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Objective. To assess the relative importance of personal and occupational risk factors for upper-extremity musculoskeletal disorders in the working population. Methods. A total of 3,710 workers (58% men) participating in a surveillance program of musculoskeletal disorders in a French region in 2002-2005 were included. Upper-extremity musculoskeletal disorders were diagnosed by 83 trained occupational physicians performing a standardized physical examination. Personal factors and work exposure were assessed by a self-administered questionnaire. Statistical associations between musculoskeletal disorders, personal, and occupational factors were analyzed using logistic regression modeling. Results. A total of 472 workers experienced at least 1 upper-extremity musculoskeletal disorder. The risk of upperextremity musculoskeletal disorders increased with age for both sexes (P < 0.001, odds ratio [OR] <4.9 in men and <5.0 in women), and in cases of prior history of upper-extremity musculoskeletal disorders (OR 3.1 and 5.0, respectively, P < 0.001). In men, upper-extremity musculoskeletal disorders were associated with obesity (OR 2.2, P ‫؍‬ 0.014), high level of physical demand (OR 2.0, P < 0.001), high repetitiveness of the task (OR 1.5, P ‫؍‬ 0.027), postures with the arms at or above shoulder level (OR 1.7, P ‫؍‬ 0.009) or with full elbow flexion (OR 1.6, P ‫؍‬ 0.006), and high psychological demand (OR 1.5, P ‫؍‬ 0.005). In women, upper-extremity musculoskeletal disorders were associated with diabetes mellitus (OR 4.9, P ‫؍‬ 0.001), postures with extreme wrist bending (OR 2.0, P < 0.001), use of vibrating hand tools (OR 2.2, P ‫؍‬ 0.025), and low level of decision authority (OR 1.4, P ‫؍‬ 0.042). Conclusion. Personal and work-related physical and psychosocial factors were strongly associated with clinically diagnosed upper-extremity musculoskeletal disorders.

Objectives: An epidemiological surveillance system for work-related musculoskeletal disorders (MSDs) was implemented in 2002 in France's Pays de la Loire region to assess the incidence and prevalence of MSDs in the general and working populations, identify levels of exposure to occupational risk factors and investigate the proportion of cases attributable to work exposure. Methods: The program combines (1) surveillance of sentinel health events in the general population (carpal tunnel syndrome (CTS) was the sentinel event for upper limb MSDs), (2) assessment of the prevalence of the main upper limb MSDs and their risk factors in the workplace based on a network of occupational physicians and (3) registration of the notification of work-related diseases (WRDs). Results: 1168 incident cases of CTS were included over a 3 year period. The estimated incidence of CTS was 1.00 per 1000 person-years in those aged 20-59 years (0.60 in men and 1.40 in women). The incidence rate was higher in employed than unemployed persons in the year of diagnosis (0.6 per 1000 vs 0.3 in men and 1.7 vs 0.8 in women). The occupational physician network noted high prevalence rates: 11% of men and 15% of women had at least one of the six main upper limb clinically-diagnosed MSDs. The WRD survey showed that MSDs represented 65% of notified WRDs. Conclusion: The Pays de la Loire program plays a significant role in informing the authorities and the public about the state of current MSDs. It is planned to extend it to a routine national surveillance program.Musculoskeletal disorders (MSDs) are impairments of bodily structures (such as muscles, tendons, nerves, vessels and cartilage) of the limbs and the back, for example tendinitis and tenosynovitis (mainly shoulder tendinitis, lateral epicondylitis and hand-wrist tendinitis), peripheral nerve entrapment (mainly carpal tunnel syndrome and ulnar tunnel syndrome), bursitis, low back pain and sciatica, and neuro-vascular syndromes (such as vibration white finger). Numerous non-specific peri-articular pain disorders have also been included under this umbrella term.

Objectives-To study the determinants of signs of carpal tunnel syndrome (CTS) in repetitive industrial work, with special attention to occupational constraints at group level and management practices of the companies. Method-a cross sectional study was conducted in three sectors: assembly line; clothing and shoe industry; food industry. A total of 1210 workers in repetitive work, from 53 diVerent companies, was compared with a control group of 337 workers. Constraints at the workplace were partly self declared, and partly assessed by the occupational physicians in charge of the employees of the company. The definition of CTS was based on a standardised clinical examination. Results-CTS was associated with repetitive work, especially packaging. It was more frequent among subjects who declared psychological and psychosomatic problems and those with a body mass index >27. Dissatisfaction with work, lack of job control, short cycle time, and having to press repeatedly with the hand were associated with the syndrome. An odds ratio (OR) of 2.24 was found for "just in time" production. Conclusions-The results emphasise the complexity of the determinants of CTS, the role of psychosocial factors at work, and the potentially negative eVects of some practices of the companies aimed at enhancing their competitiveness.

This study's purpose was to identify occupational factors that may influence the age at natural menopause in a random sample of gainfully employed French women born in 1938 (n=1,594). Occupational physicians selected the subjects from their files and interviewed them during their annual visits in 1990 and 1995. The authors used Kaplan-Meier survival curves to estimate median age at menopause (52 years) and multiple Cox models to estimate associations among women's characteristics, occupational factors, and age at menopause separately within two strata distinguished by a self-reported history of depression. Among women without such a history, earlier menopause was associated with smoking more than 10 cigarettes per day in 1990 (p<0.001), a high-strain job (p=0.01) in 1990, and difficult schedules before 1990 (p=0.03). Later menopause was associated with higher educational status (p=0.003) and repetitive work in 1990 (p=0.005). Among women with a history of depression, a later menopause was associated with having at least one child (p<0.001) and menarche later than the age of 13 years (p=0.004). Earlier menopause was associated with a high job control in 1990 (p=0.03) and high school education (p<0.01). These results suggest that certain physical job stressors may be related to age at menopause.