Division of General Medical Sciences, Washington University School of Medicine , Saint Louis , Missouri.
Department of Occupational Science and Technology, University of Wisconsin-Milwaukee , Milwaukee , Wisconsin.
J Occup Environ Hyg. 2019 Sep;16(9):628-633. doi: 10.1080/15459624.2019.1640366. Epub 2019 Jul 30.
Recent studies have shown the 2001 American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) for Hand Activity was not sufficiently protective for workers at risk of carpal tunnel syndrome (CTS). These studies led to a revision of the TLV and Action Limit. This study compares the effect of applying the 2018 TLV vs. the 2001 TLV to predict incident CTS within a large occupational pooled cohort study (n = 4,321 workers). Time from study enrollment to first occurrence of CTS was modeled using Cox proportional hazard regression. Adjusted and unadjusted hazard ratios for incident CTS were calculated using three exposure categories: below the Action Limit, between the Action Limit and TLV, and above the TLV. Workers exposed above the 2001 Action Limit demonstrated significant excess risk of carpal tunnel syndrome, while the 2018 TLV demonstrated significant excess risk only above the TLV. Of 186 total cases of CTS, 52 cases occurred among workers exposed above the 2001 TLV vs. 100 among those exposed above the 2018 value. Eliminating exposures above the 2001 TLV might have prevented 11.2% of all cases of CTS seen in our pooled cohort, vs. 25.1% of cases potentially prevented by keeping exposures below the 2018 value. The 2018 revision of the TLV better protects workers from CTS, a recognized occupational health indicator important to public health. A significant number of workers are currently exposed to forceful repetitive hand activity above these guidelines. Public health professionals should promulgate these new guidelines and encourage employers to reduce hand intensive exposures to prevent CTS and other musculoskeletal disorders.
最近的研究表明，2001 年美国政府工业卫生学家会议（ACGIH）的手部活动阈限值（TLV）对于有腕管综合征（CTS）风险的工人来说不够保护。这些研究导致了 TLV 和行动限值的修订。本研究比较了应用 2018 年 TLV 与 2001 年 TLV 预测大型职业队列研究中（n = 4321 名工人）CTS 发生率的效果。使用 Cox 比例风险回归模型来模拟从研究入组到 CTS 首次发生的时间。使用三个暴露类别计算 CTS 发生率的调整和未调整危险比：低于行动限值、行动限值与 TLV 之间、以及 TLV 以上。暴露于 2001 年行动限值以上的工人患腕管综合征的风险显著增加，而 2018 年 TLV 仅在 TLV 以上时显示出显著的超额风险。在 186 例 CTS 总病例中，52 例发生在暴露于 2001 年 TLV 以上的工人中，而 100 例发生在暴露于 2018 年值以上的工人中。消除 2001 年 TLV 以上的暴露可能会预防我们队列中看到的所有 CTS 病例的 11.2%，而通过保持暴露于 2018 年值以下，可能会预防 25.1%的病例。TLV 的 2018 年修订更好地保护工人免受 CTS 的影响，CTS 是对公共卫生很重要的公认职业健康指标。目前，大量工人接触到这些指南以上的高强度重复性手部活动。公共卫生专业人员应宣传这些新的指南，并鼓励雇主减少手部密集型暴露，以预防 CTS 和其他肌肉骨骼疾病。
