Objective The aim of the study is to explore personal and work factors related to fatal cardiac events among oil and gas extraction (OGE) workers. Methods The National Institute for Occupational Safety and Health Fatalities in Oil and Gas Extraction database was reviewed to identify fatal cardiac events among OGE workers from 2014 through 2019. A case series design was used to review case files, provide descriptive statistics, and summarize the findings. Results There were 75 fatalities identified, including 55 (73%) with sufficient information for review. Of the 55 workers, 18 (33%) worked alone. Thirty-six fatal cardiac events (66%) were unwitnessed by a coworker. Toxicology findings suggested some possible exposures to hydrogen sulfide or hydrocarbon gases or vapors. Missing data were common. Conclusions This study identified the need for cardiovascular disease prevention and treatment, emergency preparedness, lone worker programs, medical screening, and enhanced exposure control in the OGE industry.

ObjectiveThe aim of the study is to explore personal and work factors related to fatal cardiac events among oil and gas extraction (OGE) workers.MethodsThe National Institute for Occupational Safety and Health Fatalities in Oil and Gas Extraction database was reviewed to identify fatal cardiac events among OGE workers from 2014 through 2019. A case series design was used to review case files, provide descriptive statistics, and summarize the findings.ResultsThere were 75 fatalities identified, including 55 (73%) with sufficient information for review. Of the 55 workers, 18 (33%) worked alone. Thirty-six fatal cardiac events (66%) were unwitnessed by a coworker. Toxicology findings suggested some possible exposures to hydrogen sulfide or hydrocarbon gases or vapors. Missing data were common.ConclusionsThis study identified the need for cardiovascular disease prevention and treatment, emergency preparedness, lone worker programs, medical screening, and enhanced exposure control in the OGE industry.

OBJECTIVE:The aim of the study is to assess risk of common musculoskeletal disorders (MSDs) based on cardiovascular disease (CVD) risk scores.METHODS:Data from a 9-year prospective cohort of 1224 workers in three states were analyzed. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy.RESULTS:Adjusted RRs for one or more MSDs increased to 3.90 (95% confidence interval, 2.20-6.90) among those with 10-year cardiovascular disease risk scores greater than 15% and 17.4 (95% confidence interval, 3.85-78.62) among those with more than 4 disorders.CONCLUSIONS:Cardiovascular disease factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger.

Background: The objective of this study was to investigate the prevalence of carpal tunnel syndrome (CTS) in workers with trigger digit. There are few cross-sectional studies that assess this relationship. Methods: A baseline examination of 1216 workers from 17 diverse manufacturing facilities was conducted. Worker demographics, medical history, and symptoms of trigger digit were assessed. Age, sex, and body mass index were obtained. Biomechanical factors were individually measured using the Strain Index (SI). Prevalence was assessed with univariate and multivariate logistic regression. Results: Unadjusted prevalence of trigger digit was 12.0%, and among those workers, there was an unadjusted CTS prevalence of 26.7%. The adjusted multivariate model found an odds ratio (OR) of CTS of 1.56 (95% confidence interval [CI], 1.03-2.36) among the workers with trigger digit. The ORs of CTS for SI (OR = 1.53 [95% CI, 1.04-2.23]), age (OR = 1.03 [95% CI, 1.01-1.04]), and current smoking (OR = 1.76 [95% CI, 1.12-2.75]) were also significant. Sex and diabetes were not statistically significant covariates. Conclusion: The prevalence of CTS is higher among workers with trigger digit.

INTRODUCTION:Commercial motor vehicle drivers, such as truck drivers, experience unique health, lifestyle, and occupational challenges directly associated with their profession.METHODS:All participants in this multistate cross-sectional study completed questionnaire measurements. Participants were categorized with metabolic syndrome (MetS) if they had at least three of the five modified criteria used in the joint scientific statement on metabolic syndrome.RESULTS:Overall MetS prevalence was 52.4% (n = 428) of the 817 participants. Prevalence of MetS criteria were waist circumference (n = 634, 77.0%), low HDL cholesterol (n = 580, 71.0%), elevated triglycerides (n = 552, 67.6%), elevated blood pressure (n = 175, 21.2%), and elevated hemoglobin A1c (n = 97, 11.9%). Truck drivers were 2.7 times more likely to have MetS compared to the general working population.CONCLUSION:Truck drivers in the United States have a high prevalence of MetS compared to the general working population.

Introduction: Commercial motor vehicle drivers, such as truck drivers, experience unique health, lifestyle, and occupational challenges directly associated with their profession. Methods: All participants in this multistate cross-sectional study completed questionnaire measurements. Participants were categorized with metabolic syndrome (MetS) if they had at least three of the five modified criteria used in the joint scientific statement on metabolic syndrome. Results: Overall MetS prevalence was 52.4% ( n = 428) of the 817 participants. Prevalence of MetS criteria were waist circumference ( n = 634, 77.0%), low HDL cholesterol ( n = 580, 71.0%), elevated triglycerides ( n = 552, 67.6%), elevated blood pressure ( n = 175, 21.2%), and elevated hemoglobin A1c ( n = 97, 11.9%). Truck drivers were 2.7 times more likely to have MetS compared to the general working population. Conclusion: Truck drivers in the United States have a high prevalence of MetS compared to the general working population.

Background:  Previously reported risk factors for common musculoskeletal disorders (MSDs) have been low in magnitude and with unclear pathophysiological mechanisms.  Methods:  Data from a nine-year prospective cohort were analyzed.  Baseline data included computerized questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors.  Framingham risk scores were calculated.  A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy.  Monthly follow-ups were conducted to assess symptoms (development, resolution and/or treatments) and to perform physical examinations.  Nerve conduction studies were performed every 6 months if any new-onset paresthesias in the prior six-month interval were reported.    Results:  The relative risk of four different MSDs increased with rising cardiovascular disease risk scores; adjusted relative risks for one or more MSD increased to 3.90 (95% CI, 2.20, 6.90) among those with 10-year cardiovascular risk scores above 15%.  The relative risk of multiple MSDs increased more strongly with rising cardiovascular disease risk; adjusted relative risk for four or more MSDs increased to 17.40 (95% CI, 3.85, 78.62) among those with 10-year cardiovascular risk scores above 15%.  Conclusions: Cardiovascular disease risk factors are strongly associated with the subsequent development of common MSDs.  Risks among those with multiple MSDs are considerably stronger.  Further investigations of this new potential line of prevention are needed, as well as the utility of these MSDs to identify the development of silent coronary artery disease. Funding Statement: This work was supported, in part, by grants from the National Institute for Occupational Safety and Health (NIOSH/CDC) grant 1R01OH010474–01 and NIOSH Education and Research Center training grant T42/CCT810426–10. Declaration of Interests: The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Ethics Approval Statement: Institutional review boards of the University of Utah, University of Wisconsin-Milwaukee and Medical College of Wisconsin approved this study.

Objective: The primary goal of this cross-sectional analysis was to determine the relationships between self-reported low back pain (LBP) ratings and use of opioid medications. Methods: At baseline, subjects completed a computerized questionnaire. Structured interviews were conducted by residents or certified therapists under the direction of board-certified physicians. Results: There was a statistically significant nonlinear relationship between lifetime prevalence of worst LBP rating (0 to 10) and lifetime prevalence of opioid use. Those with a low pain rating for worst lifetime LBP and those with high LBP ratings were significantly more likely to have been prescribed opioids. Surprisingly, those with moderate pain ratings were the least likely to have used opioids. Conclusion: This study found a higher use of opioids between workers with low and high severe pain rating then those with moderate pain. We also found an increase of opioid use for severe pain.

Objective: To quantify sensitivity and specificity of the tender points and demonstrate how variability in case definition impacts prevalence of lateral epicondylitis (LE). Methods: Baseline data analyzed from 1216 workers from the WISTAH study, a multicenter prospective cohort study of upper extremity musculoskeletal disorders. All workers completed computerized questionnaires. structured interviews, and two independent physical examinations in accordance with an established protocol. Results: The prevalence of LE differed based on case definition ranging from 4.7% to 12.1%. Sensitivity was low for tender points 1 to 4 ranging from 6.8% to 34.6%. Specificity was high for tender points 1 to 4 ranging from 95.2% to 97.9%. Conclusions: The prevalence of lateral epicondylitis differs markedly based on case definition used. ranging more than two-fold. Standardization of a case definition is essential to allow for comparisons across studies.

Objectives: Identify if Carpal tunnel syndrome (CTS) symptoms vary by measured biomechanical exposures. Methods: A nested prospective cohort within a large, multicenter, 8-year cohort study. The CTS case definition was tingling/numbness in 2+ median nerve-served digits plus a nerve conduction study consistent with CTS. Workers were assigned to: (1) low (strain index [ SI] less than or equal to 6.1), and (2) high (SI more than 6.1) job groups. Results: Among 1201 workers, 106 had CTS. Those in the high SI group became and remained symptom-free for at least 3 months, faster than the low SI group, adjusted hazard ratio (HR) = 2.07 (95% confidence interval [CI] = 1.21 to 3.56, P = 0.008). Only surgical release trended towards resolving CTS. Light duty had no impact, and job change was associated with delayed symptoms resolution. Conclusions: High biomechanical exposures paradoxically predicted faster improvement in CTS and light duty did not result in symptom resolution.

Introduction: Diagnostic screening tests for carpal tunnel syndrome (CTS) have not been rigorously assessed in large populations. Methods: This study is a cross-sectional analysis from a prospective cohort study. Participants' (n = 1,194) symptoms and disease prevalence were measured. Sensitivity, specificity, and positive and negative predictive values (NPVs) were calculated. Results: When defining CTS as tingling/numbness in at least two median nerve–served digits and an abnormal median nerve conduction study, the prevalence was 8.9%. The sensitivity of paresthesias with nocturnal awakening was 77.4%. The sensitivity of the Phalen sign was 52.8% and that of the Hoffman-Tinel sign was only 37.7%. Discussion: The highest sensitivity (77.4%) for a case definition of CTS in this population of workers was for nocturnal tingling/numbness in a median nerve distribution, and the highest specificity (97.5%) was for continuous tingling/numbness. The Phalen sign has a sensitivity of 52.8% and NPV of 95%, suggesting that the NPV is of particular diagnostic value. Hoffman-Tinel signs seem primarily helpful for the NPV (93.7%). Level of Evidence: Level II diagnostic study

Objective: The aim of the study was to assess the relationship between leisure time exercise and whether workers ever had modified duty or lost time (MD/LT) due to low back pain (LBP) in an occupational cohort. Methods: Workers (N = 827) completed a structured interview assessing characteristics of their LBP, whether or not the pain caused modified or lost work time, and their participation in leisure time exercise. Odds ratio of modified/lost time and minutes of exercise participation were assessed. Results: Workers who participated in over 316 min/wk of leisure time exercise incurred significantly less modified/lost time, adjusted odds ratio = 0.46 (95% confidence interval, 0.23 to 0.98). There also lies a significant trend between increases in leisure time exercise and reductions in modified/lost time (P = 0.0016). Conclusion: These results suggest exercise reduces risk of MD/LT from LBP.

OBJECTIVE:Recent evidence has found potential associations between cardiovascular disease (CVD) risk factors and common musculoskeletal disorders. We evaluated possible associations between risk factors and both glenohumeral joint pain and rotator cuff tendinopathy. METHODS:Data from WISTAH hand study participants (n = 1226) were assessed for associations between Framingham Heart Study CVD risk factors and both health outcomes. RESULTS:A strong association was observed between CVD risk scores and both glenohumeral joint pain and rotator cuff tendinopathy. Peak odds ratios (ORs) of the adjusted models were 4.55 [95% confidence interval (95% CI) 1.97 to 10.31] and 5.97 (95% CI 2.12 to 16.83), respectively. The results show a dose-response trend of increasing risk. CONCLUSIONS:Individual risk factors were associated with both outcomes. Combined, CVD risk factors demonstrated a strong correlation with glenohumeral joint pain and an even stronger correlation with rotator cuff tendinopathy. Results suggest a potentially modifiable disease mechanism.

Background The pathophysiology of lateral epicondylitis (LE) is unclear. Recent evidence suggests some common musculoskeletal disorders may have a basis in cardiovascular disease (CVD) risk factors. Thus, we examined CVD risks as potential LE risks. Methods Workers ( n = 1824) were enrolled in two large prospective studies and underwent structured interviews and physical examinations at baseline. Analysis of pooled baseline data assessed the relationships separately between a modified Framingham Heart Study CVD risk score and three prevalence outcomes of: 1) lateral elbow pain, 2) positive resisted wrist or middle finger extension, and 3) a combination of both symptoms and at least one resisted maneuver. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratios (ORs) and 95% Confidence Intervals (CIs) were calculated. Results There was a strong relationship between CVD risk score and lateral elbow symptoms, resisted wrist or middle finger extension and LE after adjustment for confounders. The adjusted ORs for symptoms were as high as 3.81 (95% CI 2.11, 6.85), for positive examination with adjusted odds ratios as high as 2.85 (95% CI 1.59, 5.12) and for combined symptoms and physical examination 6.20 (95% CI 2.04, 18.82). Relationships trended higher with higher CVD risk scores. Conclusions These data suggest a potentially modifiable disease mechanism for LE.

IntroductionPrevious studies have reported higher wrist ratios (WR) related to carpal tunnel syndrome (CTS) but have not assessed effect modification by obesity and may have inadequately controlled for confounders. MethodsBaseline data of a multicenter prospective cohort study were analyzed. CTS was defined by nerve conduction study (NCS) criteria and symptoms. ResultsAmong the 1,206 participants, a square-shaped wrist was associated with CTS after controlling for confounders (prevalence ratio=2.27; 95% confidence interval [95% CI], 1.33-3.86). Body mass index (BMI) was a strong effect modifier on the relationship between WR and both CTS and abnormal NCS results, with normal weight strata of rectangular versus square wrists=8.18 (95% CI, 1.63-49.96) and 7.12 (95% CI, 2.19-23.16), respectively. DiscussionA square wrist is significantly associated with CTS after controlling for confounders. Effect modification by high BMI masked the eightfold magnitude adjusted relationship seen between WR and CTS among normal weight participants. Muscle Nerve56: 1047-1053, 2017

OBJECTIVE:The aim of this study was to systematically evaluate prevalence based on variations in case definitions used for epidemiological studies of musculoskeletal disorders (MSDs).BACKGROUND:Prior studies of MSDs have mostly relied on a single case definition based on questionnaires.METHOD:In a multicenter prospective cohort study, we systematically collected data to evaluate impacts of differences in case definitions of MSDs on prevalence of three common musculoskeletal disorders: (a) shoulder tendinosis, (b) lateral epicondylalgia, and (c) carpal tunnel syndrome. Production workers were from 21 employment settings in three diverse U.S. states and performed widely varying work. All workers completed laptop-administered structured interviews, two standardized physical examinations, and nerve conduction studies (NCS). Case definitions included symptoms only, and symptoms plus physical examinations and/or NCS.RESULTS:A total of 1,227 subjects had complete health data at baseline. The prevalence for shoulder tendinosis is 23.0% if only glenohumeral pain is used for a case definition, compared with 8.0% if a combination of pain plus a positive supraspinatus test is used. The prevalence for lateral epicondylalgia varied on the basis of lateral elbow pain (12.0%), pain plus tenderness on palpation (9.9%), or pain plus tenderness on palpation plus resisted wrist or middle finger extension (3.5%). Carpal tunnel syndrome prevalence varied on the basis of tingling or numbness in a median nerve-served digit (29.9%) or tingling or numbness plus NCS abnormalities consistent with carpal tunnel syndrome (9.0%).CONCLUSION:Variations in epidemiological case definitions have major impacts on prevalence of common MSDs. Wide-ranging differences in prevalence may have impacts on purported risk factors that need to be determined.

Objective: This manuscript systematically quantifies multiple measures of low-back pain (LBP) prevalence by pain rating in a large, multisite cohort of workers. Background: Published LBP prevalence rates vary. Studies rely on one measure of LBP and none report prevalence stratified by pain rating. Method: Cross-sectional analyses of baseline data from a multicenter prospective cohort study were performed to evaluate differences in lifetime prevalence, 1-month period prevalence, and point prevalence of LBP. Workers were from 28 different employment settings in 4 diverse U.S. states. All workers completed computerized questionnaires and structured interviews. LBP prevalence measures were stratified by pain ratings. Results: A total of 828 subjects had complete health data at baseline. Lifetime prevalence, 1-month period prevalence, and point prevalence for any LBP (≥1/10) were 63.4%, 44.0%, and 20.8% respectively. Prevalence of LBP decreased with increasing pain ratings. As an example, using a threshold of LBP ≥ 3/10 pain, prevalence measures were 61.0%, 37.6%, and 16.7% respectively. A threshold of LBP ≥ 5/10 had prevalence measures of 51.2%, 22.9%, and 9.9% respectively. Age, systolic and diastolic blood pressure, high cholesterol, high blood pressure, and tobacco use were statistically significantly related to lifetime prevalence of LBP. Conclusion: Lifetime LBP prevalence, 1-month period prevalence, and point prevalence stratified by pain ratings demonstrate a wide variation of prevalence measures of LBP and self-reported pain ratings. Higher pain rating thresholds yield lower prevalence measures and may impact assessments of risk factors. Differences in pain ratings may allow for focused surveillance within an occupational cohort.

BACKGROUND:Low Back Pain (LBP) is a common and costly problem, with variation in prevalence. Epidemiological reports of rating of pain intensity and location within the low back area are rare. The objective is to describe LBP in a large, multi-center, occupational cohort detailing both point and 1-month period prevalence of LBP by location and intensity measures at baseline.METHODS:In this cross-sectional report from a prospective cohort study, 828 participants were workers enrolled from 30 facilities performing a variety of manual material handling tasks. All participants underwent a structured interview detailing pain rating and location. Symptoms in the lower extremities, demographic and other data were collected. Body mass indices were measured. Outcomes are pain rating (0-10) in five defined lumbar back areas (i) LBP in the past month and (ii) LBP on the day of enrollment. Pain ratings were reported on a 0-10 scale and subsequently collapsed with ratings of 1-3, 4-6 and 7-10 classified as low, medium and high respectively.RESULTS:172 (20.8%) and 364 (44.0%) of the 828 participants reported pain on the day of enrollment or within the past month, respectively. The most common area of LBP was in the immediate paraspinal area with 130 (75.6%) participants with point prevalence LBP and 278 (77.4%) with 1-month period prevalence reported having LBP in the immediate paraspinal area. Among those 364 reporting 1-month period prevalence pain, ratings varied widely with 116 (31.9%) reporting ratings classified as low, 170 (46.7%) medium and 78 (21.4%) providing high pain ratings in any location. Among the 278 reporting 1-month period prevalence pain in the immediate paraspinal area, 89 (32.0%) reported ratings classified as low, 129 (46.4%), medium and 60 (21.6%) high pain ratings.CONCLUSIONS:Pain ratings varied widely, however less variability was seen in pain location, with immediate paraspinal region being the most common. Variations may suggest different etiological factors related to LBP. Aggregation of different locations of pain or different intensities of pain into one binary classification of LBP may result in loss of information which may potentially be useful in prevention or treatment of LBP.

Few prospective cohort studies of workplace low back pain (LBP) with quantified job physical exposure have been performed. There are few prospective epidemiological studies for LBP occupational risk factors and reported data generally have few adjustments for many personal and psychosocial factors.

BACKGROUND:Few prospective cohort studies of distal upper extremity musculoskeletal disorders have been performed. Past studies have provided somewhat conflicting evidence for occupational risk factors and have largely reported data without adjustments for many personal and psychosocial factors.METHODS/DESIGN:A multi-center prospective cohort study was incepted to quantify risk factors for distal upper extremity musculoskeletal disorders and potentially develop improved methods for analyzing jobs. Disorders to analyze included carpal tunnel syndrome, lateral epicondylalgia, medial epicondylalgia, trigger digit, deQuervain's stenosing tenosynovitis and other tendinoses. Workers have thus far been enrolled from 17 different employment settings in 3 diverse US states and performed widely varying work. At baseline, workers undergo laptop administered questionnaires, structured interviews, two standardized physical examinations and nerve conduction studies to ascertain demographic, medical history, psychosocial factors and current musculoskeletal disorders. All workers' jobs are individually measured for physical factors and are videotaped. Workers are followed monthly for the development of musculoskeletal disorders. Repeat nerve conduction studies are performed for those with symptoms of tingling and numbness in the prior six months. Changes in jobs necessitate re-measure and re-videotaping of job physical factors. Case definitions have been established. Point prevalence of carpal tunnel syndrome is a combination of paraesthesias in at least two median nerve-served digits plus an abnormal nerve conduction study at baseline. The lifetime cumulative incidence of carpal tunnel syndrome will also include those with a past history of carpal tunnel syndrome. Incident cases will exclude those with either a past history or prevalent cases at baseline. Statistical methods planned include survival analyses and logistic regression.DISCUSSION:A prospective cohort study of distal upper extremity musculoskeletal disorders is underway and has successfully enrolled over 1,000 workers to date.