title: Snap-fits and upper limb functional limitations in German automotive workers.
abstract: BACKGROUND
  The use of snap-fit fasteners in automotive assembly has increased in the last 10 years. Their impact on musculoskeletal function of the upper limbs in assembly workers is not well described.
  
  
  OBJECTIVE
  To investigate the association between snap-fit assembly and upper limb functional limitations (ULFLs) in workers after a large-scale expansion of snap-fit assembly by a German automotive company.
  
  
  METHODS
  Cross-sectional data on blue-collar production workers' exposure to snap-fit assembly and ULFLs were collected from medical check-ups and company registers. The association between duration of snap-fit assembly and ULFLs, and the dose-response relationship between the two were analysed using logistic regression, adjusted for body mass index, gender and employment duration before snap-fit exposure.
  
  
  RESULTS
  The study group included 10722 workers. Within the company, 8.4, 6.9 and 10.3% were exposed to snap-fit 1-12, 13-24 and ≥25 months, respectively. After adjusting for confounders, snap-fit exposure for 1-12 months [odds ratio (OR) = 1.59, 95% confidence interval (CI) 0.88-2.88] and 13-24 months (OR = 1.48, 95% CI 0.76-2.88) was not statistically significantly associated with ULFLs compared with an unexposed group. However, exposure to ≥25 months of snap-fit assembly was statistically significant associated with ULFLs showing >2-fold risk (OR = 2.44, 95% CI 1.52-3.92). No clear dose-response relationship was found.
  
  
  CONCLUSIONS
  Our study suggests a negative long-term impact from snap-fit assembly on workers' upper limb function. Company physicians should be vigilant for signs of upper limb musculoskeletal disorders among workers exposed to snap-fit assembly.
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, 80336 Munich, Germany, johan.ohlander@med.uni-muenchen.de.
authors.forename: J
authors.initials: J
authors.lastname: Ohlander
authors.affiliation: AUDI Gesundheitszentrum, AUDI AG, 85045 Ingolstadt, Germany.
authors.forename: M-C
authors.initials: MC
authors.lastname: Keskin
authors.affiliation: AUDI Gesundheitszentrum, AUDI AG, 85045 Ingolstadt, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Weiler
authors.affiliation: AUDI Gesundheitszentrum, AUDI AG, 85045 Ingolstadt, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Stork
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, 80336 Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Radon
mesh_terms: D000328:Adult; D001336:Automobiles; D003430:Cross-Sectional Studies; D012090:Cumulative Trauma Disorders / Q000209:etiology*; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D066192:Manufacturing Industry; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology* / Q000503:physiopathology; D009784:Occupational Diseases / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects; D009790:Occupations; D016017:Odds Ratio; D013997:Time Factors; D034941:Upper Extremity / Q000293:injuries / Q000503:physiopathology*; D014937:Work
keywords: Assembly methods; blue-collar workers; occupational exposure; upper extremities.