The evaluation of ergonomic risk factors among meat cutters working in Jabalpur,India

Abstract

Background:

Manual meat cutters in India are at high risk of work-related musculoskeletal disorders (WMSDs) for a variety of reasons including holding awkward postures, repetitive forceful exertions, and inadequate rest. This is the first study of its kind to investigate the nature and magnitude of WMSDs among manual meat cutters in India.

Objective:

The aim of this study was to measure the ergonomic risk factors for WMSDs among adult male manual meat cutters working in Jabalpur, India.

Methods:

We used direct observation, activity analysis, questionnaires, interviews, photography, and video to measure the quantitative ergonomic risk factors.

Results:

Ovako working posture analysis indicated high scores (four for the back in peeling, six for the arms in cutting, and six for the arms during mincing tasks). Rapid entire body assessment method (REBA) scores were also high at 10/10 for deboning and mincing tasks, all associated with repetitive movements of the arms and awkward posture of the upper part of the body.

Conclusions:

The study indicates that most tasks for meat cutters fall in the high-risk category for occupational injury. Results suggest that ergonomic interventions that address retooling and workstation and process redesign would be useful in reducing the number of injuries.     

Examination of postures and frequency of musculoskeletal disorders among manual workers in Calcutta,India

Background: Manual material handling (MMH) activities require workers to adopt various awkward postures leading to the development of musculoskeletal disorders (MSD).

Objectives: To investigate the postures adopted during heavy load handling and the frequency of MSDs among MMH workers in Calcutta, India.

Methods: We conducted a cross-sectional study with 100 MMH workers. MSD frequency was assessed via the Standardized Nordic Questionnaire. The Ovako Working Posture Assessment System (OWAS) was used to analyze working posture. We used logistic regression to predict MSD risk factors.

Results: Ninety five percent of workers reported a MSD in at least one body part in the past 12 months. According to OWAS results, 83% of the analysed work postures require immediate corrective measures for worker safety. The most harmful posture was carrying a heavy load overhead. Carrying more than 120 kg increased the odds of low back and neck pain by 4.527 and 4.555, respectively.

Conclusions: This sample had a high frequency of reported MSDs, likely attributed to physiologically strenuous occupational activities repeated on average of 30–40 times daily. Ergonomic interventions, such as the use of handcarts, and occupational training are urgently needed.     

Relationship between musculoskeletal disorders and work-related awkward postures among a group of health care workers in a hospital

BACKGROUND: There are few studies in the Italian literature on musculoskeletal disorders (MSD) among health care workers (HCW) keeping and holding awkward postures during their job. OBJECTIVES: The aims of this study were to determine the prevalence of low-back, neck and upper limb complaints and the association between risk factors and MSD in HCW working in 15 wards of the Hospital of Cuneo. METHODS: A questionnaire was submitted to 113 HCW. Information about demographic and occupational factors, and MSD characteristics were collected to be statistically elaborated. RESULTS: The prevalence of complaints regarding at least one of the 3 body regions was 71% in the whole sample (80 subjects). Low back, neck and upper limb were interested, respectively, in 58.4%, 50.4% and 25.7% of the cases. Logistic regression showed a significant association of MSD with score > 7 on the Borg scale (OR = 9.70; CI: 2.01-46.9; p < 0.01), positive musculoskeletal clinical history (OR = 3.67; CI: 1.24-10.88; p < 0.05), and visual defects (OR = 2.88; CI: 1.07-7.81; p < 0.05). Based on the answers from the questionnaire, the onset of MSD was attributed in 41 cases to organizational problems, and in 14 cases to the ergonomic characteristics of the job. CONCLUSIONS: The index of prevalence of MSD associated to work-related awkward postures (71%) is very high, greater than that observed among HCW exposed to manual lifting of weights (21%) in the hospital. Thereafter, assessment of exposure and containment of such occupational risk must be considered useful.     

The evaluation of ergonomic risk factors among meat cutters working in Jabalpur,India

Background:

Manual meat cutters in India are at high risk of work-related musculoskeletal disorders (WMSDs) for a variety of reasons including holding awkward postures, repetitive forceful exertions, and inadequate rest. This is the first study of its kind to investigate the nature and magnitude of WMSDs among manual meat cutters in India.

Objective:

The aim of this study was to measure the ergonomic risk factors for WMSDs among adult male manual meat cutters working in Jabalpur, India.

Methods:

We used direct observation, activity analysis, questionnaires, interviews, photography, and video to measure the quantitative ergonomic risk factors.

Results:

Ovako working posture analysis indicated high scores (four for the back in peeling, six for the arms in cutting, and six for the arms during mincing tasks). Rapid entire body assessment method (REBA) scores were also high at 10/10 for deboning and mincing tasks, all associated with repetitive movements of the arms and awkward posture of the upper part of the body.

Conclusions:

The study indicates that most tasks for meat cutters fall in the high-risk category for occupational injury. Results suggest that ergonomic interventions that address retooling and workstation and process redesign would be useful in reducing the number of injuries.     

Work-related Musculoskeletal Symptoms in Surgeons

Introduction Surgeons are a unique group of healthcare professionals who are at risk for developing work-related musculoskeletal symptoms (WMS). The diversity of operating skills for laparoscopic and endovascular procedures impose different physical demands on surgeons, who also work under time pressure. The present study aims to examine the physical and psychosocial factors and their association with WMS among general surgeons in Hong Kong. Method A survey was conducted among surgeons working in the General Surgery departments in public hospitals of Hong Kong. Over 500 questionnaires were mailed and 135 surgeons completed the survey successfully (response rate 27%). Questions included demographics, workload, ergonomic and psychosocial factors. The relationship of these factors with WMS symptoms in the past 12 months was examined. Results Results indicated a high prevalence rate of WMS symptoms in surgeons, mainly in the neck (82.9%), low back (68.1%), shoulder (57.8%) and upper back (52.6%) regions. Sustained static and/or awkward posture was perceived as the factor most commonly associated with neck symptoms by 88.9% of respondents. Logistic regression showed the total score for physical ergonomic factors was the most significant predictor for all 4 body regions of musculoskeletal symptoms, with OR of 2.028 (95%CI 1.29–3.19) for the neck, 1.809 (1.34–2.43) for shoulder and 1.716 (1.24–2.37) for the lower back. Workstyle score was significantly associated with the symptom severity in the low back region (P = .003) but not with the other regions. Conclusion These results confirmed a strong association of physical and psychosocial factors with the musculoskeletal symptoms in surgeons. There is a potential for such musculoskeletal symptoms to escalate in the future, with rapid advances and increasing application of minimally invasive surgery.     

石油钻井行业工人肌肉骨骼疾患及影响因素分析

目的 调查石油行业工人的职业性肌肉骨骼疾患情况,探讨可能的影响因素.方法 选取860名石油钻井行业工人为调查对象,采用国内出版、经过适当修改的北欧肌肉骨骼问卷进行流行病学横断面调查.结果 石油工人肌肉骨骼疾患年患病率排在前三位的部位分别是腰部(50.6%)、颈部(29.8%)、肩部(23.4%),除手腕、髋臀外,其他部位的年患病率在不同工龄段的差异有统计学意义(P＜0.05或P＜0.01).每周工作时间＞40 h的工人颈部、肩部、背部和腰部的肌肉骨骼疾患年患病率较每周工作＜40 h的工人高,差异有统计学意义(P＜0.05).Logistic分析显示,职业因素中工作时长时间保持弯腰姿势、长时间站立、躯干重复性的弯曲、不适搬举姿势、搬举高质量物体等是腰部疾患的危险因素(P＜0.05),组织管理因素中经常加班、休息不足是腰部疾患的危险因素(P＜0.05).结论 石油行业工人肌肉骨骼疾患比较严重,应改善劳动姿势,减轻劳动强度,合理安排劳动休息制度等,并有计划地开展一定的健康促进活动等.

Abstract：

Objective To investigate the morbidity and influence factors of work-related musculoskeletal disorders (WMSD) in oil drillers. Methods The modified Nordic Standardized Questionnaire for WMSD was used to perform the epidemiological investigation in 860 oil drillers. Results The predominant sites of WMSD in the oil drillers were waist (50.6%), neck (29.8%) and shoulder (23.4%), respectively. There were significant differences of the WMSD morbidities in all body sites except for wrist and hip among groups with different working years (P＜0.05 of P＜0.01 ). The WMSD morbidities in the neck, shoulder, back and waist of oil drillers working for more than 40 h a week were significantly higher than those of oil drillers working for less than 40 h a week (P＜0.05). The results of logistic regression analysis revealed that some occupational factors, i.e. keeping stoop and stand for long time, repeating trunk bend, keeping awkward lift posture and lifting the heave objects, were the risk factors for WMSD at waist (P＜0.05 ), also some management factors, i.e. overtime work and inadequate rest, were the risk factors for WMSD at waist (P＜0.05). Conclusion The WMSD appears to be a serious ergonomic problem in oil drillers, it is necessary to correct working posture, reduce working load, improve organizational management, and encourage a workplace health program with regular work and rest.     

Upper extremities musculoskeletal disorders: Prevalence and associated ergonomic factors in an electronic assembly factory

Objectives

To determine the magnitude, distribution and associated ergonomic factors of upper extremities musculoskeletal disorders (UEMSD) among workers of electronic assembly in Thailand.

Material and Methods

This was a cross-sectional study. 591 of 853 workers in an electronic and electrical appliance assembly factory in Bangkok, Thailand, participated in this study. A self-administered questionnaire consisting of demographic data and ergonomic factors was collected from October 2010 to January 2011. Clinical examination of each worker was performed by an occupational physician. The criteria for diagnosis of UEMSD came as a result of a consensus reached by a group of orthopedists. The associated factors were analyzed using a multiple logistic regression.

Results

The point prevalence of clinically diagnosed UEMSD was as follows: radial styloid tenosynovitis — 13.03% (95% CI: 10.31–15.75), trigger finger — 9.48% (95% CI: 7.11–11.84), carpal tunnel syndrome — 8.12% (95% CI: 5.91–10.33), lateral epicondylitis — 3.38% (95% CI: 1.92–4.85), and medial epicondylitis — 1.69% (95% CI: 0.65–2.73), respectively. The adjusted odds ratio with statistical significance associated with UEMSD was as follows: high force of wrist — 1.78 (95% CI: 1.06–2.99), awkward posture of wrist — 2.37 (95% CI: 1.28–4.37) and contact stress at wrists — 1.75 (95% CI: 1.02–3.00) to develop radial styloid tenosynovitis. For trigger finger, the ratios were awkward posture of fingers — 2.09 (95% CI: 1.12–3.90) and contact stress on finger — 1.86 (95% CI: 1.04–3.34). For medial epicondylitis, it was an awkward posture of using elbows — 3.14 (95% CI: 1.10–8.95). However, this study did not find any associations between repetitive motion and any UEMSD.

Conclusions

UEMSD are most commonly found in electronic assembly workers. The relevant parties should provide comprehensive ergonomic resolution for these workers.     

Karl Morgan and Alice Stewart,Survivors on the Nuclear Stage

Abstract

Background:

Health care workers (HCWs) are exposed to occupational related health hazards. Measuring worker perception and the prevalence of these hazards can help facilitate better risk management for HCWs, as these workers are envisaged to be the first point of contact, especially in resource poor settings.

Objective:

To describe the perception of occupational health hazards and self-reported exposure prevalence among HCWs in Southern India.

Methods:

We used cross sectional design with stratified random sampling of HCWs from different levels of health facilities and categories in a randomly selected district in Southern India. Data on perception and exposure prevalence were collected using a structured interview schedule developed by occupational health experts and administered by trained investigators.

Results:

A total of 482 HCWs participated. Thirty nine percent did not recognize work-related health hazards, but reported exposure to at least one hazard upon further probing. Among the 81·5% who reported exposure to biological hazard, 93·9% had direct skin contact with infectious materials. Among HCWs reporting needle stick injury, 70·5% had at least one in the previous three months. Ergonomic hazards included lifting heavy objects (42%) and standing for long hours (37%). Psychological hazards included negative feelings (20·3%) and verbal or physical abuse during work (20·5%).

Conclusion:

More than a third of HCWs failed to recognize work-related health hazards. Despite training in handling infectious materials, HCWs reported direct skin contact with infectious materials and needle stick injuries. Results indicate the need for training oriented toward behavioral change and provision of occupational health services.     

Ergonomics in Modern Dairy Practice: A Review of Current Issues and Research Needs

ABSTRACT

Dairy farming is an ancient occupation. Traditionally, cows have been manually milked while tethered in stalls or stanchions. In the latter half of the 20th century as machine milking emerged, the parlor milking system has become more popular, especially among larger dairy farms. The transition from manual milking to automatic milking systems as well as the transition from stanchion to parlor milking systems involved a dramatic change in milking tasks. These transitions have resulted in changing patterns of occupational exposure to risk factors for work-related musculoskeletal disorders among dairy workers. However, aspects of the milking task such as sanitization of teats, stripping milk from teats, and attachment and detachment of milking equipment have remained relatively the same. Work-related musculoskeletal symptoms have been reported in the low back, shoulders, hands/wrists, and knees. Research that has measured exposures to risk factors for work-related musculoskeletal disorders among dairy farm workers has been limited, especially when using ergonomic tools to directly measure exposure, such as electrogoniometry or electromyography. Self-reported exposure measures have been most commonly used. The interventions that have been tested to reduce exposure to risk factors for work-related musculoskeletal disorders include assisted lift-hold devices, use of lighter-weight equipment, adjustable flooring, and use of rubber mats. However, research evaluating potential solutions to reduce dairy farm worker exposure to risk factors for musculoskeletal disorders is scarce. Future research efforts should further characterize hazards while simultaneously testing viable solutions that fit within the business model of the dairy farm industry.     

Burnout among Occupational Therapists in Portugal: A Study of Specific Factors

Abstract

This pilot study was conducted using a sample of 374 Portuguese occupational therapists to evaluate burnout levels and prevalence among occupational therapists as well as to relate those levels to practitioner age, gender, client age, years of professional activity, and area of practice. The Copenhagen Burnout Inventory questionnaire (Portuguese version) and a sociodemographic questionnaire was used. Results showed that ～23%, 44%, and 45% of occupational therapists presented with client-related burnout, personal burnout (PB), and work-related burnout, respectively. Higher rates of burnout were observed across all dimensions as the age of the professionals increased, with more years of working increased the client-rated rate, and client age increased the PB rate. Outcomes suggest a need to implement intervention programs to promote personal and organizational strategies to prevent burnout.     

High job demands and lack of time: A future challenge in occupational therapy

Abstract

Objective: The aim of this study was to identify work-related stress factors that contributed to work-related stress among Swedish occupational therapists and to investigate the association between work-related stress, demographic factors, and perceived overall stress. Methods: A postal questionnaire and a letter of invitation were sent to 807 Swedish occupational therapists, selected at random and representing 10% of occupational therapists working in Sweden. The response rate was 59%. A stress index presenting 49 stress factors graded on a scale from 1 (indicating no source of stress) to 6 (definitely a source of stress) was included. In addition, the level of perceived overall stress during the last two weeks was scored on a rating scale with the end points 0 (no stress) and 10 (extreme stress). Results: The main findings indicated that lack of resources and lack of time were the main stressors. “Working at a superficial level due to lack of time” was the only variable associated with high overall stress when both work-related and personal factors were included. Professional identity and clarity concerning the role were graded low with regard to stress. Conclusions: Work-related stress is just one aspect of the overall stress experienced but knowledge about its consequences highlights the importance of further studies.     

Evaluation and management of occupational low back disorders

This clinical practice review of occupational low back disorders describes work-related risk factors, occupational history, physical evaluation, clinical tests, diagnosis, care, and prevention. It is part of a quality assurance (QA) and quality improvement (QI) effort to establish exemplary occupational practice standards. It emphasizes the involvement of occupational medicine physicians in exposure assessment, care of injured workers, and disease prevention. Important occupational risk factors such as lifting, awkward body posture and vibration, in addition to psychosocial, socio-economic and other factors are summarized. The focus is on mechanical back disorders. Return-to-work, rehabilitation and prevention strategies are discussed as part of integrated disability management involving the injured worker, the primary care provider, employers and other relevant parties.     

Understanding occupational sitting: Prevalence,correlates and moderating effects in Australian employees

ObjectiveTo (1) compare occupational sitting between different socio-demographic, health-related, work-related and psychosocial categories, (2) identity socio-demographic, health-related, work-related and psychosocial correlates of occupational sitting, and (3) examine the moderating effect of work-related factors in the relation between correlates and occupational sitting.MethodsRandomly-selected Australian adults completed a web-based survey assessing socio-demographic (country of birth, gender, age, education, income), health-related (general health, weight, physical activity), work-related (employment status, occupational task, occupational classification) and sedentary-specific psychosocial (social norm, social support, self-efficacy, control, advantages, disadvantage, intention) factors, and occupational sitting-time. t-tests, ANOVAs and multiple linear regression analyses were conducted (in 2013) on a sample of employees (n = 993).ResultsRespondents sat on average for 3.75 (SD = 2.45) h/day during work. Investigated correlates explained 41% of the variance in occupational sitting. More occupational sitting was associated with being male, being younger, higher education and income, part-time and full-time employment, sedentary job tasks, white-collar/professional occupations, higher BMI, and perceiving more advantages of sitting less at work. Employment status and occupational classification moderated the association between control to sit less and occupational sitting. A lack of control to sit less was associated with higher occupational sitting in part-time and full-time workers, but not in casual workers; and in white-collar and professional workers, but not in blue-collar workers.ConclusionsMost important contributors to occupational sitting were work-related and socio-demographic correlates. More research is needed to confirm present results.     

Occupational low back pain among workers in some small-sized factories in Ardabil, Iran

The main purpose of this study was to assess some of the individual and occupational risk factors contributing to induction or intensification of LBP among the employees suffering from this problem in four small size factories in Ardabil, Iran. This study was a cross-sectional study that was conducted among the personnel of four industrial companies. Interview, questionnaire survey, medical examination (Lasegue test), radiographic evaluation, and ergonomic survey (using the NIOSH checklist) were the methods to collect data. The result of the study was divided into two parts: individual factors and work-related factors. The highest frequency of low back pain was observed in the age of 30-34 years old, medium height and heavy weight with 34.4, 84.4, and 33.0 percent, respectively. With regard to work-related factors, load lifting with 44.7 and body posture with 18.4 percent contributed to low back pain as the most important occupational causes among the patients. Observing recommended regulations and limitations of load lifting, modifying and optimizing ergonomic conditions in the workplace, selecting workers with suitable body strength on the basis of a pre-employment examination and implementing a continuous educational program for employees were the most important methods recommended to prevent low back pain.     

中国医疗行业工作相关肌肉骨骼疾患发生模式及其影响因素分析

  目的  调查中国医疗行业工作相关肌肉骨骼疾患(work-related musculoskeletal disorders, WMSDs)发生情况,探究不同岗位不良工效学职业危害因素及WMSDs发生模式。  方法  通过《北欧肌肉骨骼疾患问卷(修改版)》电子问卷系统对中国6 854名医疗行业从业人员进行横断面调查。根据美国国家职业安全卫生研究所(National Institute for Occupational Safety and Health, NIOSH)判定WMSDs方法进行发生结果统计分析。应用潜类别分析(latent class analysis, LCA)对主要工种WMSDs多部位发生模式进行分析,利用logistic回归分析法确定不良工效学因素。  结果  调查样本中,不计部位的总体WMSDs发生率为56.1%。其中,医生为54.15%、护士为58.66%、护工为51.04%、技师为54.05%、药师为48.48%。根据LCA分类结果,医生与护士WMSDs发生模式主要有颈肩型和躯干型;技师主要为颈肩型;药师为颈肩型;护工主要为颈肩型和轻微疼痛型。多因素logistic回归分析结果显示,颈肩型医生发生危险主要来自手腕长期弯曲(OR=1.383, P=0.036),频繁坐位工作(OR=2.110, P=0.020),工作姿势经常不舒服(OR=2.023, P=0.001);躯干型医生发生危险主要有腿部姿势受限(OR=1.413, P=0.044),频繁不舒适工作姿势(OR=4.402, P＜0.001);颈肩型护士发生危险主要来自颈部大幅度前倾(OR=2.218, P=0.024),长时间频繁坐位工作(OR=1.533, P=0.006);躯干型护士发生危险有长时间频繁坐位工作(OR=1.883, P < 0.001),频繁不舒适工作姿势(OR=2.137, P < 0.001)。  结论  中国医疗行业WMSDs发生率同世界主流国家地区相比处于中等水平。但行业总体不良工效学危害水平较高,不良作业姿势普遍存在。其中颈部、肩部、上背部、下背部的工效学负荷水平较高,主要与颈部工作中长时间保持不变、长时间低头、颈部大幅度前倾、手腕长期弯曲、长时间保持转身、腿部空间受限、长时间坐姿、作业姿势不舒服等职业因素有关。应通过加强宣教培训、增加辅助助力设施、改善工作组织模式等方式,降低肌肉骨骼损伤危险。     

Self-Reported Musculoskeletal Pain in Latino Vineyard Workers

ABSTRACT

The agricultural economy in the United States is dependent on millions of Latino migratory workers. Despite the health risks associated with this line of work, many agricultural workers lack health insurance or access to health care services. The purpose of this study was to collect demographic data and investigate the musculoskeletal health of Latino migratory vineyard workers. A physical therapy team collected demographic data at health clinics held at vineyards in Oregon. Nearly half (48.4%) of all vineyard workers reported experiencing musculoskeletal symptoms (MSS) in at least one region of the body. The primary region of reported MSS was the back (32% of all men and 43.7% of all women). In most cases, those who reported MSS were significantly older than those who did not report MSS. Future research is necessary to identify personal and work related injury risk factors in order to develop prevention programs.     

Musculoskeletal Disorders and Agricultural Risk Factors Among Korean Farmers

Farming is a strenuous occupation with various health risks, with musculoskeletal disorders (MSDs) being some of the most common. The risk factors for MSDs among Korean farmers are not well understood. Data were obtained from the Korean Farmers’ Occupational Disease and Injury Survey (2012), which interviewed 16,113 participants regarding their demographic profiles, self-reported MSDs, and agricultural characteristics. Multiple logistic regression analysis was used to identify the risk factors for MSDs. Subjects reported MSDs in the neck or upper extremities (5.89%), lower extremities (19.62%), and back (26.9%). Working in animal husbandry significantly increased the risk of MSDs in the neck/upper extremities, compared with irrigation farming (odds ratio: 1.837, 95% confidence interval: 1.130–2.987). The risk of MSDs increased significantly with number of years of farming, after adjusting for age and sex (neck/upper extremities, P for trend = .0002; lower extremities, <.001; back, <.001). Agriculture type, years of farming, and ergonomic factors increased the risk of MSDs among Korean farmers.     

Whole body biomechanical burden of healthcare workers: Proposal for a complementary risk assessment and management tool (HOARA)

Introduction:We have developed a new tool, named Holistic Approach Risk Assessment (HOARA), to support occupational safety and health professionals (OSH) in risk assessment and management when evaluating the biomechanical load of healthcare workers.Objectives:The primary aim of the HOARA is to support OSH in risk assessment and management of biomechanical hazards in healthcare facilities. This tool ensures a superior level of analysis by targeting independently various body compartments during all activities completed throughout the work shift. These include: head, neck, back and upper and lower limbs.Methods:For each body segment, ergonomic determinants were defined on the basis of previous literature, according to which task and job analyses were performed. Upon direct observation, ergonomic factors were given a score based on their temporal extent. Subsequently, action-body segment raw indices and weighted indices were calculated.Results:Results of the application of the method are shown. Of note, a relational database was set up to improve its usability.Conclusions:From an occupational health perspective, the HOARA, integrated with other methods, is expected to allow a more effective management of human resources, especially when assigning workers to specific jobs or tasks. Overall, the HOARA will be instrumental in assessing the impact of fitness for work judgments on work organization and its resources, in compliance with the guidelines from the Società Italiana di Medicina del Lavoro (SIML).Key words: WRMSDs, low back pain, risk assessment, risk management, whole body mechanical load     

Combined ergonomic exposures and development of musculoskeletal pain in the general working population: A prospective cohort study

Objective:This study aimed to investigate the importance of combined ergonomic exposures at work for the development of musculoskeletal pain.Methods:Through four rounds (2012–2018) of the Work Environment and Health in Denmark Study, 18 905 employees of the general working population replied to a baseline and 2-year follow-up questionnaire. First, a k-means cluster analysis of seven ergonomic factors (back bending, arm above shoulders, lifting etc., from ‘never’ to ‘almost all the time’) identified nine naturally occurring clusters. Second, using a weighted survey regression model controlling for age, gender, survey year, education, lifestyle, influence at work, and pain intensity at baseline, we estimated development of pain intensity (0–10) in the neck-shoulder and low-back in these clusters. The largest cluster served as reference to the other clusters and was characterized by low ergonomic exposures.Results:Clusters characterized by multiple combined ergonomic exposures for a relatively high percentage of the working time showed the largest increase in neck-shoulder as well as low-back pain intensity from baseline to follow-up. However, clusters characterized by high exposure to a few specific ergonomic factors also increased pain significantly, eg, standing/walking combined with lifting/carrying or twisted/bent back for the majority of the working time increased low-back pain, whereas repetitive arm movements for the majority of the working time with or without standing/walking increased neck-shoulder pain.Conclusion:Combined occupational ergonomic exposures play an important role in the development of musculoskeletal pain. Workplace preventive approaches should consider this in risk assessments and organization of the work.