Knee Disorders and Occupational Biomechanical Risks

描述(申请人提供)：膝关节疾病是残疾和过早离开工作的主要来源，但对与工作相关的膝关节疾病的风险知之甚少。大多数发现与工作相关的研究都依赖于职称或相对简单的问卷调查来进行暴露评估，并粗略地描述了暴露的特征，而没有关于生物力学风险因素的水平或类型的信息。因此，由于暴露于尴尬的持续姿势、蹲下、跪下、举重等不同强度和持续时间的暴露，膝关节疾病与膝关节压力或扭矩之间的关联知之甚少。职业流行病学中现场观察方法和基于问卷的暴露评估的最新进展使我们能够通过提供更好的人体工学危险因素类型的规范以及对这些暴露强度的半定量估计来改进这种定性的风险描述。工会木匠的工作人口将成为目标，因为他们有一系列类型和强度的膝部疾病的生物力学风险。这项拟议的研究旨在关注与慢性生物力学暴露于下肢相关的骨性关节炎和其他慢性膝关节疾病的风险。具体目标是开发和评估方法，以：1)使用马萨诸塞州木匠联合福利基金和圣路易斯木匠健康和福利信托基金提供的医疗保险记录，识别和描述膝关节疾病的事故案例；以及2)通过实地观察分析，评估木匠工作中发生的各种暴露。包括来自两个州的数据库，使研究人群翻了一番，并允许纳入所有范围的木工任务，以及对疾病和暴露的地区比较。这项研究的结果将是关于这些工作中生物力学暴露的新知识，可以直接应用于预防已知的风险情况(例如，导致不可接受的扭矩的任务)，以及可以应用于后续病例对照调查的方法，旨在提供有关骨关节炎和其他膝关节疾病与木匠经历的职业暴露之间关系的定量数据。

DESCRIPTION (provided by applicant): Knee disorders are a major source of disability and early departure from work but there is limited knowledge about the risk of knee disorders related to work. Most studies finding associations with work have relied on job titles or relatively simple questionnaire surveys for exposure assessment and characterized exposure crudely, without information on level or type of biomechanical risk factors. As a result, little is known about the association of knee disorders with compressive force or torque on the knee joint resulting from varying intensities and durations of exposures to awkward sustained postures, squatting, kneeling, weight lifted, etc. Recent advances in field observation methods and questionnaire-based exposure assessment in occupational epidemiology permit us to improve upon this qualitative risk characterization by providing better specification of types of ergonomic risk factors along with semi-quantitative estimates of exposure intensity for these. A working population of union carpenters will be targeted because they have a range of types and intensity of biomechanical risks for knee disorders. The proposed study is designed with a focus on the risk of osteoarthritis and other chronic knee conditions associated with chronic biomechanical exposures to the lower limb. The specific objectives are to develop and evaluate methods to: 1) identify and characterize incident cases of knee disorders using medical insurance records available from the Carpenters' Combined Benefits Fund of Massachusetts and the Carpenters' Health and Welfare Trust Fund of St. Louis; and 2) assess a diverse range of exposures occurring in carpenters' jobs through observational analyses in the field. Including the databases from both states doubles the study population and permits inclusion of the full range of carpenter tasks as well as regional comparisons of disorders and exposures. The outcomes from this study will be new knowledge about biomechanical exposures in these jobs that can be directly applied to preventing known risk circumstances (e.g., tasks resulting in unacceptable torque), as well as methods that can be applied in a subsequent case-control investigation designed to provide quantitative data on the associations between osteoarthritis and other knee disorders and occupational exposures experienced by carpenters.