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Exposure-response relationships for the ACGIH threshold limit value for hand-activity level: results from a pooled data study of carpal tunnel syndrome.

Authors
Kapellusch JM; Gerr FE; Malloy EJ; Garg A; Harris-Adamson C; Bao SS; Burt SE; Dale AM; Eisen EA; Evanoff BA; Hegmann KT; Silverstein BA; Theise MS; Rempel DM
Source
Scand J Work Environ Health 2014 Nov; 40(6):610-620
NIOSHTIC No.
20045438
Abstract
Objective: This paper aimed to quantify exposure response relationships between the American Conference of Governmental Industrial Hygienists' (ACGIH) threshold limit value (TLV) for hand-activity level (HAL) and incidence of carpal tunnel syndrome (CTS). Methods: Manufacturing and service workers previously studied by six research institutions had their data combined and re-analyzed. CTS cases were defined by symptoms and abnormal nerve conduction. Hazard ratios (HR) were calculated using proportional hazards regression after adjusting for age, gender, body mass index, and CTS predisposing conditions. Results: The longitudinal study comprised 2751 incident-eligible workers, followed prospectively for up to 6.4 years and contributing 6243 person-years of data. Associations were found between CTS and TLV for HAL both as a continuous variable [HR 1.32 per unit, 95% confidence interval (95% CI) 1.11-1.57] and when categorized using the ACGIH action limit (AL) and TLV. Those between the AL and TLV and above the TLV had HR of 1.7 (95% CI 1.2-2.5) and 1.5 (95% CI 1.0-2.1), respectively. As independent variables (in the same adjusted model) the HR for peak force (PF) and HAL were 1.14 per unit (95% CI 1.05-1.25), and 1.04 per unit (95% CI 0.93-1.15), respectively. Conclusion: Those with exposures above the AL were at increased risk of CTS, but there was no further increase in risk for workers above the TLV. This suggests that the current AL may not be sufficiently protective of workers. Combinations of PF and HAL are useful for predicting risk of CTS.
Keywords
Exposure-assessment; Threshold-limit-values; Musculoskeletal-system-disorders; Carpal-tunnel-syndrome; Nerve-function; Long-term-study; Employee-exposure; Risk-analysis; Risk-factors; Statistical-analysis; Exposure-levels; Repetitive-work; Force; Hand-injuries; Overloading; Biomechanics; Epidemiology; Extremities; Author Keywords: American Conference of Governmental Industrial Hygienists; biomechanical overload; CTS; epidemiology; HAL; hand force; MSD; musculoskeletal disorder; peak force; physical exposure; repetition; threshold limit value; upper extremity
Contact
Jay Kapellusch, Department of Occupational Science & Technology University of Wisconsin, Milwaukee, PO Box 413, Milwaukee, WI 53201, USA
CODEN
SWEHDO
Publication Date
20141101
Document Type
Journal Article
Email Address
kap@uwm.edu
Funding Type
Grant
Fiscal Year
2015
Identifying No.
Grant-Number-R01-OH-009712; M122014; Grant-Number-T42-OH-008429
Issue of Publication
6
ISSN
0355-3140
NIOSH Division
DSHEFS
Source Name
Scandinavian Journal of Work, Environment & Health
State
CA; WI; IA; DC; WA; OH; MO; UT
Performing Organization
University of California, San Francisco
Page last reviewed: June 28, 2019
Content source: National Institute for Occupational Safety and Health Education and Information Division