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Musculoskeletal Disorder among 52,261 Chinese Restaurant Cooks Cohort: Result from the National Health Insurance Data

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To investigate the incidence of musculoskeletal disorders (MSDs) and the particular MSDs to which Chinese restaurant cooks are most at risk in Taiwan, National Health Insurance Data from 1998 to 2002 were used to identify MSDs for study populations, including 52,261 certified cooks and 209,044 references matched for age and sex. The annual incidence of MSDs was around 25% and 20% for cooks and references, respectively, and the cook-to-reference risk ratios ranged from 1.29 to 1.35 (p<0.001). The most frequently affected body part was the low back, but the epicondyle was at higher risk (OR>2) than other sites for the cooks. Cooks are at higher risk of having MSDs complaints and MSDs related to the elbow show the highest risk.
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J Occup Health 2008; 50: 163–168
Received Jul 9, 2007; Accepted Dec 7, 2007
Correspondence to: T.-N. Wu, Institute of Environmental Health,
College of Public Health, China Medical University and Hospital,
91 Hseuh-Shih Road, Taichung 404, Taiwan
(e-mail: tnwu@mail.cmu.edu.tw)
Journal of
Occupational Health
Musculoskeletal Disorder among 52,261 Chinese Restaurant Cooks
Cohort: Result from the National Health Insurance Data
Huei-Sheng SHIUE
1, 2
, Chih-Wei LU
1
, Chiou-Jong CHEN
3
, Tung-Shen SHIH
3, 4
,
Shiao-Chi W
U
5
, Chun-Yuh YANG
6
, Ya-Hui YANG
1
and Trong-Neng WU
4, 7
1
Graduate Institute of Occupational Safety and Health, Kaohsiung Medical University,
2
Department of Physical
Medicine and Rehabilitation, E-Da Hospital/I-Shou University,
3
Institute of Occupational Safety and Health, Labor
Affairs Council,
4
Institute of Environmental Health, College of Public Health, China Medical University and
Hospital,
5
Institute of Health and Welfare Policy, National Yang Ming University,
6
Faculty of Public Health,
Kaohsiung Medical University and
7
Institute of Environmental Health, National Yang Ming University, Taiwan
Abstract: Musculoskeletal Disorder among 52,261
Chinese Restaurant Cooks Cohort: Result from the
National Health Insurance Data: Huei-Sheng S
HIUE,
et al
. Graduate Institute of Occupational Safety and
Health, Kaohsiung Medical University, Taiwan—To
investigate the incidence of musculoskeletal disorders
(MSDs) and the particular MSDs to which Chinese
restaurant cooks are most at risk in Taiwan, National
Health Insurance Data from1998 to 2002 were used to
identify MSDs for study populations, including 52,261
certified cooks and 209,044 references matched for
age and sex. The annual incidence of MSDs was
around 25% and 20% for cooks and references,
respectively, and the cook-to-reference risk ratios
ranged from 1.29 to 1.35 (
p
<0.001). The most
frequently affected body part was the low back, but the
epicondyle was at higher risk (OR>2) than other sites
for the cooks. Cooks are at higher risk of having MSDs
complaints and MSDs related to the elbow show the
highest risk.
(J Occup Health 2008; 50: 163–168)
Key words: Chinese restaurant cooks, Health
insurance, Musculoskeletal disorder (MSD),
Occupational disease, Incidence
Musculoskeletal disorders (MSDs) are common
complaints in industry, particularly among workers with
intensive manual labor, as a leading cause of work related
illness. In many countries, MSDs are also the leading
cause of work-related illness. The Health and Safety
Executive of the U.K. has reported that MSDs are the
most common occupational illness in Great Britain,
affecting 1.0 million people anually with a cost to society
of £5.7 billion
1)
. In the U.S., low back pain accounts for
one fourth of compensation claims and one third of
compensation costs
2)
. Gou et al. found that 37% workers
in Taiwan had subjective symptoms of MSDs
3)
.
Numerous reports on MSDs have been published but few
of them have concerned cooks.
Repetitive manual work, lifting and forceful
movements, awkward posture and efforts are well-known
risk factors contributing to MSDs
4–8)
. A cook’s work is
characterized by long standing hours, constant leaning
forward of the body, and repetitive motion in the upper
limbs
9, 10)
. Because of the high body strain associated
with preparing raw materials and cuisine, cooks and
restaurant workers are at high risk of MSDs
11–13)
. Most
studies of MSDs have considered subjective health
complaints obtained with questionnaire survey. Some of
these complaints might be minor without the need for
medical attention. Therefore, workers with MSDs seeking
medical care deserve better understanding. The purpose
of this study was to investigate the incidence and risk of
MSDs and the particular MSDs to which Chinese
restaurant cooks are most at risk in Taiwan using health
insurance data.
Methods
Study population
The study population included 65,535 certified cooks
who had registered with the Bureau of Employment and
Vocational Training (BEVT) in Taiwan and worked in
the business of Chinese cuisine. Individuals with
duplicated files, incomplete information, and/or aged less
than 18 yr in 1998 were excluded from the data analyses.
164 J Occup Health, Vol. 50, 2008
Valid cooks were 22,445 men and 29,816 women in 2003.
The reference subjects were from the general population
selected from the 2003 reimbursement claims data of the
National Health Insurance (NHI) of Taiwan. For each
cook, four reference subjects were identified randomly,
and matched for sex and age (within one year).
Implemented in 1995, this insurance program covered
96.2% of population in 2003
14)
. The National Health
Insurance Bureau provided electronic data with patients’
sex, birthday, the classification code of the disease
diagnosed, data of health services received, and the clinic
or hospital code. Thus, 209,044 non-cooks were
identified from the NHI files as reference subjects for
this study. Using the national registration identification
numbers of cooks obtained from BEVT, they were linked
to the insurance data. Information associated with these
cooks extracted from the NHI data were merged with the
data of the reference subjects to establish a data set with
scrambled patient identification numbers to protect
anonymity.
Definitions
Cases of musculoskeletal disorders were identified
from the NHI data for the years from 1998 to 2002 using
the 9th revision of the International Classification of
Diseases (ICD), for both the certified Chinese restaurant
cooks and the reference group. Musculoskeletal disorders
(MSDs) were defined as patients diagnosed with either
an ICD-9 code between 710 to 739 or A-code (abridged
code) between 431 to 439. The A codes were converted
into ICD-9 for data analysis. In this study, we were
concerned about the leading causes of work-related and
repetitive motioning disorders, so we excluded tumor
(ICD-code 170, 171, and 213) or trauma (injury or
poisoning, ICD-9-CM code between 800 to 999).
The relationship between repeated motion in the upper
limbs and regional tendinitis had been well
documented
4–8)
. Thus, we chose tendonitis of the
shoulder, elbow, and wrist to investigate the occupational
risk of the cooks. As well as repetitive motion, the cooks
often bend or twist their wrists and this has also been
reported as a risk factor of carpal tunnel syndrome, so
carpal tunnel syndrome was also included as an
occupational disease. Prolonged standing and lifting of
heavy objects contributes to low back pain, so disc
herniation of the lumbar spine and lumbago were also
chosen. Therefore, the incidence of common work-related
MSDs were compared in this study, including
displacement of the thoracic or lumbar intervertebral disc
without myelopathy (ICD-9 code 722.1), lumbago (ICD-
9 code 724.2), rotator cuff syndrome of the shoulder (ICD-
9 code 726.1), medial epicondylitis (ICD-9 code 726.31),
lateral epicondylitis (ICD-9 code 726.32), trigger finger
(ICD-9 code 727.03), radial styloid tenosynovitis (ICD-
9 code 727.04), and carpal tunnel syndrome (ICD-9 code
354.0).
Statistical methods
First we calculated the overall MSD complaints for
the two study groups in 1998–2002. The annual incidence
was the number of new cases that developed the MSDs
divided by the size of the population at risk in each year;
the 5-yr cumulative incidence was the number of new
cases that developed the MSDs divided by the size of the
population at risk from 1998 to 2002. The annual
incidence of MSDs was calculated for the study group,
with cooks-to-references risk ratios presented as odds
ratio (OR) and 95% confidence interval (CI). The chi-
square test was used to obtain the OR and 95% CI. Data
analysis further compared the average age-specific
incidences in these five years between the two groups.
The site-specific incidences of MSDs for the cooks and
references were also compared. In order to identify sex-
specific differences in the MSD risk, we also calculated
the mean of sex-age-specific incidence for cooks and
references (Fig. 1).
Fig. 1. Five-year age and gender-specific average incidence of musculoskeletal disorders between cooks and
references (non-cooks).
165Huei-Sheng SHIUE, et al.: Musculoskeletal Disorder among 52,261 Chinese Restaurant Cooks Cohort
Results
The sex-distribution (57.1% women and 42.9% men)
and their average ages (35.3 yr in women and 32.3 yr in
men) in cooks were the same as those in the reference
group (Table 1). The 5-yr cumulative incidence of having
had MSD was higher in the cooks than in the references
(59.5% vs. 50.9%, p<0.001). Table 2 shows that the
annual incidence of MSDs for the cooks ranged from
23.60% to 26.25% and that for the references ranged from
18.72% to 21.65%. The cooks-to-references odd ratios
in 1998–2002 showed that cooks were 1.29–1.34 more
likely than references to receive MSD care.
Age-specific incidence
There was an increasing trend with age for MSD
incidence in both the cooks and the reference group (Table
3). The age-specific rate increased from approximately
13.22% in the 20–24 yr old group to 46.92% in the 60 yr
old and above group for cooks. The age-specific
incidence in the cooks was consistently greater than that
in the references. The cooks-to-references odds ratio
peaked in the 35–39 yr old groups (OR 1.42, 95% CI
1.39–1.46).
Sex-age-specific comparison
Figure 1 shows the sex- and age-specific incidence of
having MSDs for cooks and references. In both men and
women, the cooks had a higher risk of acquiring MSDs
than the male references. In general, starting with the
20–24 yr old group, female cooks had the highest
incidence in almost every age group, followed by the
female reference groups. The incidence increased as age
increased. The incidence of MSDs in female cooks aged
60 yr was much greater than that in the age group of
20–24 yr, 52.3% vs. 14.2%.
Incidence of specific sites
Table 4 shows the work-related MSDs incidence for
specific body sites diagnosed in 2001 and 2002. The
cooks had higher incidences of complaints for all types
of MSD than the references. The incidence of lumbago
(ICD code 724.2) was the highest among these disorders
in both study groups. The highest OR was found in medial
epicondylitis (ICD code 726.31), followed by lateral
epicondylitis (ICD code 726.32). The incidences of carpal
tunnel syndrome were also higher in cooks than in
references with the cooks-to-references OR of 1.76 (95%
CI: 1.5–2.1).
Table 1. Demographic data and five-year cumulative incidence of MSDs in Chinese restaurant cooks
and references
Cooks References
N 52,261 209,044
Gender Female 29,816 (57.1%) 119,264 (57.1%)
Male 22,445 (42.9%) 89,780 (42.9%)
Age (yr) Female 35.3 ± 10.1 35.3 ± 10.1
Male 32.3 ± 9.3 32.3 ± 9.3
Five-year cumulative incidence of MSDs
a,b,c
31,110 (59.5%) 106,369 (50.9%)
a
MSDs: musculoskeletal disorders.
b
The five-year cumulative incidence was the number of new cases
that developed MSDs divided by the size of the population at risk from 1998 to 2002.
c
p-value<0.001.
Table 2. The annual incidence of musculoskeletal disorders for Chinese restaurant
cooks and references, 1998–2002
Year Incidence
a
(%) OR
b
(95% CI)
b
p-value
b
Cooks References
1998 23.60 18.72 1.34 (1.31–1.37) <0.001
1999 24.62 19.68 1.33 (1.30–1.36) <0.001
2000 25.87 20.56 1.35 (1.32–1.38) <0.001
2001 25.98 21.17 1.31 (1.28–1.34) <0.001
2002 26.25 21.65 1.29 (1.26–1.32) <0.001
a
The annual incidence was the number of new cases that developed MSDs divided by
the size of the population at risk in each year.
b
Chi-square test.
166 J Occup Health, Vol. 50, 2008
Discussion
Overall incidence and incidence by disease
To the authors’ knowledge, this study is the first to
report the physician-diagnosed incidence of MSDs with
a large sample for cooks in the business of Chinese
cuisine. The strength of this study is that all cooks
included in this study were government certified instead
of self-reported, therefore it is unlikely to have
misclassification of the cooks’ status was unlikely. The
National Health Insurance in Taiwan is a mandatory-
enrollment universal health insurance program with a
coverage rate of higher than 96.2%
14)
. The randomly
selected references in this study make the measures of
incidence reliable and similar to using the whole
population as the denominator. Thus, selection bias was
substantially reduced. No previous studies have used
national-wide insurance health data to investigate
musculoskeletal disorders for cooks. The large sample
size allowed the assessment of multiple-site information
on specific MSDs with great accuracy and fewer common
complaints.
One limitation of this study is that it cannot be sure
that all of the registered cooks remained at work at
restaurants during this study period. Some of them may
have quit the job of cooking during the study period.
Table 4. Incidence of specific work-related musculoskeletal disorders in cooks and references, and cooks to references risk ratios
in 2001 and 2002
2001 2002
ICD-9 code Incidence
a
(%) OR
b
p-value
b
Incidence
a
(%) OR
b
p-value
b
Cooks References (95% CI)
b
Cooks References (95% CI)
b
722.1 HIVD 0.66 0.48 1.38 (1.22–1.56) <0.001 0.70 0.49 1.43 (1.27–1.61) <0.001
724.2 Lumbago 4.91 4.05 1.22 (1.17–1.28) <0.001 4.73 3.88 1.23 (1.17–1.29) <0.001
726.1 Rotator cuff syndrome 0.48 0.33 1.49 (1.29–1.72) <0.001 0.58 0.35 1.66 (1.45–1.90) <0.001
of shoulder
726.31 Medial epicondylitis 0.05 0.03 2.08 (1.30–3.31) 0.002 0.06 0.02 2.52 (1.58–4.02) <0.001
726.32 Lateral epicondylitis 0.43 0.21 2.10 (1.79–2.47) <0.001 0.48 0.24 1.96 (1.68–2.28) <0.001
727.03 Trigger finger 0.21 0.11 1.92 (1.53–2.42) <0.001 0.23 0.13 1.75 (1.41–2.17) <0.001
727.04 Radial styloid 0.10 0.06 1.90 (1.37–2.62) <0.001 0.09 0.06 1.42 (1.01–1.98) 0.042
tenosynovitis
354.0 Carpal tunnel syndrome 0.43 0.24 1.76 (1.50–2.06) <0.001 0.46 0.26 1.76 (1.51–2.05) <0.001
a
The annual incidence was the number of new cases that developed the MSDs divided by the size of the population at risk in each
year.
b
Chi-square test.
Table 3. Average five-year age-specific incidence of musculoskeletal disorders among cooks
and references from 1998 to 2002
Age (yr) Five-year cumulative
incidence
a
(%) OR
b
95%CI
b
p-value
b
Cooks References
18–19 12.48 10.18 1.26 1.16–1.37 <0.0001
20–24 13.22 11.33 1.19 1.15–1.23 <0.0001
25–29 15.26 12.06 1.31 1.27–1.36 <0.0001
30–34 20.06 15.12 1.41 1.37–1.45 <0.0001
35–39 25.78 19.65 1.42 1.39–1.46 <0.0001
40–44 31.84 25.20 1.39 1.36–1.42 <0.0001
45–49 37.77 31.39 1.33 1.29–1.36 <0.0001
50–54 43.99 37.71 1.30 1.25–1.35 <0.0001
55–59 46.53 40.30 1.29 1.21–1.37 <0.0001
60 46.92 44.57 1.10 1.00–1.21 0.044
a
The five-year cumulative incidence was the number of new cases that developed MSDs divided
by the size of the population at risk from 1998 to 2002.
b
Chi-square test.
167Huei-Sheng SHIUE, et al.: Musculoskeletal Disorder among 52,261 Chinese Restaurant Cooks Cohort
However, the incidence of MSD was only slightly under
estimated because of low job turnover among cooks. An
other limitation is that the insurance program has not been
verified for the ICD codes in the claim files. To reduce
the influence of inappropriate records, all ICD-9 codes
under the category of musculoskeletal and soft tissue
disorders were included. Inappropriate records and
misdiagnosis were likely minor and unlikely to be
different between the groups. Therefore, underestimate
of the relative risk was not likely. We are also concerned
that some cooks not registered with the government were
selected for the reference group. But, the chance of
selecting unregistered cooks from a large general
population size (approximately 23 millions) was very
minor.
The incidence of MSDs in the study populations was
around 25% annually in average or 59.5% in the 5-yr
observation period, lower than the incidences reported
in other studies
3, 11–13, 15)
. Cooks at hotels in Taiwan have
high reported incidences of low back pain (54.7%), neck
pain (55.6%), and shoulder pain (58.9%)
12)
. A Norwegian
study showed that 80% of hotel foods service employees
reported a lifetime experience of MSDs, including 39.3%
of low back pain and 42.4% of shoulder pain
16)
. Most
previous studies have used self-reported subjective
symptoms of MSDs, Parkes et al. found that less than
half of workers who had suffered from MSDs would visit
a doctor
15)
. It is likely a large number of Chinese
restaurant cooks did not seek medical assistance for
MSDs.
The incidence of lumbago was much higher than other
selected MSDs in this survey. It was compatible with
most studies that back pain is the most frequently reported
MSD
3, 17, 18)
. The odds ratios of medial and lateral
epicondylitis were also significant. The risk for
epicondylitis was nearly two times higher in cooks than
in the general population. Ono et al. performed physical
examinations of 200 female cooks aged from 40 to 59 yr,
and also found a significantly higher incidence of
epicondylitis in cooks (11.5%) than in references (2.5%)
with an adjusted OR of 5.4 ( 95% CI 2.4 to 11.9)
10)
.
Incidence by age and gender
An increasing trend with age for MSD incidence was
noted in this study. We also examined the interaction of
age and sex. The incidence of MSD complaints was
higher in women than in men and the gender difference
increased with increasing age. Female cooks aged 60 yr
and older were approximately three times more likely
than young female cooks to seek medical assistance for
MSDs. The variation of incidence by age and gender is
based on help-seeking behavior for MSD. Old workers
were more likely to seek help than younger groups. A
Japanese study also found that pains for female kitchen
workers increased successively with age. The pain in
the axial area, and the upper and lower limbs increased
from 22.0% among workers aged less than 40 yr to 49.0%
among those of 51 yr and older
10)
. Häkkänen et al.
followed up 532 trailer assembly workers and found that
women have a higher rate of sick leave than men (3.3%
vs.2.2%) particularly for neck and shoulder disorders
(relative risk=12.8, 95% CI 3.7–44.5)
19)
. A recent
Norwegian study had a similar finding, that women are
at higher risk than men for low back pain (43.9% vs.
35.2%) and shoulder pain (51.5% vs. 32.0%)
16)
. In our
study, gender difference in the incidence of MSDs was
also noted; women were at higher risk of MSDs than
men. In the oldest groups, the relative risk between the
cooks and the referents reduced. It is likely that work-
related MSDs reduced after work load lessened with age
and the incidence of osteoarthritis significantly increased
with age (data not shown).
These results demonstrate that Chinese restaurant cooks
are at higher risk of having MSDs than the general
population. The most frequently affected body part was
the low back, but when compared to other populations,
upper limbs were at higher risk than the other sites of the
body, especially elbows. Ergonomic studies should be
launched to innovate upon the working style to reduce
MSDs among Chinese restaurant cooks.
Acknowledgment: This study was conducted with
support from Institute of Occupational Safety and Health,
Labor Affairs Council, Executive Yuan, Taiwan.
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... Among the catering industry workers, chefs are the lead cooks managing the kitchen 12 . Surveys from various Asian countries (India, Hong Kong and Taiwan) has shown that the prevalence of WMSD is high among restaurant chefs especially among Chinese restaurant chefs [13][14][15] . A study conducted among 52,261 Chinese restaurant cooks in Taiwan has shown that nearly 25% of cooks suffer WMSDs 14 . ...
... Surveys from various Asian countries (India, Hong Kong and Taiwan) has shown that the prevalence of WMSD is high among restaurant chefs especially among Chinese restaurant chefs [13][14][15] . A study conducted among 52,261 Chinese restaurant cooks in Taiwan has shown that nearly 25% of cooks suffer WMSDs 14 . Similarly, a study in Hong Kong reported that more than two third of chef suffers from WMSDs 15 . ...
... Based on the results of this study, the highest prevalence of WMSD among chef are the feet (59.5%), lower back (52.5%) and shoulders (48.5%). It is similar to other previous studies reports that the highest prevalence of WMSD among chef are shoulders and lower back, except neck pain which was reported lower percentage in this study [13][14][15]18,27,28 . The feet have the highest prevalence in this study possible due to prolonged standing during long working hour. ...
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Background: Among the workers in the catering industry, the chef is reported to have the highest prevalence of Work-related Musculoskeletal Disorders (WMSD).Even though working posture was documented as one of the risk factors, the analysis of working posture and musculoskeletal pain was not extensively studied in Malaysia.
... 4 WMSD risks among food and beverage services industry (FBSI) workers specifically have been identified. [5][6][7][8] FBSI work is characterized by long hours, prolonged standing and leaning forward, repetitive and fast hand and wrist movements, prolonged and forceful hand and wrist exertion, and carrying and lifting heavy objects, all well-known risk factors for WMSDs. 1,5,[7][8][9] Studies have investigated the association between such tasks and WMSDs. ...
... [5][6][7][8] FBSI work is characterized by long hours, prolonged standing and leaning forward, repetitive and fast hand and wrist movements, prolonged and forceful hand and wrist exertion, and carrying and lifting heavy objects, all well-known risk factors for WMSDs. 1,5,[7][8][9] Studies have investigated the association between such tasks and WMSDs. For example, Tomita et al found significant lower back pain in workers who prepared a large number of meals daily (≥150 vs <150 meals/ person-day). ...
... 6 Some complaints in the survey questionnaire may be minor and not need medical treatment, or may lack accuracy or completeness due to recall bias. 5 Very little existing literature reports population-based data to examine WMSD risk. One study by Shiue et al (2008) reported physiciandiagnosed WMSD incidence in 52 261 Chinese restaurant cooks using health insurance data from 1998 to 2002, and found higher risk among cooks in Taiwan. ...
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Objectives Occupational characteristics in the food and beverage service industry (FBSI) have been found to be associated with musculoskeletal disorders (MSDs). This study aimed to examine gender and site‐specific incident risks of MSDs among FBSI workers in Taiwan using a national population‐based database. Methods We conducted a 15‐year population‐based cohort study among 224 506 FBSI workers in Taiwan using data from five large nationwide databases to estimate direct standardized incidence ratios (SIRs) for identifying specific MSDs related to overexertion and repetitiveness during work. Overall, MSDs risks were also investigated by gender, sub‐industrial categories, and certificate types. Results We found SIRs for overall MSDs for male and female workers of 1.706 (95% CI, 1.688‐1.724) and 2.198 (95% CI, 2.177‐2.219), respectively. Our findings indicate significantly increased WMSD risk for both men and women, including median/ulnar nerve disorders (ICD‐9 354.0‐354.2); spondylosis and allied disorders (ICD‐9 721); intervertebral disc disorders (ICD‐9 722); disorders of the back (ICD‐9 724); peripheral enthesopathies and allied syndromes (ICD‐9 726); synovium, tendon, and bursa disorders (ICD‐9 727); and soft tissues of the peripheral system disorders (ICD‐9 729). Food stall workers and workers with Chinese cuisine or baking licenses were at higher risk among sub‐industrial categories and certificate types. Conclusion This large‐scale study revealed that FBSI workers were at higher risk for several MSDs than the general population. This information could help prioritize MSD problems and identify a high‐risk population. Relevant policy and ergonomic improvements and interventions could be implemented for health promotion in this industry.
... Our study finding is in accordance with previous study by Chen et al., (2020) reported prevalence of as high 93% among bakery workers(12). Simultaneously, another study conducted byShiue et al., (2008) reported that the cooks in Chinese restaurants have a high prevalence of MSDs and the result shows that ankles and feet are the most common body parts to be affected by MSDs of all body parts, with the prevalence of 76.9%, followed by the upper back 60.6% and shoulder 58.7%(16). ...
... Our study finding is in accordance with previous study by Chen et al., (2020) reported prevalence of as high 93% among bakery workers(12). Simultaneously, another study conducted byShiue et al., (2008) reported that the cooks in Chinese restaurants have a high prevalence of MSDs and the result shows that ankles and feet are the most common body parts to be affected by MSDs of all body parts, with the prevalence of 76.9%, followed by the upper back 60.6% and shoulder 58.7%(16). ...
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Background: Musculoskeletal disorders (MSDs) is known as the second most common cause of disability in the world. The chef is reported to have the highest prevalence of MSDs among the catering sector employees. However, the study about the prevalence of MSDs and associated work-related risk factors specifically among pastry chefs is very limited in Malaysia. Objectives: To determine the prevalence of MSDs and associated work-related risk factors among pastry chefs in Malacca, Malaysia. Methodology: This cross-sectional study recruited 104 participants by convenience sampling of pastry chefs from Malacca, Malaysia. Dutch Musculoskeletal Questionnaire (DMQ) was adopted to determine the prevalence of MSDs and associated work-related risk factors. Results: The prevalence of MSDs among pastry chefs in Malacca, Malaysia within 12 months is reported as 92.3% with the highest prevalence in the ankles (76.9%), followed by upper back (60.6%), and shoulder (58.7%) respectively. There is a significant association between work-related risk factors which includes prolonged working in an uncomfortable posture, working in the same posture for a long period of time, exerting great force on tools, often bending and twisting of trunk and neck in causing MSDs among pastry chefs. Conclusion: The prevalence of MSDs among pastry chefs is relatively high. The majority of the pastry chefs involved in this study reported with MSDs. Working characteristic plays a crucial role in causing MSDs. Further evaluation and ergonomic adjustment of the working environment can be implemented to prevent the development of MSDs among pastry chefs.
... Muskuloskeletale Beschwerden hatten bei taiwanesischen Köchen eine jährliche Inzidenz von 25 % und bei finnischen, weiblichen Küchenhilfen eine 3-Monats-Präva-lenz für Beschwerden in Nacken-, Schulter-und Handbereich von 71 %, 34 % bzw. 49 % [7,14]. In der von uns ausgewerteten Stichprobe bezogen sich 7,8 % der Verdachtsanzeigen auf Erkrankungen des Bewegungsapparats (BK-Ziffern 2101 bis 2113). ...
... In der von uns ausgewerteten Stichprobe bezogen sich 7,8 % der Verdachtsanzeigen auf Erkrankungen des Bewegungsapparats (BK-Ziffern 2101 bis 2113). Eine Auswertung von Routinedaten der nationalen Krankenversicherung Taiwans ergab, dass die berufliche Tätigkeit als Koch einen Risikofaktor für Sehnenscheidenentzündung darstellt (Odds-Ratio 2,52; [14]). In den uns vorliegenden Daten findet sich hierfür kein Beleg. ...
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Background Only few data are available on work-related accidents and occupational diseases for kitchen workers in Germany. Routine data based on claims data from the Occupational Accident Insurance for Healthcare and Welfare Services (BGW) were used for a differentiated analysis.Methods The analysis included BGW claims data between 2008 and 2017 for kitchen helpers and cooks with notification of a work-related accident or a suspected occupational disease. Descriptive statistics were used for occupational groups and group differences were evaluated using a χ2-test.ResultsAround 70% of the accidents and notifications of suspected occupational diseases were from kitchen helpers and 30% from cooks. Kitchen helpers were more often injured by stumbling accidents and in the manual transport of objects than cooks. Almost half the accidents suffered by cooks were associated with handling knives and almost 17% with burns. In both groups more than 80% of the suspected occupational diseases were skin diseases and 5% were diseases associated with lumbar disc problems caused by the lifting and carrying heavy loads. Just under 3% were obstructive airway diseases. The occupational disease was confirmed in 78% of cases, which were mostly skin diseases caused by working with fluids, disinfectants or cleaning agents.DiscussionIncision wounds and stumbling accidents are also described by other authors as the most common accidents among kitchen workers. Most occupational diseases among kitchen workers in health services were skin diseases but similar prevalence rates have not been reported by other authors. In contrast, a high prevalence of musculoskeletal symptoms in the shoulders or hands have been reported for which no evidence was found in the present data.
... Thus, participatory ergonomics programs have been proposed to prevent WRMSs (Magnavita, 2009a;Magnavita et al., 2007). In addition, the personal factors such as increasing age was an identified significant risk factor on shoulder WRMSs (Magnavita, 2009b;Shiue et al., 2008). Obesity (Luime et al., 2004), anxiety, depression, job strain (Magnavita, 2009b, and environmental discomfort (Magnavita et al., 2011) werer also found associated with shoulder WRMSs in western context. ...
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Nursing assistants (NAs) working in nursing homes (NHs) are at higher risk for work-related musculoskeletal symptoms (WRMSs) than their counterparts working in other health care settings. Worldwide, NAs have ranked shoulders in the top three body parts at risk of WRMSs. However, factors associated with their shoulder WRMSs are currently unknown. The aim of this study was to identify these associated risk factors among NAs working in NHs. 440 NAs from 47 nursing homes (with 60–90% response rate from each nursing home), recruited by convenience sampling, participated in this cross-sectional study in 2014–2015. A validated and reliable questionnaire was used for data collection. Information on demographic, job content questionnaire (JCQ), perceived physical exertion (PE), workstyle, ergonomic and manual handling knowledge and other work-related factors was collected using a self-administered questionnaire. 53% of the participants reported experiencing with WRMSs in their shoulders. Nine associated factors of shoulder WRMSs were identified using bivariate analysis. With the adjustment of age and gender using multivariable logistic regression, body mass index (OR = .931, 95% CI [.874–.991]), job title of health workers (OR = 2.72, 95% CI [1.18–6.25]) and workstyle-working through pain (OR = 1.06, 95% CI [1.01–1.11]) remained as predictors. Effort should be directed at integrating “workstyle intervention” into lifestyle physical activity training for NAs.
... Furthermore, a prospective study of 52,261 Chinese restaurant cooks revealed a 1.29-1.35 times higher risk of MSDs compared to their matched references [14]. In addition, musculoskeletal complaints were reported as the most common health problems that led to cooks leaving their jobs [15]. ...
Article
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Background The socioeconomic burden of musculoskeletal disorders (MSDs) is significant and kitchen work is a high-risk occupation for MSDs due to the intensive manual workload and repetitive movements that are involved. However, there are very few studies on MSDs and rest breaks as a workplace intervention among kitchen workers. This study examined the relationship between insufficient rest breaks and increased MSD risk among Korean kitchen workers. Methods Sociodemographic and occupational factors of 1,909 kitchen workers were collected from the 3rd–4th Korean Working Conditions Survey data. Five items on rest breaks at work were categorized into two groups (“sufficient”/“insufficient”). The number of MSDs and work-related MSDs (WMSDs), an outcome variable, was obtained from the sum of MSDs/WMSDs in three anatomical sites (back, neck and upper limb, lower limb). The association between rest breaks and MSDs was estimated using zero-inflated negative binomial analyses, with adjustments for age, education level, and weekly working hours, and the analyses were stratified by sex. Results After adjustment, significant associations were found between insufficient rest breaks and an increased risk of MSDs (odds ratio [OR] 1.68 95% confidence interval [CI] 1.11–2.54) and WMSDs (OR 1.40 95% CI 1.01–1.96) among female kitchen workers. Insufficient rest breaks were significantly associated with MSDs in female kitchen workers in all three anatomical sites. Conclusion This study emphasizes the need for rest breaks as a workplace intervention for preventing MSDs in kitchen workers. Further studies to reveal the causality of this relationship are required.
... Among 905 individuals in two previous studies, the neck (54.3%) and shoulders (57.9%) were more involved than other body regions (22.3-52.75%) [4,5]. A Norwegian study found that 80% of hotel FWs reported lifelong musculoskeletal pain, including 42.4% with neck/shoulder pain [6]. ...
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Objectives: It is unclear which factors increase the risk of developing pressure pain hypersensitivity, a type of neurophysiological hyperexcitability. The present study investigated the relative contributions of physical and psychological factors to pressure pain hypersensitivity of the upper trapezius for each sex. Methods: In total, 154 individuals with neck/shoulder myofascial pain participated, among 372 food service workers. Participants completed a questionnaire (age, sex, Beck Depression Inventory, and Borg Rating of Perceived Exertion scale) and then were photographed to measure posture. Pressure pain sensitivity, two range of motions (cervical lateral-bending and rotation), and four muscle strengths (serratus anterior, lower trapezius, biceps, and glenohumeral external rotator) were measured by a pressure algometer, iPhone application, and handheld dynamometer. For each sex, forward multivariate logistic regression was used to test our a priori hypothesis among selected variables that a combination of psychosocial and physical factors contributed to the risk for pressure pain hypersensitivity. Results: In multivariate analyses, lower trapezius strength (odds ratio = 0.94, 95% confidence interval = 0.91–0.97, p = 0.001) was the only significant risk factor for pressure pain hypersensitivity in men. Dominant painful ipsilateral cervical rotation range of motion (odds ratio = 0.96, 95% confidence interval = 0.92–0.99, p = 0.037) was the only risk factor for pressure pain hypersensitivity in women. Discussion: Lower trapezius strength and dominant painful ipsilateral cervical rotation range of motion could serve as guidelines for preventing and managing pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain. Trial registration: Research Information Service (CRIS) under the code KCT0002810 (granted on 20/04/2018) and the registration timing was retrospective.
... (non-cooks) which our study couldn't provide except for hours work (>10 OR=.72, .08-6.2 95%CI). 20 We find some comparison of our study with the previous literature which indicates that there is a finding of musculoskeletal related pain in chefs. However, there are limitations to our study as this study was conducted within a short period. ...
Article
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Background: Work-related musculoskeletal pain arises in many occupations. Chefs working in restaurants perform the repetitive motion, forceful exertions in non-neutral body postures, which make them susceptible to musculoskeletal pain. This occupation needs to be evaluated for the chefs on the musculoskeletal pain scale for better understanding of their demanding job description in a restaurant which causes health problems. Objective: To determine the frequency of musculoskeletal pain in chefs working in restaurants of Lahore. Methodology: Cross-sectional survey design with convenient sampling technique was used. Numeric pain rating scale (NPRS) and the Nordic questionnaire was undertaken to determine the frequency among chefs working in different restaurants of Lahore. Inclusions of chefs were based on satisfying the criteria of age from 25-50, experience of 2 years or more and minimum working hours 8. While incomplete questionnaire, previous trauma or surgery to the site of pain or kitchen aid workers were excluded from the study. The data was gathered from the period of June 2018 till September 2018. Results: This study includes n=200 male chefs. Mean and standard deviation of NPRS was 0.52 ± 1.35. 37(18.5%) chefs responded that they experienced pain within the past 12 months. Low back being the most affected region 12(8%), followed by region of neck 9(4.5%), shoulder 7(3.5%), wrist/hand 4(2.0%), knees 4(2.0%), hips/thighs 3(1.5%) ankle/feet 2(1.0%). The odds ratio of developing musculoskeletal pain if working >10 hours is OR=0.72 (0.08-6.2 95%CI). Significant association between the age groups and NPRS was found (χ2=16.30, p=0.012). Conclusion: This study demonstrated that musculoskeletal pain is frequent in chefs, though it was found to be low on NPRS. Low back pain was found to be the frequent region of the complaint. Keywords: Frequency, Low Back Pain, Musculoskeletal Pain, Numeric Pain Rating Scale.
Article
It is unclear which factors contribute to the developing pressure pain hypersensitivity of the upper trapezius, a type of neurophysiological hyperexcitability. The present study investigated the relationship between physical and psychological factors and pressure pain hypersensitivity of the upper trapezius for each sex. In total, 154 individuals with neck/shoulder myofascial pain participated, among 372 food service workers. Participants completed a questionnaire (Beck Depression Inventory, and Borg Rating of Perceived Exertion scale) and were photographed to measure posture. Pressure pain sensitivity, 2 range of motions (cervical lateral bending and rotation), and 4 muscle strengths (serratus anterior, lower trapezius [LT], biceps, and glenohumeral external rotator) were measured by a pressure algometer, iPhone application, and handheld dynamometer, respectively. For each sex, forward multivariate logistic regression was used to test our a priori hypothesis among selected variables that a combination of psychosocial and physical factors contributed to the risk for pressure pain hypersensitivity. In multivariate analyses, LT strength (odds ratio = 0.94, 95% confidence interval = 0.91–0.97, P = .001) was the only significant influencing factor for pressure pain hypersensitivity in men. Dominant painful ipsilateral cervical rotation range of motion (odds ratio = 0.96, 95% confidence interval = 0.92–0.99, P = .037) was the only influencing factor for pressure pain hypersensitivity in women. LT strength and dominant painful ipsilateral cervical rotation range of motion could serve as guidelines for preventing and managing pressure pain hypersensitivity of the upper trapezius in food service workers with nonspecific neck/shoulder myofascial pain.
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Background: Subjectively reported health complaints account for approximately 50% of all long-term sickness compensation and permanent disability in Northern European countries. The prevalence of these complaints in the population at large was examined. Methods: Data from national surveys conducted in 1993 of 2,030 men and 2,016 women above 15 years of age in Denmark, Finland, Norway, and Sweden were analysed. Results: As many as 75% of our sample had at least some subjective health complaints for the previous 30 days. More than 50% had experienced tiredness, 42% headache, 37% worry, 35% low back pain and 33% pain in their arms or shoulders. The prevalence was higher in women than in men. In general, substantial muscle pain was more common in older subjects, but tiredness, headache, worry and depressive mood were more common in young subjects. Conclusion: The very high prevalence of these complaints in the general population should be taken into account whenever these complaints are reported to be due to any new environmental factor or disease.
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The prevalence and severity of musculoskeletal disorders (MSD) were assessed in cross-sectional and longitudinal data obtained from male employees in the UK oil and gas industry. The roles of the physical and psychosocial work environment, and of individual factors were examined in relation to reported MSD. • Assessed by the Nordic Musculoskeletal Questionnaire (MSQ) (N=321), lower back pain showed the highest 12-month prevalence rate (51%) but, taken together, neck, shoulders and/or upper back MSD had a similar prevalence rate. Mental health, workload, physical environment stressors, and body mass index predicted MSD, although their relative importance varied across different body areas. • In cross-sectional analyses (N=1462), relationships between psychosocial work measures and MSD in the neck/shoulders/back were mediated by psychological distress, but ‘job activity level (strenuous, active, and sedentary) and physical stressors remained significant direct predictors. The effect of ‘negative affectivity’ on MSD was also mediated by psychological distress, particularly anxiety. • In longitudinal analyses (N=321), anxiety and social support were significant factors predicting change in MSD over the five-year period, 1995-2000. In common with other published findings, the evidence suggested that the primary causal direction was from anxiety to MSD. • Factor analysis identified three scales (stress/anxiety, work, and lifestyle) in a set of items assessing beliefs about MSD causes (N=676). MSD problems were primarily attributed to work and lifestyle factors. Individual experiences of MSD, including perceived causes and medical consultations, were also analysed.
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Background This study examined the relationship of repetitive work and other physical stressors to prevalence of upper limb discomfort, tendinitis, and carpal tunnel syndrome.Methods Three hundred fifty-two workers from three companies participated. Job exposure levels for repetition and other physical stressors were quantified using an observational rating technique. Ergonomic exposures were rated on a 10-point scale, where 0 corresponded to no stress and 10 corresponded to maximum stress. Job selection was based on repetition (three categories: high, medium, and low) to ensure a wide range of exposures. Physical evaluations on all participating workers were performed by medical professionals and included a self-administered questionnaire, physical exam, and limited electrodiagnostic testing.ResultsRepetitiveness of work was found to be significantly associated with prevalence of reported discomfort in the wrist, hand, or fingers (odds ratio (OR) = 1.17 per unit of repetition; OR = 2.45 for high vs. low repetition), tendinitis in the distal upper extremity (OR = 1.23 per unit of repetition; OR = 3.23 for high vs. low repetition), and symptoms consistent with carpal tunnel syndrome (OR = 1.16 per unit of repetition; OR = 2.32 for high vs. low repetition). An association was also found between repetitiveness of work and carpal tunnel syndrome, indicated by the combination of positive electrodiagnostic results and symptoms consistent with carpal tunnel syndrome (OR = 1.22 per unit of repetition; OR = 3.11 for high vs. low repetition).Conclusions These findings indicate that repetitive work is related to upper limb discomfort, tendinitis, and carpal tunnel syndrome in workers. Further research with a wider range of exposures is needed to evaluate the effects of other physical stresses alone and in combination. Am. J. Ind. Med. 36:248–259, 1999. © 1999 Wiley-Liss, Inc.
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Carpal tunnel syndrome has been reported to occur between two and ten times as frequently in women as in men. It also has been reported that this syndrome is often associated with the performance of certain manual tasks. Such cases can be considered an occupational disease. This study was addressed to the question: Why do some people develop carpal tunnel syndrome while others do not? Two matching female populations, one with a known history of carpal tunnel syndrome and one without a known history of carpal tunnel syndrome, were selected and differences in hand size and work methods were studied. Both populations were employed in the same production sewing jobs. While differences in hand size were not found, use of forceful exertions and of deviated wrists and pinch hand position - particularly during forceful exertions - were found to be associated with carpal tunnel syndrome.
Article
Aims : As subjective health complaints are one of the major reasons for short- and long-term sickness absence it is important to know the prevalence of these conditions in the general population. Methods : In this cross-sectional study, 1,240 individuals (aged 15-84 years) from the normal population in Norway answered the Subjective Health Complaint (SHC) inventory in spring 1996. Results : The prevalence of reporting subjective health complaints was high: 80% reported musculoskeletal complaints, 65% reported “pseudoneurological” complaints (tiredness, depression, dizziness), 60% gastrointestinal complaints, 34% allergic complaints, and 54% flu-like complaints. The prevalence of substantial complaints was low: 13% reported musculoskeletal complaints, 5% reported “pseudoneurological”complaints, 4% gastrointestinal complaints, 2% allergic complaints, and 18% flu-like complaints. Women had higher prevalence of musculoskeletal, “pseudoneurological”, and allergic complaints compared with men, and reported more substantial complaints on all subscales. Individuals older than 50 years were less likely to report headache, tiredness, eczema, and fl u-like complaints compared with individuals younger than 30 years. However, they had higher risk of arm pain, shoulder pain, palpitations, and several gastrointestinal and allergic complaints. The intensity of musculoskeletal, gastrointestinal, and allergic complaints was signifi cantly higher in the oldest age group. Conclusions: Subjective health complaints are very common in the normal population; there are gender and age differences in both prevalence and degree of complaints. The intensity of subjective health complaints forms a continuum, and there are no obvious cut-off point to indicate what are “normal” complaints and what is illness.
Article
Objectives: To investigate work-related musculoskeletal discomfort (WMSD) and its association with tasks carried out by commissary foodservice employees in northern Taiwan. Methods: A cross-sectional survey of a convenient sample of 309 commissary employees was conducted at 20 factories from 2002-2003 to collect information on individual's demographic characteristics, work characteristics, and perceived discomfort from work. Results: The study participants frequently used both hands (55.0%) while working. The tasks for most study participants included moving objects (61.2%), packing lunch boxes (56.3%), and cleaning dishes (52.1%). Most study participants used trolleys (62.5%) and spent a lot of time standing (88.7%). Results showed significant WMSD was found from the tasks of packing lunch boxes using the upper arm or the ankle/ feet, moving objects using the forearm, and washing materials using the lower back and waist. Carrying heavy objects for more than 1 minute for each task was associated with an increased risk of 12 body site-specific WMSD, especially for the upper back (OR=16.9) and feet (OR=14.4). Shoulder pain was significantly associated with awkward postures including lifting the hand over the shoulder, twisting the body trunk, and carrying heavy objects for more than 1 minute. Conclusion: Different postures at work may lead to different body site-specific WMSD. Carrying heavy materials was found to be associated with an elevated risk of discomfort in the upper back and feet.
Article
Objectives: To estimate the prevalence and severity of musculoskeletal disorders (MSD) and to assess the relationship between MSD and work movement characteristics in a sample of hotel foodservice employees in Taiwan. Methods: A cross-sectional survey was conducted between January and April in 2001 among a convenient sample of 905 foodservice individuals from 24 hotel restaurants all over Taiwan to collect information on individual's demographic characteristics, daily activities, work movement characteristics, and perceived presence and severity of body part specific MSD. Multiple linear regression models were used to assess the adjusted relationship between work movement frequency and body part specific MSD. Results: Lower back/waist pain was most prevalent (52.6%) among kitchen staff whereas both sanitation and dining room staff suffered mostly from shoulder pain with prevalence rates of 63.4% and 64.3%, respectively. With respect to the severity, the kitchen staff who suffered from MSD had the highest severity score for several body parts including the shoulder, upper arm, upper back, and knee joint. The highest body part specific severity score for the sanitation and dining room staff was the knee joint and ankle/foot, respectively. The multiple linear regression analysis suggested stronger associations for shoulder pain and "frequent bending while moving/lifting heavy objects" or "frequent long-lasting moving/lifting objects"; finger/wrist pain and "continual twisting of the wrist" or "frequently vigorous action of the wrist"; and low back/waist pain and "frequent bending while moving/lifting heavy objects." Conclusions: Our data suggested that the body part specific prevalence rate of MSD was between 21.5% (upper leg) and 58.9% (shoulder) among hotel foodservice workers in Taiwan. The prevalence for lower back/waist pain (54.7%) was second only to shoulder or neck pain in the study participants. Analysis of correlation suggests that moving/lifting heavy objects showed a stronger association with shoulder pain than did any other work movement. On the other hand, lower back/waist pain had a relatively strong association with postures such as stooping.
Article
OBJECTIVES To investigate the effects of physical work load and job experience on morbidity from musculoskeletal disorders among trailer assembly workers. METHODS A longitudinal study was carried out in a trailer assembly factory with many new workers employed during the follow up. The sickness absence of 532 workers (160 experienced and 372 new (separately for the first year of employment and from the second year on)) was followed up. Exposure was assessed by job titles, visits, task descriptions, and some direct measurements. The associations between the explanatory variables and sick leave were assessed by log linear models. RESULTS A higher rate of sick leave due to disorders of the upper limbs was found for new workers compared with experienced ones, especially in the high work load group. Women had a higher rate than men. New male workers in physically strenuous tasks had a high rate of sick leave due to neck and shoulder disorders. CONCLUSIONS As being unaccustomed to work seems to increase the risk of musculoskeletal disorders, special attention should be paid to newly employed workers.
Article
Background: Subjectively reported health complaints account for approximately 50% of all long-term sickness compensation and permanent disability in Northern European countries. The prevalence of these complaints in the population at large was examined. Methods: Data from national surveys conducted in 1993 of 2,030 men and 2,016 women above 15 years of age in Denmark, Finland, Norway, and Sweden were analysed. Results: As many as 75% of our sample had at least some subjective health complaints for the previous 30 days. More than 50% had experienced tiredness, 42% headache, 37% worry, 35% low back pain and 33% pain in their arms or shoulders. The prevalence was higher in women than in men. In general, substantial muscle pain was more common in older subjects, but tiredness, headache, worry and depressive mood were more common in young subjects. Conclusion: The very high prevalence of these complaints in the general population should be taken into account whenever these complaints are reported to be due to any new environmental factor or disease.