Palmer Keith T, Harris E Clare, Coggon David
MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK.
Occup Med (Lond). 2007 Jan;57(1):67-74. doi: 10.1093/occmed/kql127. Epub 2006 Nov 23.
To assess occupational associations with tenosynovitis and epicondylitis, we conducted a systematic literature review. We focused particularly on evidence that might support compensation of these disorders 'on the balance of probabilities'.
We searched the MEDLINE and EMBASE electronic biomedical databases to 1 January 2005 using combinations of keyword and medical subject headings, and also the references cited in two state-of-the-art reviews from the 1990s. Primary research reports were retrieved and checked for further relevant citations. From each paper, we abstracted a standardized set of information on study populations, exposure contrasts and estimates of effect.
We found and summarized 18 papers. In the main, these based analysis on job titles rather than on directly assessed physical activities. Few occupations were studied more than once, however, and there was little consistent evidence of jobs or work activities that carried more than a doubling of risk for either disorder.
Compensation of occupational illness can be problematic for disorders that are not specific to work and for which there are no distinctive clinical features in occupationally related cases. Attribution can, however, be made on the balance of probabilities if there is convincing evidence that risk is at least doubled in an occupational group. Our review highlights the relative lack of data to support such attribution for tenosynovitis and epicondylitis, and discusses the difficulty of compensating upper limb disorders.
为评估腱鞘炎和肱骨外上髁炎与职业的相关性，我们进行了一项系统的文献综述。我们特别关注那些可能支持“基于可能性权衡”对这些疾病进行赔偿的证据。
我们使用关键词和医学主题词的组合在MEDLINE和EMBASE电子生物医学数据库中检索到2005年1月1日的文献，同时还检索了20世纪90年代两篇前沿综述中引用的参考文献。检索并获取了原始研究报告，并检查是否有进一步的相关引用。从每篇论文中，我们提取了一组关于研究人群、暴露对比和效应估计的标准化信息。
我们找到并总结了18篇论文。这些论文主要基于职位头衔进行分析，而非直接评估身体活动。然而，很少有职业被多次研究，而且几乎没有一致的证据表明哪些工作或工作活动会使这两种疾病的风险增加一倍以上。
对于并非工作特有的、在职业相关病例中没有明显临床特征的疾病，职业病赔偿可能会存在问题。然而，如果有令人信服的证据表明某职业群体的风险至少增加一倍，那么就可以基于可能性权衡进行归因。我们的综述强调了相对缺乏支持对腱鞘炎和肱骨外上髁炎进行此类归因的数据，并讨论了上肢疾病赔偿的困难。
