title: Validation of the ACGIH TLV for hand activity level in the OCTOPUS cohort: a two-year longitudinal study of carpal tunnel syndrome.
abstract: OBJECTIVE
  This study aimed to evaluate the risk of musculoskeletal disorders to the hand-wrist system. The American Conference of Governmental Industrial Hygienists (ACGIH) proposed threshold limit values (TLV©) based on hand activity level (HAL) and normalized peak force (PF). We validated ACGIH TLV© in OCTOPUS, a large cohort study on carpal tunnel syndrome (CTS).
  
  
  METHODS
  Industrial and service workers were followed from 2000-2003. We classified subjects with respect to action limit (AL) and TLV. Case definitions were: (i) self-reported symptoms; and (ii) combination of symptoms and positive nerve conduction studies. Poisson regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate incidence rate ratios (IRR) of CTS.
  
  
  RESULTS
  There were 4097 eligible workers. Of these, 236 (5.8%) were non-responders, 2194 (53.6%) had a complete follow-up, 728 (17.8%) were lost after intermediate assessment, and 939 (22.9%) were lost after baseline. Among the 3860 subjects with complete information at baseline, 2599 (67.3%) were women [mean age 38.1 [standard deviation (SD) 9.5] years; mean body mass index (BMI) 23.8 (SD 3.9) kg/m2]. ACGIH TLV© classification predicted both CTS symptoms [IRR between AL and TLV 2.43 [95% confidence interval (95% CI) 1.77-3.33]; above TLV 3.32 (95% CI 2.34-4.72)] and CTS confirmed by nerve conduction studies [IRR between AL and TLV 1.95 (95% CI 1.21-3.16); above TLV 2.70 (95% CI 1.48-4.91)].
  
  
  CONCLUSIONS
  We found a dose-response relationship between ACGIH TLV© classification and risk of CTS. The increased risk observed for workers exposed between AL and TLV suggests that the current AL and TLV might not be sufficiently protective.
authors: UO Medicina del Lavoro, S Orsola-Malpighi University Hospital, Via Pelagio Palagi 9, Bologna, Italy.
authors: Roberta
authors: R
authors: Bonfiglioli
authors: Stefano
authors: S
authors: Mattioli
authors: Thomas J
authors: TJ
authors: Armstrong
authors: Francesca
authors: F
authors: Graziosi
authors: Francesco
authors: F
authors: Marinelli
authors: Andrea
authors: A
authors: Farioli
authors: Francesco S
authors: FS
authors: Violante
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002349:Carpal Tunnel Syndrome / Q000209:etiology*; D005260:Female; D006225:Hand / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D018570:Risk Assessment