Work-associated impairments of the cervical spine and upper extremities

Prikazan je povijesni pregled praćenja oštećenja kralješnice i gornjih ekstremiteta vezanih uz rad. Ispitujući faktore rizika u nastanku cerviko-brahijalnog sindroma (CBS) u uzorku od 120 invalida rada zapaženo je da prisilan, prignut položaj tijela pri radu, osobito u žena značajno pridonosi većoj učestalosti bolesti (70,0% prema 38% u žena poredbene skupine bez cervikobrahijalnog sindroma; P < 0,01 ). Dizanje tereta također je češće uočeno u Žena s CBS-om (12% prema 6% u poredbenoj skupini; P<0,05). Ponavljanje istih pokreta pri radu navodilo je 52,9% muškaraca i 80% žena s CBS-om a samo 41,4% muškaraca i 50% žena bez CBS-a (P<0,01). Težina najtežih tereta koje su ispitanici dizali tijekom rada bila je značajno veća od opterećenja teretom ispitanika poredbene skupine. U žena smatra se da čak postoji kauzalna povezanost između prekomjernih opterećenja i nastanka CBS-a. Pri ranom otkrivanju bolesnika s CBS-om ističe se važnost registriranja umora, a osobito boli u vratnoj kralješnici te smanjenja snage stiska šake kao i izdržljivosti manualnog rada. Ranim prepoznavanjem bolesti, poboljšanjem uvjeta rada ali i rekreativnim aktivnostima mogu se prevenirati bolesti koje su sve češće u modernim tehnologijama i/ili usporiti njihovo pogoršanje.A chronological review of damage to the spine and upper extremities associated with work was carried out in a sample of 120 retired disabled workers. Examination of risk factors for cervicobrachial syndrome (CBS) showed that the forced, bent position of the body at work contributed significantly to the frequency of the disease, particularly in women (70.0% against 38 % in controls P < 0.01 ). The lifting of heavy loads was also frequently observed in women with CBS (12% compared to 6% in the control group (P<0.05). Repeated movements during work were claimed by 52.9% of the males and 80% of the females with CBS and by only 41.4% of the males and 50% of the females without it (P < 0.01). The heaviest load lifted by subjects with CBS at work exceeded significantly that of control subjects. It is considered that there is a causal link between excessive burden and the occurrence of CBS in women. For early diagnosis of CBS, tiredness, pain in the cervical spine, reduced strength in the hands and poor ability to endure manual work are signs to be looked for. Early recognition of disease, improved working conditions and recreation can help prevent the disease or slow down its progress

Diseases of the locomotive system in agricultural workers

Tokom epidemiološkog istraživanja učestalosti kroničnih bolesti stanovništva u SR Hrvatskoj, 1982. godine pregledan je uzorak stanovništva u životnoj dobi od 48 do 67 godina. Uzorkom je bilo obuhvaćeno i 128 stanovnika - poljoprivrednika iz pretežno agrarnog područja općine Virovitica i 25 stanovnika - poljoprivrednika s otoka Visa. Komparativnu skupinu činili su ispitanici iz istih područja koji su kao osnovno zanimanje naveli neku drugu djelatnost (ukupno 99 ispitanika iz Virovitice i 62 s Visa). U poljoprivrednika smo češće zapazili teže oblike artroza ekstremiteta (41 %), i Dupuytrenove kontrakture (8 %), dok su rjeđe negoli u komparativnoj skupini zapaženi bolni sindromi vratne i slabinske kralješnice (55 %; 61 %). Reumatoidni artritis je zapažen u 4,8 % poljoprivrednika iz Virovitice, a niti u jedne žene iz komparativne skupine. S obzirom na nalaze prije 10 godina u istih ispitanika zapazili smo da je incidencija spondilartroza podjednaka u poljoprivrednika i u komparativnoj grupi, ali je veći porast zabilježen kod nalaza artroza u komparativnoj skupini (18 % prema 2 % u poljoprivrednika).In an epidemiological investigation of the frequency of chronic diseases among the inhabitants of Croatia a sample of population aged 48-67 years was examined in 1982. The sample included 128 agricultural workers from the mainly farming region of Virovitica and 25 agricultural workers from the island of Vis. A comparative group was formed of subjects from the same areas whose basic occupation was given as some other activity (a total number of 99 subjects from Virovitica and 62 from Vis). In the group of agricultural workers severe forms of arthrosis of the extremities (41 %) and Dupuytren\u27s contracture (8 %) were observed more frequently than in the control groups whereas pain syndromes of the cervical and lumbar spine were less frequent (55 % : 61%). Rheumatoid arthritis was present in 4.8 % of the female agricultural workers from Virovitica and in none from the control group. Comparison with the results for 1972 shows that the Incidence of spondylarthritis was the same in agricultural and control workers whereas a great increase was recorded in the incidence of arthrosis in the control group (18 % : 2 % in agricultural workers)

Acute gout attacks and occupation

U dvije skupine bolesnika pratili smo pojavu akutnih ataka uloga, i to prvu skupinu od 162 bolesnika u specijalističkoj reumatološkoj službi te drugu skupinu od 124 bolesnika u primarnoj zdravstvenoj zaštiti. U skupini koju smo pratili u specijalističkoj službi našli smo da pojava akutnih ataka uloga nije vezana uz zanimanje bolesnika, dok je u skupini koju smo pratili u primarnoj zdravstvenoj zaštiti pojava akutnih ataka uloga bila vezano uz zanimanje. Ove razlike tumačimo time što je u češćem kontaktu liječnika primarne zdravstvene zaštite i bolesnika bilo moguće uočili pojavu koju u specijalističkoj službi nismo mogli iz razloga što bolesnike u toj službi nismo vidjeli u svakom na-padu akutnih uloga. Uočili smo da u bolesni-ka s ulozima postoje akutni ali i kronični provokativni faktori koji traumatizacijom i mikrotraumatizacijom stvaraju predilekcijska mjesta za kristalizaciju mokraćne kiseline.The appearance of acute gout attacks was followed in two groups of persons, one of 162 patients who were treated in a specialist rheumatology service clinic and another of 124 individuals who received treatment through a primary health care centre. The findings in the two groups differed. In the first group no connection between gout attacks and patients occupation could be established. In the second group the connection was evident. This is explained by the existence of a closer contact between the primary health care physician and his patients enabling the physician to perceive a relationship of which the specialist remains unaware seeing his patients less often, In gout patients the presence was established of acute as well as of provocative factors which are responsible for creating predilection sites for crystallization of uric acid as a result of mechanical injury

The relationship be1ween selected psychic factors and degenerative diseases and disorders of the locomotor system

Procjenjivana je zastupljenost karakteristika ličnosti neurotizma, ekstroverzije - introverzije i asteničkih crta ličnosti u tri skupine od po 50 ispitanika: refereničnoj, skupini reumatičnih pacijenata u kojih subjektivne tegobe i objektivni funkcionalno-anatomski status lokomotomog sustava nisu bili u skladu i skupini reumatičnih pacijenata čije su subjektivne tegobe i objektivni funkcionalno-anatomski status lokomotornog sustava bili u skladu. Sve je ispitanike pregledao reumatolog. Od psihologijskih tehnika primijenjeni su intervju i upitnici ličnosti Cornell Index i Eysenck Personality Questionnaire (EPQ). Prema rezultatima univarijantne analize varijance zastupljenost neurotizma i asteničkih dimenzija ličnosti bila je značajno veća u skupini pacijenata koji su dali neprimjerene izjave o veličini subjektivnih tegoba nego u refereničnoj skupini i skupini pacijenata koji su dali primjerene izjave o veličini tegoba. To upućuje na zaključak da se dio zdravstvenih tegoba nekih pacijenata može pripisati subjektivnoj nadgradnji i neurotskim karakteristikama ličnosti.The incidence of neuroticism, extroversion - introversion and astenic personality characteristics was studied in three groups of 50 subjects each: controls, rheumatic patients in whom subjective complaints and objective medical status of the locomotor system were not analogous, and rheumatic patients in whom complaints and objective medical status of the locomotor system were analogous. Ali subjects were examined by a rheumatologist and interviewed by a psychologist. The psychological methods applied were: short interview, Eysenck Personality Questionnaire (EPQ) and Comell Index. According to the results of univariate analysis of variance the group of subjects with inadequate complaints had significantly higher scores on the scales of neuroticism and astenic personality characteristics than the control group and the group of subjects with adequate subjective complaints. The results of this work indicate that some health complaints can be partly attributed to superposition of symptoms and neurotic personality characteristics

Analysis of working conditions and sick absences due to rheumatic diseases

Slučajnim 50 %-tnim uzorkom obuhvaćeno je 465 radnica dviju zadarskih tvornica gdje su različiti radni uvjeti. Putem standardiziranog upitnika dobiveni su podaci iz osobne i radne anamneze, podaci o socijalnom statusu ispitanica, njihovoj fizičkoj aktivnosti te mikroklimatskim uvjetima u radnoj sredini. Klinički je pregledane, laboratorijski obrađeno s obzirom na reumatske tegobe 185 radnica tvornice »A« i 280 radnica tvornice »B«. Korištenjem osobnog zdravstvenog kartona analiziran je opći morbiditet te apsentizam zbog reumatskih bolesti u posljednjih pet godina. U tvornici »A« 79,4 % radnica radilo je stojeći u hladnoći i vlazi, dok je u tvornici »B« 86,3 % radilo sjedeći u suhom. Reumatske su tegobe zabilježene kod 80,8 % radnica, i to u 93,7 % među radnicama tvornice »A«, a 78, 9 % u tvornici »B« (P < 0,01). U tvornici »B« radnice su više bolovale od degenerativnih bolesti vratnog dijela kralješnice, a radnice u tvornici »A« više od reumatoidnog artritisa (17,3 % : 2,8 %) i izvanzglobnog reumatizma (53,5 % : 13,2 %) (P < 0,01). Bolovanje zbog reumatskih tegoba bilo je u tvornici »A« zabilježena kod 12,4% radnica a 25,5% u »B«. Međutim, s obzirom na broj dana bolovanja (64,6 u »A« : 35,8 u »B«), apsentizam zbog reumatskih bolesti bio je značajno češći u tvornici s lošijim radnim uvjetima, većim fizičkim naprezanjima i nepovoljnim radnim položajem.A random 50 % sample consisting of 465 female workers was selected from two factories with different working conditions, 185 from factory A and 280 from factory B. Data on personal and work histories, social status, physical activity and ambient conditions at the workplace were collected by means of standardized questionnaire. Clinical, laboratory and X-ray examinations were carried out for rheumatic complaints. Personal medical files were consulted to determine the overall rnorbidity and absenteeism attributable to rheumatic diseases in the past five years. In factory A 79.4 % of the women worked in standing posture, in a cold and damp space, whereas in factory B 86.3 % were seated in a dry space while working. Rheumatic complaints were recorded from 93.7 % of factory A workers and from 78.9 % of those in factory B (P < 0.01). In the latter factory there were more workers suffering from degenerative diseases of the neck portion of the spine whereas in the former those suffering from rheumatoid arthritis (17.3 : 2.8 %) and out-joint rheumatism (53.5 : 13.2 %) (P < 0.01) were more numerous. Sick leaves because of rheumatic illnesses were recorded for 12.4 % of women in factory A and for 25.5 % of those in factory B. In terms of the number of days of sick leave (64.6 % in A compared to 35.8 % in B) absenteeism due to rheumatic diseases had a significantly higher rate in the factory with poorer working conditions, greater physical demands and unsuitable body postures at work

Pain syndromes of the spine in the active population

Anketom, koja je tijekom 1981. i 1982. godine provedena u svim radnim organizacijama SOUR-a ŽTP Zagreb obuhvaćeno je 9 565 radnika u dobi od 18 do 65 godina. Većinu zaposlenih činili su muškarci (86 %), i to najvećim dijelom KV radnici (36 %) i radnici SSS (20 %) te VKV radnici (17,3 %). U trenutku ispitivanja bol u vratnoj kralješnici navodilo je 9,8 % muškaraca i 17,4 % žena, dok je križobolju imalo 27,4 % muškaraca i 28,4 % žena. S obzirom na životnu dob, učestalost bolnog sindroma vratne kralješnice pravilno je rasla. Sijevajuću bol iz križa u nogu, koja se javljala više puta, navodilo je 1,8 % mlađih muškaraca te 44,9 % starijih od 51 godine, kao i 4,7 % mlađih žena i 31,3 % žena starijih od 51 godine. Zbog križobolje je kraće od mjesec dana :izostajalo s posla 14,6 % svih ispitanika, od 1 do 6 mjeseci bolovalo je 8 % radnika, dok je 1,4 % ispitanika zbog križobolje bolovalo duže od 6 mjeseci. Češće su zbog križobolje izostajati s posla NKV i PKV radnici, a apsentizam je bio prisutan već i u mlađoj životnoj dobi (2,9 %). Najveći porast apsentizma zbog križobolje izražen je u četvrtom desetljeću života. S obzirom na kvalifikaciju ispitanika, bol u vratnoj kralješnici najčešće su napominjali KV radnici (36,3 %), dok je križoboIja bila najčešća u NKV radnika (25,5 %). Učestalost sijevajuće boli iz križa u nogu proporcionalno se smanjivala s obzirom na višu kvalifikaciju ispitanika. U raspravi se ovi podaci uspoređuju s podacima sličnih istraživanja u svijetu i kod nas.In 1981 and 1982 a questionnaire study was carried out in the Railwav Transport Company in Zagreb among 9 565 workers aged from 18 to 65 years. The majority of the employees were male (86 %), mainly skilled workers (36 %). At the time of investigation pain in the cervical spine was reported by 9.8 % of males and 17.4 %, of females (P < 0.01), whereas back pain was reported by 27.4 % of males and 28.4 % of females. The frequency of pain in the cervical spine increased with age from 2.3 % in males younger than 30 years to 16 % in those older than 51 years, and respectively from 6.8 % to 29 % in females. The frequency of back pain ranged from 11.7 % in the group of youngest males to 39 % in males older than 51 years, and from 13.2 % to 44.6 % in females. Radiating pain from the spine to the leg was reported more than once by 1.8 % of younger males, and by 29.2 % of those older than 51 years. Sick absences due to back pain of less than a month\u27s duration were noted for 14.6 % of all workers, those lasting 1-6 months in 8 % and those longer than six months in 1.4 % of the workers. These absences were more frequent among unskilled and semiskilled workers, but were also present among young workers (2.9 %). The greatest increase in the rate of sick absences due to back pain was noted in the fourth decade of life. With regard to qualifications pain in the cervical spine was the most frequent complaint of highly skilled and unskilled workers. The frequency of radiating pain decreased in proportion with the degree of workers\u27 qualifications from 19.1 % in the case of unskilled workers to 12.8 % among highly skilled workers (P < 0.001)