression, and a perceived risk of persistence were each associated with a longer time to recovery.Conclusions In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.     

Threshold of Musculoskeletal Pain Intensity for Increased Risk of Long-Term Sickness Absence among Female Healthcare Workers in Eldercare

Purpose

Musculoskeletal disorders increase the risk for absenteeism and work disability. However, the threshold when musculoskeletal pain intensity significantly increases the risk of sickness absence among different occupations is unknown. This study estimates the risk for long-term sickness absence (LTSA) from different pain intensities in the low back, neck/shoulder and knees among female healthcare workers in eldercare.

Methods

Prospective cohort study among 8,732 Danish female healthcare workers responding to a questionnaire in 2004–2005, and subsequently followed for one year in a national register of social transfer payments (DREAM). Using Cox regression hazard ratio (HR) analysis we modeled risk estimates of pain intensities on a scale from 0–9 (reference 0, where 0 is no pain and 9 is worst imaginable pain) in the low back, neck/shoulders and knees during the last three months for onset of LTSA (receiving sickness absence compensation for at least eight consecutive weeks) during one-year follow-up.

Results

During follow-up, the 12-month prevalence of LTSA was 6.3%. With adjustment for age, BMI, smoking and leisure physical activity, the thresholds of pain intensities significantly increasing risk of LTSA for the low back (HR 1.44 [95%CI 1.07–1.93]), neck/shoulders (HR 1.47 [95%CI 1.10–1.96]) and knees (HR 1.43 [95%CI 1.06–1.93]) were 5, 4 and 3 (scale 0–9), respectively, referencing pain intensity of 0.

Conclusion

The threshold of pain intensity significantly increasing the risk for LTSA among female healthcare workers varies across body regions, with knee pain having the lowest threshold. This knowledge may be used in the prevention of LTSA among health care workers.     

The influence of visual display terminal use on the physical and mental conditions of administrative staff in Japan

Visual display terminals (VDT) are standard equipment for many office workers. Their use, however, may increase the risk of developing adverse conditions related to vision, the musculoskeletal system, and mental health. We carried out a survey among 3070 workers aged 18 to 67 years (mean, 39.9 years) at a prefectural administrative office, in which 76% of subjects were visual display terminal (VDT) users. We examined the relationship between duration of daily VDT use and eyestrain, neck or upper extremity pain, back pain, and mental health, and estimated the effect of breaks and rest during VDT work on these symptoms. The 12-item General Health Questionnaire (GHQ-12: total scores ranged from 0 to 12) was used to identify potential poor mental health status, and subjects with 4 or more were considered to have symptoms of psychological distress. Seventeen percent of subjects reported eyestrain, 19.1% reported upper extremity pain, 11.6% reported back pain, and 17% of subjects had GHQ-12 scores of 4 or higher. Logistic regression analysis showed that duration of daily VDT use and lack of breaks and rest during VDT work were significantly associated with eyestrain, neck or upper extremity pain, back pain, and psychological distress. In order to protect users from the adverse effects associated with VDT work, reducing daily VDT exposure, taking breaks, and rest during VDT work are important.     

Interrelated hypoalgesia,creep, and muscle fatigue following a repetitive trunk flexion exposure

Repetitive trunk flexion can damage spinal tissues, however its association with low back pain in the workplace may be confounded by factors related to pain sensitivity. Muscle fatigue, exercise-induced hypoalgesia, and creep-induced neuromuscular changes following repetitive trunk flexion may all affect this assumed exposure-pain relationship. This study’s purpose was to determine how mechanical pain sensitivity in the low back is affected by a repetitive trunk flexion exposure and identify factors associated with changes in low back pain sensitivity. Pressure pain thresholds, perceptions of sub-threshold stimuli, and muscle fatigue in the trunk and tibia, as well as lumbar spine creep were tracked in 37 young healthy adults before and up to 40 min after a 10-min repetitive trunk flexion exposure. Pressure pain thresholds (p = 0.033), but not perceptions of sub-threshold stimuli (p > 0.102) were associated with approximately a 12.5% reduction in pain sensitivity 10 min after completing the exposure, while creep and local muscle fatigue effects were only observed immediately following the exposure. Creep and fatigue interactions and the corresponding tibial measure co-varied with individual low back pressure pain thresholds. The net hypoalgesic effects of repetitive trunk flexion have the potential to partially mask possibly injurious loads, which could contribute to the severity or incidence of lower back injuries related to these exposures.     

Mortality (1950-1999) and cancer incidence (1969-1999) in the cohort of Eldorado uranium workers

This study assessed the relationship between radon decay product (RDP) exposure and mortality and cancer incidence in a cohort of 17,660 Eldorado uranium workers first employed in 1932-1980 and followed up through 1999. The analysis was based on substantially revised identifying information and dosimetry for workers from the Beaverlodge and Port Radium uranium mines and for the first time includes workers from a radium and uranium refinery and processing facility in Port Hope, Canada. Overall, male workers had lower mortality rates of all causes and all cancers and lower incidence rates of all cancers compared with the general Canadian male population, a likely healthy worker effect. Individual cancer rates were also reduced except for lung cancer mortality (SMR = 1.31, P < 0.001) and incidence (SIR = 1.23, P < 0.001). The excess relative risk per 100 WLM (ERR/100 WLM) of lung cancer mortality (N = 618, ERR/100 WLM = 0.55, 95% CI: 0.37, 0.78, P < 0.01) and incidence (N = 626, ERR/100 WLM = 0.55, 95% CI: 0.37, 0.81, P < 0.001) increased linearly with increasing RDP exposure. Adjustment for effect modification by time since exposure, exposure rate and age at risk resulted in comparable estimates of risk of lung cancer for all three uranium worksites. RDP exposures and γ-ray doses were not associated with any other cancer site or other cause of death. The risk estimates are in agreement with the results of the pooled analysis of 11 miner cohorts and more recent studies of uranium workers. The current analysis provides more precise risk estimates and compares the findings from the mortality study with the incidence study. Future follow-up of the cohort and joint analysis with other uranium miners' studies should shed more light on the effects of low RDP exposures as experienced by current workers as well as help to understand and address the health risks associated with residential radon.     

Lymphocyte DNA damage in bus manufacturing workers

To study the effect of occupational exposure, smoking, and drinking on lymphocyte DNA damage in bus manufacturing workers, 346 employees (106 women and 240 men) from six job categories (welders, mechanics, painters, and assembling, auxiliary and managerial workers) in a bus manufacturing factory in Guangzhou were included. Significant differences of tail moment among the six job categories were found (P=0.003) with adjustment for age and gender. Smoking increased tail moment significantly (3.14 (2.89-3.40) versus 2.79 microm (2.63-2.97), P=0.023). Analysis of covariance showed that occupational exposure (P=0.001) and smoking (P=0.019) had significant effect on tail moment after adjusting for all factors, whereas age and gender had no effect on DNA damage. Stratified analysis showed that painters (P=0.002), auxiliary workers (P=0.011), and mechanics (P=0.044) had larger tail moments than managerial workers after adjusting for age, gender, smoking, and drinking.     

The CUPID (Cultural and Psychosocial Influences on Disability) study: methods of data collection and characteristics of study sample

Background

The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample.

Methods/Principal Findings

A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as “repetitive strain injury” (RSI).

Conclusions/Significance

The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.     

A dynamic 3D biomechanical evaluation of the load on the low back during different patient-handling tasks

The objective of this study was to investigate the low-back loading during common patient-handling tasks. Ten female health care workers without formal training in patient handling performed nine patient-handling tasks including turning, lifting and repositioning a male stroke patient. The low-back loading was quantified by net moment, compression, and shear forces at the L4/L5 joint, measured muscle activity (EMG) in erector spinae muscles and rate of perceived exertion (RPE; Borg scale). The experiments were videotaped with a 50Hz video system using five cameras, and the ground and bedside reaction forces of the health care worker were recorded by means of force platforms and force transducers on the bed. The biomechanical load was calculated using a dynamic 3D seven-segment model of the lower part of the body, and the forces at the L4/L5 joint were estimated by a 14 muscles cross-sectional model of the low back (optimisation procedure). Compression force and torque showed high task dependency whereas the EMG data and the RPE values were more dependent on the subject. The peak compression during two tasks involving lifting the patient (4132/4433N) was significantly higher than all other tasks. Four tasks involving repositioning the patient in the bed (3179/3091/2932/3094N) did not differ, but showed higher peak compression than two tasks turning the patient in the bed (1618/2197N). Thus, in this study the patient-handling tasks could be classified into three groups-characterised by lifting, repositioning or turning-with different levels of peak net torque and compression at the L4/L5 joint.     

Muscular mechanical energy expenditure as a process for detecting potential risks in manual materials handling

The problem of injuries in manual materials handling remains a big concern in industrialized countries. It has become imperative in occupational biomechanics to extend the analyses to all pertinent factors involved in working tasks and to adopt an experimental approach leading to the understanding of the relative demands imposed simultaneously on all body joints. The evaluation of joint muscular work and the processes of energy generation, absorption and transfer appears promising as a tool in the detection of risk factors in working tasks. The present study consisted of evaluating two tasks (lifting and lowering) performed at five different heights (from 15 to 185 cm) with five different loads (from 3.3 to 22.0 kg). The subjects were eight experienced workers from a food product warehouse. Cinematography techniques and two AMTI force platforms were used to collect the data. Dynamic and planar segmental analyses were performed to calculate the net muscular moments at the joints, and work was calculated from the integration of muscular power. Factorial analyses of variance with repeated measures were performed on the dependent variables to evaluate the main effects of tasks, loads, and heights (for lifting and for lowering) and the interactions. The results revealed the adoption of different movement strategies in the handling of heavier loads. In the first, a larger emphasis of energy transfer and movement economy; in the second, a reduction in the relative contribution of the shoulders to the detriment of an increased participation of the lower back and hips was found. The comparison between lifting and lowering tasks indicated that lifting was only slightly more demanding than lowering for maximum muscular moments (about 15%) but much more so for mechanical work (about 40%); however, the nature of the efforts in eccentric contractions suggests that the lowering of heavy loads may be risky. Finally, the results revealed the deviation of height of handling from the waist level to be a significant factor. Handling at lower heights was considerably more demanding but the work was shared by several joints, mainly by the hips and lower back (about 70%); on the other hand, in handling above the waist, the work efforts were concentrated on the upper limbs (about 80%). In most cases, the participation of lower limbs was minimal and some movement strategies are suggested for future research.     

DNA damage in lymphocytes of benzene exposed workers correlates with trans,trans-muconic acids and breath benzene levels

Benzene causes many kinds of blood disorders in workers employed in many different environments. These diseases include myelodisplastic syndrome and acute and chronic myelocytic leukemia. In the present study, five occupational work places, including six industrial process types, namely, printing, shoe-making, methylene di-aniline (MDA), nitrobenzene, carbomer, and benzene production were selected, and the levels of breath benzene, and trans,trans-muconic acids (t,t-MA) and phenol in urine were evaluated, as well as hematological changes and lymphocyte DNA damage. The concentration of benzene in breath was less than 3 ppm in the workplaces, and benzene exposure was found to be higher in work places where benzene is used, than in those where benzene is produced. At low levels of benzene exposure, urinary t,t-MA correlated strongly with benzene in air. Highest Olive tail moments were found in workers producing carbomer. Levels of breathzone benzene were found to be strongly correlated with Olive tail moment values in the lymphocytes of workers, but not with hematological data in the six workplaces types. In conclusion, the highest benzene exposures found occurred in workers at a company, which utilized benzene in the production of carbomer. In terms of low levels of exposure to benzene, urinary t,t-MA and DNA damage exhibited a strong correlation with breath benzene, but not with hematological data. We conclude that breath benzene, t,t-MA and lymphocytic DNA damage are satisfactory biomonitoring markers with respect to benzene exposure in the workplace.     

Relationship between moments at the L5/S1 level, hip and knee joint when lifting

A study was performed to determine the influence of load magnitude on the self selected technique of lifting. Specifically, it was hypothesized that with heavier weights a tendency would occur to lift more with the back and less with the legs. Flexion-extension moments at the L5/S1 level, hip and knee joints were calculated for subjects when lifting boxes weighing from 50 to 250 N. Lifts were performed using a freestyle technique at normal speed. The moment profiles (moment plotted vs time) were analyzed kinematically and as a function of the weight lifted. The kinematics of the lift changed as the weight increased. The moment at the L5/S1 level increased with increasing weight, however, the corresponding knee moment decreased. Thus, an inverse relationship was found between the moment at the L5/S1 level and the knee joint moment. An increase in weight lifted was also associated with an increase in the angular velocity at the knee while lifting. Apparently with heavier weights there is a tendency to extend the knees earlier during the lift than with lighter weights, confirming our hypothesis. This explains the reduced knee moment. Our findings lead to the hypothesis that quadriceps muscle strength limits the subjects' ability to lift with their knees flexed.