Exposure Response Relationships for CTS and Epicondylitis from Pooled Data

描述（由申请人提供）：拟议的研究提供了一个独特的机会，以提供测量的职业生物力学压力源，非职业性体力活动，人口统计学，病史，心理社会因素之间的可靠性反应估计;和腕管综合征（CTS），外上髁炎（LEPI）和内上髁炎（MEPI）的风险。三项前瞻性队列研究将汇集来自35个美国工作场所的数据，代表广泛的职业，行业和物理暴露水平。1，973名员工入组，1，698名员工接受了长达110个月的随访（平均随访= 34个月）。全面的数据可在每个工人的生物力学压力，体检演习，正中和尺神经传导研究在手腕。将估计生物力学应激源与CTS、LEPI和MEPI的患病率和发生率之间的暴露-反应关系，同时调整相关效应修饰因子和混杂因素。本研究中使用的生物力学应激源的测量包括已建立的ACGIH手部活动水平（HAL）阈值极限值（TLV）模型和1995年应变指数（SI），以及新开发的模型：（i）修订应变指数（RevSI），（ii）复合应变指数（COSI）和（iii）累积应变指数（CSTR I）。这些研究的全面身体暴露数据功能：（i）个人工人暴露量随时间变化的暴露量，以及（ii）力、重复和姿势的每种组合的详细数据（子任务数据）。这些数据使我们能够详细地模拟生物力学压力源，这在以前是不可能的，使用创新的方法，如RevSI，COSI和RESLI。这三个研究中心都有关于潜在混杂因素和协变量的全面数据，包括工人人口统计学、既往病史、非职业爱好和活动以及心理社会因素。所有临床试验机构都使用了CTS、LEPI和MEPI的匹配病例定义，包括症状加身体动作和神经传导研究。汇集三项研究的现有数据将使我们能够在更广泛的生物力学压力源中估计相对风险函数的大小和形状：（i）提高信心和精度，（ii）对于工作轮换的工人，以及（iii）对于具有多种力，重复， 和姿态。这项拟议研究的结果将帮助雇主设计安全和富有成效的工作，并为公共卫生机构和职业健康研究人员提供信息，以更有效地指导预防计划。

DESCRIPTION (provided by applicant): The proposed research offers a unique opportunity to provide exposure-response estimates between measured occupational biomechanical stressors, non-occupational physical activities, demographics, medical history, psychosocial factors; and risk of carpal tunnel syndrome (CTS), lateral epicondylitis (LEPI), and medial epicondylitis (MEPI). Three prospective cohort studies will pool data from 35 US workplaces, representing a wide range of occupations, industries, and physical exposure levels. 1,973 employees were enrolled and 1,698 were followed for up to 110 months (average follow-up = 34 months). Comprehensive data are available on each worker's biomechanical stressors, physical examination maneuvers, and median and ulnar nerve conduction studies at the wrist. Exposure-response relationships will be estimated between biomechanical stressors and the prevalence and incidence of: CTS, LEPI, and MEPI, while adjusting for relevant effect modifiers and confounders. Measures of biomechanical stressors used in this study include established models of ACGIH Threshold Limit Value (TLV) for Hand Activity Level (HAL), and the 1995 Strain Index (SI), as well as newly developed models: (i) Revised Strain Index (RevSI), (ii) Composite Strain Index (COSI), and (iii) Cumulative Strain Index (CUSI). Comprehensive physical exposure data from these studies feature: (i) individual worker exposure with changes in exposure over time, and (ii) detailed data for each combination of force, repetition, and posture (sub-task data). These data allow us to model biomechanical stressors in detail not previously possible using innovative approaches such as RevSI, COSI, and CUSI. The three sites all have comprehensive data on potential confounders and covariates including worker demographics, past medical history, non-occupational hobbies and activities, and psychosocial factors. All sites used matching case definitions for CTS, LEPI, and MEPI that included symptoms plus physical maneuvers and nerve conduction studies. Pooling existing data across the three studies will enable us to estimate the magnitude and shape of the relative risk function across a wider range of biomechanical stressors: (i) with improved confidence and precision, (ii) for workers with job rotation, and (iii) for tasks with multiple combinations of force, repetition, and posture. Results from this proposed research will help employers to design safe and productive jobs and provide public-health agencies and occupational health researchers with information to more effectively guide prevention programs.