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Journal of Occupational & Environmental Medicine:
doi: 10.1097/JOM.0b013e31825fa545
Letters to the Editor

Description of Musculoskeletal Disorders and Occupational Exposure From a Field Pilot Study of Large Population-Based Cohort (CONSTANCES)

Carton, Matthieu MD; Leclerc, Annette PhD; Plouvier, Sandrine MD, PhD; Herquelot, Eleonore MSc; Zins, Marie MD; Goldberg, Marcel MD, PhD; Roquelaure, Yves MD, PhD; Descatha, Alexis MD, PhD

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“Population-Based Epidemiological Cohorts” Research Platform Centre for Research in Epidemiology and Population Health Université de Versailles Saint Quentin-Inserm Villejuif, France

“Population-Based Epidemiological Cohorts” Research Platform Centre for Research in Epidemiology and Population Health Université de Versailles Saint Quentin-Inserm Villejuif, France

Laboratoire d'Ergonomie et d'Epidémiologie en Santé au Travail LUNAM, Université d'Angers CHU Angers, France

“Population-Based Epidemiological Cohorts” Research Platform Centre for Research in Epidemiology and Population Health Université de Versailles Saint Quentin-Inserm Villejuif, France

AP-HP Occupational Health Department University Hospital of Paris West Suburb, Poincaré site CHU Garches, France

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The authors declare that there are no conflicts of interest. The authors alone are responsible for the content and writing of the article.

To the Editor:

Musculoskeletal disorders (MSDs) have become one of the most significant and costly health problems in the working population. Information about the prevalence of MSDs available in the literature, mainly coming from specific company-based studies, may suffer from a lack of comparability because of the variability of the population.1–4 Because the relative importance of each risk factor for MSDs varies according to work environments,5 these studies should be extrapolated to the entire working population with caution.6 Furthermore, besides the occupational setting potentially leading to overrating or underrating of MSD or exposure, depending on the potential benefit or risk to social status of the workers, these studies have problems in observing workers, especially those with temporary jobs.

The “Cohorte des consultants des Centres d'examens de santé” (CONSTANCES) project was designed to set up a large population-based longitudinal cohort designed as an “open epidemiologic laboratory” accessible to the epidemiologic research community with the aim of contributing to the development of epidemiologic research and to provide useful public health information. In conclusion, the cohort was composed of a random sample of adults aged 18 to 69 years at inception, and inclusion took place in Health Screening Centers (HSCs).7 We hypothesize that the information provided by cohort participants that will be included in HSCs will also provide information about participants usually not observed in studies about occupational settings, such as unemployed population or temporary workers.

We made use of the data collected during the pilot phase of the project to describe the prevalence of MSDs and exposure to the risk factors. In view of setting up of the full CONSTANCES cohort, we checked whether their prevalence is similar to that in other large MSD studies. We also detailed the main characteristics of the participants, their exposure, and complaints to verify that HSCs and CONSTANCES could provide an interesting setting for studies about temporary workers and the unemployed population.

The study sample was taken from the field pilot study of CONSTANCES. It took place in seven of the participating HSCs throughout France, from May 2009 to May 2010 for a 4- to 5-month period in each center. It was designed to include 3500 participants (women and men in almost equal numbers), and the preliminary analysis of the data showed that this sample was close to the general adult population in France regarding sex, age, and socioeconomic status.7 Most of the variables used in the field pilot study were taken from self-administered questionnaires. In the present study, we used the following: sociodemographic characteristics (sex, age, social position, educational and income levels, and employment status); and occupational factors (current occupational exposure to biomechanical hazards) that were collected based on the Saltsa consensus and the French MSD surveillance system.8,9 Specific scales for MSD based on the Nordic questionnaire were filled out.2,10,11 Presence of symptoms lasting at least 30 days during the past 12 months by site was also considered.

For unemployed population, only not retired participants and those with previous jobs were considered and compared with the working sample. In the working population, associations between type of contract and social position with sociodemographic characteristics, work exposure, and MSDs were described.

The sample included 3471 participants; 1643 men and 1829 women. Among them, 113 (3.2%) never worked, 443 (1.7%) reported to be retired, 328 (9.4%) had no job, and 2587 (74.5%) were working at the time of the study. The 328 participants (112 men and 216 women) who reported to be unemployed (not retired, but had never worked) were older (50 to 60 years) (men: 38.4% vs 26.7%; women: 32.4% vs 25.4%; P < 0.05) and more often blue-collar workers (men: 31.1% vs 22.2%; women: 8.3% vs 4.8%, respectively) compared with the working population. Unemployed men had significantly more shoulder persistent pain than working men (22.6% vs 12.3%) and unemployed women had more hand, elbow, back, and knee pain (22.3%, 13.6%, 36.1%, and 26.0% vs 15.0%, 8.8%, 25.9%, and 18.8%, respectively) than working women. When the information was collected (n = 180), unemployed people reported to be seeking a job (53.9%, n = 97), have voluntarily resigned from their jobs (26.7%, n = 48), or have a health problem (19.4%, n = 35).

Table 1 shows the prevalence of occupational exposure and persistent musculoskeletal pain in men and women according to social position and employment status. In men and women, there was a clear gradient between social position and prevalence of occupational exposure to physical effort, squatting position, working with arms up, or screwing with hand. In men, the prevalence of persistent back and knee pain increased with social position (not significant for other sites). In women, there is a clear gradient in the prevalence of pain with the social position for all sites except the neck. Very few women reported temporary jobs. In men and women, occupational exposures were strongly associated with employment status. Although very few men reported temporary jobs, they seemed to report more persistent musculoskeletal pain (significant only for elbows).

Table 1
Table 1
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Finally, we considered whether the field pilot study gave a fair description of MSDs and biomechanical exposure in a large sample of the general population. Limitations came from the design of the pilot study and its inclusion criteria. The study had a cross-sectional design based on a large and nontargeted population. Nevertheless, we found the globally expected levels of exposure and pain. The first results regarding temporary workers and unemployed populations clearly open a way for more research on these usually hard-to-reach populations in occupational studies.12–15 The high prevalence of MSDs in our sample of temporary workers and participants who had to stop working is promising for future research within the large longitudinal CONSTANCES cohort.

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CONCLUSIONS

This field pilot study showed valid results about MSDs with interesting information for particular populations of usually unreached participants. The limited sample will be extended and would give additional material for studying these populations.

Matthieu Carton, MD

Annette Leclerc, PhD

Sandrine Plouvier, MD, PhD

Eleonore Herquelot, MSc

Marie Zins, MD

Marcel Goldberg, MD, PhD

“Population-Based Epidemiological

Cohorts” Research Platform

Centre for Research in Epidemiology and

Population Health

Université de Versailles Saint

Quentin-Inserm

Villejuif, France

Yves Roquelaure, MD, PhD

“Population-Based Epidemiological

Cohorts” Research Platform

Centre for Research in Epidemiology and

Population Health

Université de Versailles Saint

Quentin-Inserm

Villejuif, France

Laboratoire d'Ergonomie et

d'Epidémiologie en Santé au Travail

LUNAM, Université d'Angers

CHU Angers, France

Alexis Descatha, MD

“Population-Based Epidemiological

Cohorts” Research Platform

Centre for Research in Epidemiology

and Population Health

Université de Versailles Saint

Quentin-Inserm

Villejuif, France

AP-HP Occupational Health Department

University Hospital of Paris West Suburb,

Poincaré site

CHU Garches, France

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REFERENCES

1. Silverstein BA, Stetson DS, Keyserling WM, Fine LJ. Work-related musculoskeletal disorders: comparison of data sources for surveillance. Am J Ind Med. 1997;31:600–608.

2. Descatha A, Roquelaure Y, Chastang JF, et al. Validity of Nordic-style questionnaires in the surveillance of upper-limb work-related musculoskeletal disorders. Scand J Work Environ Health. 2007;33:58–65.

3. Palmer KT, Reading I, Calnan M, Coggon D. How common is repetitive strain injury? Occup Environ Med. 2008;65:331–335.

4. Bonneterre V, Faisandier L, Bicout D, et al. Programmed health surveillance and detection of emerging diseases in occupational health: contribution of the French national occupational disease surveillance and prevention network (RNV3P). Occup Environ Med. 2010;67:178–186.

5. Bernard BP. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, the Upper-Limb, and Low Back. Cincinnati, OH: Centers for Disease Control and Prevention, NIOSH; 1997.

6. Miranda H, Viikari-Juntura E, Heistaro S, Heliovaara M, Riihimaki H. A population study on differences in the determinants of a specific shoulder disorder versus nonspecific shoulder pain without clinical findings. Am J Epidemiol. 2005;161:847–855.

7. Zins M, Bonenfant S, Carton M, et al. The CONSTANCES cohort: an open epidemiological laboratory. BMC Public Health. 2010;10:479.

8. Sluiter BJ, Rest KM, Frings-Dresen MH. Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders. Scand J Work Environ Health.. 2001;27(suppl 1):1–102.

9. Roquelaure Y, Ha C, Leclerc A, et al. Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. Arthritis Rheum. 2006;55:765–778.

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14. Smith CK, Silverstein BA, Bonauto DK, Adams D, Fan ZJ. Temporary workers in Washington State. Am J Ind Med. 2010;53:135–145.

15. Roquelaure Y, Petit Lemanach A, Ha C, et al. Working in temporary employment and exposure to musculoskeletal constraints. Occup Med (Lond). 2012 February 17 [epub ahead of print].

Copyright © 2013 by the American College of Occupational and Environmental Medicine

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