To explore definitions for multi-site pain, and compare associations with risk factors for different patterns of musculoskeletal pain, we analysed cross-sectional data from the Cultural and Psychosocial Influences on Disability (CUPID) study. The study sample comprised 12,410 adults aged 20-59 years from 47 occupational groups in 18 countries. A standardised questionnaire was used to collect information about pain in the past month at each of 10 anatomical sites, and about potential risk factors. Associations with pain outcomes were assessed by Poisson regression, and characterised by prevalence rate ratios (PRRs). Extensive pain, affecting 6-10 anatomical sites, was reported much more frequently than would be expected if the occurrence of pain at each site were independent (674 participants v 41.9 expected). In comparison with pain involving only 1-3 sites, it showed much stronger associations (relative to no pain) with risk factors such as female sex (PRR 1.6 v 1.1), older age (PRR 2.6 v 1.1), somatising tendency (PRR 4.6 v 1.3) and exposure to multiple physically stressing occupational activities (PRR 5.0 v 1.4). After adjustment for number of sites with pain, these risk factors showed no additional association with a distribution of pain that was widespread according to the frequently used American College of Rheumatology (ACR) criteria. Our analysis supports the classification of pain at multiple anatomical sites simply by the number of sites affected, and suggests that extensive pain differs importantly in its associations with risk factors from pain that is limited to only a small number of anatomical sites.

SummaryLarge international variation in the prevalence of disabling forearm and low back pain was only partially explained by established personal and socioeconomic risk factors.

Objectives-To investigate the relation between diVerent types of exposure to noise and a classic sign of noise induced hearing loss (NIHL), the audiometric notch. Methods-The study sample had exposure to both continuous and impulse noise and was drawn from a population of electrical transmission workers. Audiograms, taken as part of a hearing conservation programme, were read by three clinicians experienced in the assessment of NIHL. Working independently and using their clinical judgment, they were asked to identify localised increases in the threshold of hearing (audiometric notches) which they would attribute to noise, had a suitable history of exposure been elicited. Prevalent cases of NIHL were identified by the presence of a notch in either ear. Risk factors for NIHL were assessed by a questionnaire which sought information about exposure to air blast circuit breaker noise; firearms; explosions, and continuous noise. The odds of exposure to these factors in those with and without hearing loss were calculated, and odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression. Results-Of the 648 questionnaires sent out 357 were returned, a response rate of 55%. Of these, at least two out of the three assessors identified 175 (49%) people with a notch at any audiometric frequency. There was no association between these cases and the NIHL risk factors identified by the questionnaire, but a further frequency specific analysis showed a small proportion of people (15 (4%)) with notches at 4 kHz who had the expected associations with exposure to noise and a significant OR for firearms of 4.25 (95% CI 1.28 to 14.1). The much larger proportion of people with 6 kHz notches (110 (31%)) did not show these associations. Conclusions-To diagnose NIHL it is important to elicit a detailed and accurate history of exposure to noise: although the notch at 4 kHz is a well established clinical sign and may be valuable in confirming the diagnosis, the 6 kHz notch is variable and of limited importance. (Occup Environ Med 2001;58:46-51)

Background The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample. Methods/Principal Findings A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as “repetitive strain injury” (RSI). Conclusions/Significance The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.

We report a cross-sectional study comparing the health-related quality of life (HRQOL) of individuals residing in the proximity of a wind farm to those residing in a demographically matched area sufficiently displaced from wind turbines. The study employed a nonequivalent comparison group posttest-only design. Self-administered questionnaires, which included the brief version of the World Health Organization quality of life scale, were delivered to residents in two adjacent areas in semirural New Zealand. Participants were also asked to identify annoying noises, indicate their degree of noise sensitivity, and rate amenity. Statistically significant differences were noted in some HRQOL domain scores, with residents living within 2 km of a turbine installation reporting lower overall quality of life, physical quality of life, and environmental quality of life. Those exposed to turbine noise also reported significantly lower sleep quality, and rated their environment as less restful. Our data suggest that wind farm noise can negatively impact facets of HRQOL.

Objectives: To describe the prevalence, characteristics and impact of musculoskeletal disorders (MSDs) in New Zealand nurses, postal workers and office workers. Methods: A postal survey asked participants about MSDs, (low back, neck, shoulder, elbow, wrist/hand or knee pain lasting longer than one day), and demographic, physical and psychosocial factors. Nurses were randomly selected from the Nursing Council database, postal workers from their employer's database and office workers from the 2005 electoral roll. Results: The response rate of potentially eligible participants was 58% (n=443). Participants were aged 20–59 years; 86% were female. Over the 12 months prior to the survey 88% of respondents had at least one MSD lasting longer than a day and 72% reported an MSD present for at least seven days. Of the 1,003 MSDs reported, 18% required time off work and 24% required modified work duties. In the month prior to the survey 17% of MSDs made functional tasks difficult or impossible. Low back, neck and shoulder pain prevalence did not differ by occupation. Postal workers had the highest prevalence of elbow and wrist/hand pain; nurses of knee pain. Conclusions: The high prevalence of MSDs among these workers indicates that they are indeed in ‘at risk’ occupations. In each occupational group MSDs encompass a range of anatomical sites, however the overall pattern of MSDs differs by occupation. MSDs have a significant impact on activities at work and home. Implications: Primary and secondary prevention strategies should encompass a range of anatomical sites and specifically target different occupational groups.

In injury prevention and rehabilitation the physical nature of the work needs to be addressed for most MSDs, with modest decreases in risk seemingly possible. Addressing job strain could provide significant benefit for those with neck and wrist/hand pain, while the effects of somatisation and the promotion of good mental health may provide smaller but global benefits.

Objective: To describe the epidemiology of lower limb injuries in the New Zealand Defence Force (NZDF). Method: Data from all NZDF lower limb injury claims from an 11‐month period were examined for type, site, and circumstances of injury. Both injury codes and narratives were analysed, allowing each injury event to be classified according to mechanism of injury, object involvement, and activity at the time of injury, as well as type and site. Results: The commonest lower limb musculoskeletal injuries were ankle sprains or strains (35%) and knee sprains or strains (16%). Most commonly, injuries were due to acute over‐exertion (37%), involved no other person (50%), and occurred while running (28%) or playing team sports (25%). The injury rate for recruits was more than five times that of trained personnel. Conclusions: Potential interventions should target ankle sprains primarily, but also knee sprains and fractures. Fractures, while accounting for only 6% of lower limb injuries, should be a priority because of their high medical and time‐lost costs. Interventions must also take into account the high incidence of injuries involving individuals alone and sustained during recruit training. The study also demonstrated that analysis of military injury narratives provides valuable extra information on injury causation and the circumstances of injury, and allows more accurate characterisation of the injury process. Implications: This study will provide the basis for development of an injury prevention strategy for lower limb training injuries in the NZDF.