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Occupational Medicine Advance Access originally published online on December 13, 2007
Occupational Medicine 2008 58(1):64-70; doi:10.1093/occmed/kqm136
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© The Author 2007. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Musculoskeletal symptoms among seafood production workers in North Norway

Lisbeth Aasmoe1, Berit Bang1, Cathrine Egeness1 and Maja-Lisa Løchen2,3

1 Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
2 Department of Preventive Medicine, Institute of Community Medicine, University of Tromsø, Tromsø, Norway
3 Department of Cardiology, University Hospital of North Norway, Tromsø, Norway

Correspondence to: Lisbeth Aasmoe, Department of Occupational and Environmental Medicine, University Hospital of North Norway, Box 16, N-9019 Tromsø, Norway. Tel: +47 77 62 84 98; fax: +47 77 62 74 71; e-mail: lisbeth.aasmoe{at}unn.no


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Funding
 Conflicts of interest
 References
 
Aims To investigate the prevalence of musculoskeletal complaints among male and female production workers in different types of seafood industries in North Norway and to analyse associations between musculoskeletal symptoms and some possible risk factors in the seafood industry.

Methods A self-administered anonymous questionnaire, covering several aspects concerning occupational environment and health issues, was mailed to employees in seafood-processing plants in North Norway.

Results A total of 1767 employees in 118 seafood-processing plants participated giving a 50% response rate. This included 744 production workers in whitefish, shrimp and salmon industries, and 129 administrative workers in all types of seafood industries. The prevalence of musculoskeletal symptoms was high among seafood production workers. The odds ratio for symptoms from upper limbs was significantly higher for females compared to men. Production workers had the highest relative risk for symptoms from wrist/hands (OR = 4.1–9.4) and elbows (OR = 3.5–5.2) when compared to administrative workers. The main difference between types of seafood industries was the high prevalence of symptoms from wrist/hands among female (82%) and male (64%) production workers in the salmon industry compared to whitefish (62 and 47%, respectively) and shrimp industry (66 and 37%, respectively).

Conclusions Musculoskeletal symptoms were found among the majority of production workers in the whitefish, shrimp and salmon industry, the highest prevalence being among female workers. The main difference between types of seafood industries was the high prevalence of symptoms from wrist/hands among workers in the salmon industry. Cold work was an important risk factor for musculoskeletal symptoms.

Keywords      Cold environment; epidemiology; gender difference; musculoskeletal symptoms; seafood production workers; work related


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Funding
 Conflicts of interest
 References
 
Musculoskeletal pain and diseases are common and frequently cause disability and reduced work capacity. Epidemiological studies of workers have associated these disorders with many work-related physical and psychosocial factors [1,2]. In a recent population-based study, the most frequently reported work-related health problem was musculoskeletal pain [3]. In this study, the estimated work-related fraction of the total prevalence for pain in the neck/shoulder, arms/hands and back was 74, 73 and 49%, respectively.

Seafood workers are exposed to some well-known risk factors for musculoskeletal disorders such as work at high speed, repetitive and monotonous work and a heavy physical workload [2]. Musculoskeletal symptoms and disorders in the seafood-processing industry have been described in a handful of articles previously [4–7]. The prevalence of musculoskeletal symptoms from the upper limbs was higher among seafood workers with a high degree of repetitive movements and sustained forceful movements compared to seafood workers with other type of work [4]. Ergonomic workplace analyses in these industries have shown gender segregation at work tasks. Women were mostly assigned extremely repetitive and short-cycled work tasks, and most of the work tasks for men were less repetitive and some of them were very heavy [5]. The difference in work tasks may in part explain the sex difference in prevalence of musculoskeletal symptoms with almost three times higher prevalences of upper limb complaints among female seafood workers compared to male workers, but no significant differences for symptoms from other body regions [5].

To our knowledge, studies on musculoskeletal symptoms and disorders in the shrimp- and salmon-processing industry have not been published. The first aim of the present study was to examine and compare the prevalence of musculoskeletal symptoms among male and female production workers in different types of seafood industry in North Norway, i.e. whitefish, shrimp and salmon industries. The second aim was to analyse associations between musculoskeletal complaints and some possible risk factors in the seafood industry.


   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 Funding
 Conflicts of interest
 References
 
We carried out a cross-sectional study in a population of workers in the seafood industry in North Norway. A self-administered anonymous questionnaire was mailed to employees in 118 seafood-processing plants in North Norway in December 2000. In addition to sociodemographic data and work characteristics, the questionnaire covered several aspects concerning occupational, environment and health issues [8,9]. Included in the present study were questions on perceived health status, physical activity at work, work in a cold environment and work practices. Under the heading ‘musculoskeletal problems while working’, questions about musculoskeletal symptoms during the last 12 months were included. The participants were asked ‘Have you had any of these symptoms during the last 12 months’. The possible responses were symptoms from neck/shoulder, elbow, wrist, back and leg (including hip, thigh, knee and foot). If the answer was ‘yes’, they were asked if they considered these symptoms to be work related. In addition, they were also asked whether they had experienced musculoskeletal symptoms or musculoskeletal discomfort during different types of work.

In the statistical analysis, age was stratified into four age groups: <30, 30–39, 40–49 and >49 years. Length of employment was stratified into three groups: <2, 2–10 and >10 years. Perceived health status was merged in two groups: poor/not good and good/excellent. The participants were asked if they felt cold at work, the three alternative responses were yes often, sometimes and no never. In the analysis, we compared two groups; yes often and no never.

The Regional Committee for Medical Research Ethics North Norway, University of Tromsø, Norway, and the Norwegian Data Inspectorate approved the study.

The statistical package SPSS® 14.0 (SPSS Inc., Chicago, IL, USA) was used for the analysis. The prevalence is given as valid per cent. Statistical analysis was performed by Pearson chi-square test and logistic regression analysis. Prevalence rates were adjusted for age according to the direct standardization method, based on the distribution among persons answering the questionnaire in this study. The level of statistical significance was set to P-values <0.05 and 0.01.

Multivariate logistic regression analyses were used to examine the association between explanatory variables as type of industry, gender, work practice and cold environment and musculoskeletal symptoms as outcome variables. Possible confounders included as covariates are given in Table 5 and were included regardless of significance in the models. The results are presented as odds ratio (OR), statistical significance and 95% confidence intervals (CIs).


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  		Table 5. ORs and 95% CIs for musculoskeletal symptoms among production workers by types of seafood industry, gender, work experience and cold environment in rows A–D

 

   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 Funding
 Conflicts of interest
 References
 
A total of 3551 employees in 118 seafood-processing plants in North Norway were sent the questionnaire. Altogether, 1767 employees (50%) responded after one reminder. Of the 1767 persons answering the questionnaire, a group of 873 employees in 105 seafood-processing plants was selected on the basis of type of industry, work tasks and completeness of data. Included in the study are 744 production workers in whitefish, shrimp and salmon industries and 129 administrative workers in all types of seafood industries (Table 1). Excluded were small groups of processing workers in other types of industries (processing of herring, other crustaceans and fresh water species), forklift drivers, canteen workers, laboratory workers, technicians and workers with insufficient data on age, gender, work tasks or type of industry.


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  		Table 1. Characteristics of the study population (N = 873)

 
There was a strong division of work tasks based on gender in the seafood industry. Over 50% of women had predominantly sedentary work. In contrast, most men had work characterized by walking and lifting. Despite gender segregation of work tasks, both men and women in all types of seafood industry work at a continuously high speed, and most of the work is repetitive and monotonous, without job rotation. Perceived health status was reported as good/excellent by 60–70% of all participants. The labour turnover in the seafood industry was small, as 40–50% of all workers had been in this industry for >10 years. The mean employment period was ~12 years for production workers and 15 years for administrative workers.

Table 2 shows the age-adjusted 12-month prevalence of symptoms from neck/shoulder, wrist/hands, elbow, back and leg among production workers and administrative workers. The prevalence of most musculoskeletal symptoms was high and higher among production workers compared to administrative workers. The prevalence for most symptoms, except back symptoms, was higher among women compared to men among production workers as well as among administrative workers. The main difference between types of seafood industries was the high prevalence of symptoms from wrist/hand among salmon production workers compared to whitefish and shrimp workers, otherwise there were small differences between production workers in different seafood industries. The prevalence of musculoskeletal symptoms, except from back symptoms, increased with age. The participants were asked if the symptoms were related to work. Among production workers, the reported work-related fraction for musculoskeletal symptoms ranged from 79 to 93%. Among administrative workers, the reported work-related fractions were between 8 and 78%. In both groups, the reported work-related fraction was slightly higher among women compared to men.


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  		Table 2. Age-adjusted 12-month prevalence of musculoskeletal symptoms among production workers and administrative workers according to gender and type of industry

 
Table 3 shows the age-adjusted prevalence of musculoskeletal symptoms/discomfort due to ergonomic risk factors assumed by the workers to cause their musculoskeletal symptoms. Except for precision work, all the listed factors are reported as possible risk factors for musculoskeletal symptoms by 35–89% of the production workers. Precision work is also reported as a possible risk factor, but less frequently. Gender differences were most pronounced in the salmon industry. In the salmon and whitefish industry, 7 of 10 and 5 of 10 risk factors, respectively, were reported as significantly higher risk factors among female compared to male workers. Monotonous, repetitive work, precision work, lifting above shoulder level, awkward position, work at high speed and twist and rotation in hip/knees and wrists were significantly higher ergonomic risk factors for musculoskeletal symptoms/discomfort among female compared to male workers in the salmon industry. In the whitefish industry, the corresponding ergonomic risk factors which were higher among female workers compared to male workers were monotonous, repetitive work, heavy load, work at high speed and twist and rotation in lumbar regions and wrists. The gender difference was less pronounced in the shrimp industry as only heavy load was a significantly higher ergonomic risk factor among female compared to male workers.


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  		Table 3. Age-adjusted prevalence of musculoskeletal symptoms/discomfort among female and male production workers by ergonomic risk factors

 
The musculoskeletal co-morbidity, here defined as having more than one musculoskeletal symptom, was high and significantly higher among female production workers compared to males, as shown in Table 4. There was no difference in co-morbidity between types of seafood industries. Among production workers, 7–9% reported only one symptom in contrast to 17–29% of the administrative workers. The dominating ‘one-single’ symptom was neck/shoulder symptoms among females and neck/shoulder or back symptoms among males.


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  		Table 4. Age-adjusted prevalence of musculoskeletal co-morbidity among female and male production workers and administrative workers in the seafood industry

 
After adjusting for possible confounders, ORs for all types of musculoskeletal symptoms, except for symptoms from leg, were higher for production workers compared to administrative workers as shown in Table 5. The ORs for symptoms from wrist/hand and elbow were high among production workers in all types of seafood industries and highest in the salmon industry. ORs for symptoms from upper limbs, neck/shoulder, wrist/hands and elbow were two to three times higher among female compared to male production workers (Table 5).

There was an increased OR for symptoms from legs only with increasing work experience. A total of 22% of the production workers reported that they often felt cold at work in contrast to 3% among administrative workers. Table 5 shows that feeling cold at work was a strong risk factor for all types of musculoskeletal symptoms among production workers.


   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Funding
 Conflicts of interest
 References
 
Among production workers, the 12-month prevalence of all musculoskeletal symptoms was high and higher among females compared to males. Working as a production worker in this industry is characterized by a high exposure to several ergonomic risk factors assumed to cause musculoskeletal symptoms, as shown in Table 3. We also found a high prevalence of most musculoskeletal symptoms among administrative workers. The relatively high prevalence of musculoskeletal symptoms among administrative workers may in part be explained by the fact that many have worked as production workers earlier and/or they participate in the production when needed, e.g. in periods with sickness absence among production workers.

Most epidemiological studies have shown that the prevalence of most muscular pain conditions is higher in females compared to males [10–12]. Our results indicate that this is also the case in the seafood industry. The major musculoskeletal symptom reported was neck and shoulder pain and corresponds to other studies in the seafood industry [4–6]. Neck/shoulder pain is a known and common consequence of repetitive and monotonous work. There is a long tradition of gender segregation in work tasks in the seafood industry, and most female production workers have highly repetitive and monotonous work, often in the same position and without job rotation. They cut, clean, rinse and pack, normally performing the same work task all day long. Most men have work characterized by walking and lifting. The gender segregation on work tasks may in part explain why female production workers have a higher prevalence of symptoms from the upper limbs compared to males in this study. This gender difference has also been observed in a previous study in the seafood industry [5].

We found that production workers had a higher relative risk for symptoms from wrist/hands and elbows compared to administrative workers. Other studies have also shown high prevalences of symptoms from elbows, wrist and hands among seafood workers [4–7]. The highest OR for wrist/hand symptoms was found in the salmon industry. In the salmon industry, the work is characterized by heavy lifting for both men and women mainly due to the large size of the fish (2–5 kg). Salmon industry work is also characterized by forceful gripping along the production line, in contrast to work in the whitefish and shrimp industry. In addition to forceful grips, some of the workers in the salmon industry also use pneumatic tools as the fish are cleaned by vacuum suction. Carpal tunnel syndrome has been shown to be associated with hand-held vibrating tools as well as prolonged and highly repetitive movements of the wrist, especially in combination with a forceful grip [13]. The prevalence of carpal tunnel syndrome has been shown to be high among fish-processing workers and higher among workers with highly repetitive and sustained forceful movement (29%) compared to workers with less repetitive and sustained forceful movements (8%) [4]. Workers in our study were not asked about specific diseases or diagnoses; however, we suspect that some of the symptoms may be due to carpal tunnel syndrome, especially among salmon workers.

Severity of muscular complaints might be reflected in the number of symptoms reported, as co-morbidity and chronicity of musculoskeletal complaints have been shown to be highly correlated [14,15]. Previous studies have shown musculoskeletal co-morbidity prevalences in office workers, shipyard workers and dentists of 24, 16 and 35%, respectively [14,16]. Among seafood production workers in this study, the co-morbidity was as high as 87 and 80% among females and males, respectively, indicating severe musculoskeletal symptoms. The labour turnover in the seafood industry in our study is low, reflecting that even if workers have severe musculoskeletal problems they continue in work. Most plants are located in rural areas where the options for changing employment are low. Workers are laid off in periods due to production shutdown and therefore have the opportunity to recover. This may in part explain why workers with severe musculoskeletal symptoms continue in work.

This study indicates that work in moderate cold environment is a strong risk factor for all types of musculoskeletal problems. We have previously shown that even if the ambient temperature in the seafood production areas was relatively high, other factors such as differences in air temperatures between head and feet levels, exposure to excessive cold water, lack of shielding from cold areas and high degree of contact with cold seafood products result in a high prevalence of workers feeling cold and increase the risk for musculoskeletal symptoms [17]. Cold work has been shown to be associated with impairment of muscle function, higher prevalence of musculoskeletal symptoms and also an increased risk for carpal tunnel syndrome [18–21]. For this reason, we cannot rule out the possibility of confounding of cold environment on the associations between exposure to ergonomic risk factors and work-related musculoskeletal symptoms.

One limitation in this study is the low response rate of the questionnaire (50%). Self-administered questionnaires tend to be returned by those who perceive the questions as relevant to their own situation. Musculoskeletal symptoms were only a small part of this questionnaire, and therefore bias due to selection of workers with musculoskeletal symptoms is not likely. In North Norway, there are seasonal variations in most fisheries. In periods of high activity, there is a need for extra employees, and many of the seasonal workers are foreign workers. In other periods, most workers are laid off. The questionnaire was sent to each plant and distributed to the workers, and workers laid off at that time therefore did not participate in this study. There is no reason to believe that laid-off workers had a different prevalence of musculoskeletal symptoms than those who responded to the questionnaire. A high percentage of foreign workers at some factories is likely to be a confounding factor. The questionnaire was not translated into other languages because earlier attempts to do so had shown that answers were difficult to interpret. Thus the results are biased in the sense that they reflect only the situation of Norwegian workers, not foreign workers. The results may have shifted in either direction if the foreign part of the workforce had been included. Even if the overall response rate was relatively low, the response among Norwegian workers actually at work and who received the questionnaire was much higher. We therefore believe that the results in our study are representative of the general population of Norwegian workers in the seafood industry in North Norway.

In conclusion, the high prevalence of musculoskeletal symptoms calls for strategies to reduce the burden of workload and monotonous, repetitive work in the seafood industry. The main difference between types of seafood industries was the high prevalence of symptoms from wrist/hands among workers in the salmon industry compared to whitefish and shrimp industry. Further investigations are needed to study the association between symptoms from wrist/hand and carpal tunnel syndrome. Moderate cold exposure was an important risk factor for musculoskeletal symptoms.


Key points
  • Musculoskeletal symptoms were found in the majority of production workers in the whitefish, shrimp and salmon industry.
  • The main difference between types of seafood industries was the high prevalence of symptoms from wrist/hands among workers in the salmon industry compared to other types of industries.
  • An important risk factor for musculoskeletal symptoms was moderate cold exposure.

 


   Funding
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Funding
Conflicts of interest
 References
 
The Confederation of Norwegian Business and Industry's Working Environment Fund, Oslo, Norway (1709).


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Funding
 Conflicts of interest
References
 
None declared.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Funding
 Conflicts of interest
 References
 

  1. Bernard BP, ed. Musculoskeletal Disorders and Workplace Factors. A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. (1997) Cincinnati, OH: National Institute for Occupational Safety and Health, U.S. Department of Health and Human Services.

  2. Barondess JA, ed. Musculoskeletal Disorders and the Workplace (2001) Washington, DC: National Academy of Sciences.

  3. Mehlum IS, Kjuus H, Veiersted KB, Wergeland E. Self-reported work-related health problems from the Oslo Health Study. Occup Med (Lond) (2006) 56:371–379.[CrossRef][Medline]

  4. Chiang HC, Ko YC, Chen SS, Yu HS, Wu TN, Chang PY. Prevalence of shoulder and upper-limb disorders among workers in the fish-processing industry. Scand J Work Environ Health (1993) 19:126–131.[Web of Science][Medline]

  5. Nordander C, Ohlsson K, Balogh I, Rylander L, Pålsson B, Skerfving S. Fish processing work: the impact of two gender dependent exposure profiles on musculoskeletal health. Occup Environ Med (1999) 56:256–264.[Abstract/Free Full Text]

  6. Ólafsdóttir H, Rafnsson V. Musculoskeletal symptoms among women currently and formerly working in fish-filleting plants. Int J Occup Environ Health (2000) 6:44–49.[Medline]

  7. Ohlsson K, Hansson GÅ, Balogh I, et al. Disorders of the neck and upper limbs in women in the fish processing industry. Occup Environ Med (1994) 51:826–832.[Abstract/Free Full Text]

  8. Bang B, Aasmoe L, Aamodt BH, et al. Exposure and airway effects of seafood industry workers in northern Norway. J Occup Environ Med (2005) 47:482–492.[CrossRef][Web of Science][Medline]

  9. Aasmoe L, Bang B, Andorsen GS, Evans R, Gram IT, Løchen ML. Skin symptoms in the seafood-processing industry in north Norway. Contact Dermatitis (2005) 52:102–107.[CrossRef][Web of Science][Medline]

  10. Wijnhoven HAH, deVet HCW, Picavet HSJ. Explaining gender differences in chronic musculoskeletal pain in a general population. Eur J Pain (2006) 124:158–166.

  11. Bingefors K, Isacson D. Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain—a gender perspective. Eur J Pain (2004) 8:435–450.[CrossRef][Web of Science][Medline]

  12. De Zwart BCH, Frings-Dresen MHW, Kilbom Å. Gender differences in upper extremity musculoskeletal complaints in the working population. Int Arch Occup Environ Health (2001) 74:21–30.[CrossRef][Web of Science][Medline]

  13. Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med (Lond) (2007) 57:57–66.[Medline]

  14. Alexopoulos EC, Tanagra D, Konstantinou E, Burdorf A. Musculoskeletal disorders in shipyard industry: prevalence, health care use, and absenteeism. In: BMC Musculoskelet Disord (2006) 24. http://www.biomedcentral.com.

  15. Wijnhoven HAH, deVet HCW, Picavet HSJ. Prevalence of musculoskeletal disorders is systematically higher in women than in men. Clin J Pain (2006) 22:717–724.[CrossRef][Web of Science][Medline]

  16. Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet Disord (2004) 5:16–23.[CrossRef][Medline]

  17. Bang BE, Aasmoe L, Aardal L, et al. Feeling cold at work increases the risk of symptoms from muscles, skin, and airways in seafood industry workers. Am J Ind Med (2005) 47:65–71.[CrossRef][Web of Science][Medline]

  18. Piedrahíta H, Punnett L, Shahnavaz H. Musculoskeletal symptoms in cold exposed and non-cold-exposed workers. Int J Ind Erg (2004) 34:271–278.[CrossRef]

  19. Oksa J, Ducharme MB, Rintamaki H. Combined effect of repetitive work and cold on muscle function and fatigue. J Appl Physiol (2002) 1:356–361.

  20. Pienimakí T. Cold exposure and musculoskeletal disorders and disease. A review. Int J Circumpolar Health (2002) 61:173–182.[Medline]

  21. Niedhammer I, Landre MF, LeClerc A, et al. Shoulder disorders related to work organization and other occupational factors among supermarket cashiers. Int J Occup Environ Health (1998) 4:168–178.[Medline]


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