Improvements in urban air quality are largely driven by controls on industrial and mobile source emissions, but such factors may have limited influence on many rural environments where biomass combustion (eg, wood stoves) serves as the primary source of fine particulate matter (PM2.5). The authors tracked changes in children's respiratory health during a wood stove intervention in a rural mountain valley community heavily impacted by wood smoke-derived PM2.5.
Community-wide impacts on children's health were assessed by prospectively collecting surveys from parents of school children during four winter periods in Libby, Montana. Generalised estimating equations with a logit link were used to estimate the effect of reduction in ambient PM2.5 on wheeze prevalence and other reported symptoms and infections.
Over 1100 wood stoves were replaced with new lower emission wood stoves or other heating sources. Ambient PM2.5 was 27.6% lower in the winters following the changeout programme compared with baseline winters. There was a 26.7% (95% CI 3.0% to 44.6%) reduced odds of reported wheeze for a 5 μg/m3 decrease in average winter PM2.5. Lower ambient PM2.5 was also associated with reduced odds for reported respiratory infections, including cold (25.4% (95% CI 7.6% to 39.7%)), bronchitis (54.6% (95% CI 24.2% to 72.8%)), influenza (52.3% (95% CI 42.5% to 60.5%)) and throat infection (45.1% (95% CI 29.0% to 57.6%)).
This wood stove intervention provided a unique opportunity to prospectively observe health benefits resulting from a targeted air pollution reduction strategy in a rural community.
Prior investigations identified an association between airborne cadmium and lung cancer but questions remain regarding confounding by arsenic, a well-established lung carcinogen.
A cadmium smelter population exhibiting excess lung cancer was re-analysed using a retrospective exposure assessment for arsenic (As), updated mortality (1940–2002), a revised cadmium (Cd) exposure matrix and improved work history information.
Cumulative exposure metrics for both cadmium and arsenic were strongly associated making estimation of their independent effects difficult. Standardised mortality ratios (SMRs) were modelled with Poisson regression with the contribution of arsenic to lung cancer risk constrained by exposure–response estimates previously reported. The results demonstrate (1) a statistically significant effect of Cd independent of As (SMR=3.2 for 10 mg-year/m3 Cd, p=0.012), (2) a substantial healthy worker effect for lung cancer (for unexposed workers, SMR=0.69) and (3) a large deficit in lung cancer mortality among Hispanic workers (SMR=0.27, p=0.009), known to have low lung cancer rates. A supralinear dose-rate effect was observed (contribution to risk with increasing exposure intensity has declining positive slope). Lung cancer mortality was somewhat better predicted using a cadmium burden metric with a half-life of about 20–25 years.
These findings support an independent effect for cadmium in risk of lung cancer mortality. 1/1000 excess lifetime risk of lung cancer death is predicted from an airborne exposure of about 2.4 μg/m3 Cd.
To evaluate bagasse (sugar cane fibres) and microbiological exposure among sugar cane refinery workers in Costa Rica and its relationships with respiratory, allergy and eye problems.
Ventilatory lung function and total serum IgE were measured in 104 sugar cane workers in five departments at one refinery before the harvesting season, and repeated for 77 of the workers at the end of the season. Information on the prevalence of respiratory and other symptoms was collected with a standardised questionnaire. During the harvesting season, inhalable dust, endotoxin and mould levels were measured among 74 randomly selected sugar cane workers across departments.
During the harvesting season, dust levels were relatively high in some departments, while endotoxin and mould levels were around background levels. Workers' ventilatory lung function differed between departments before, but not during the harvesting season or between seasons. During the harvesting season, the prevalence of wheeze and eye problems almost doubled in workers exposed to bagasse and other types of dust, whereas shortness of breath and rhinitis increased only in bagasse-exposed workers. Reporting wheeze and shortness of breath was positively associated with the number of years working at the refinery, suggesting a long-term health effect.
In this refinery, the differences in workers' ventilatory lung function before the harvesting season are unlikely to be explained by bagasse exposure. However, the increase in reported symptoms (wheeze, shortness of breath, eye problems and rhinitis) over the season is likely due to irritation by dust, in particular bagasse, rather than microbiological agents.
Occupational asthma is the most frequently reported work-related respiratory disease in many countries. It is defined as asthma that is caused by a specific workplace exposure to certain substances and not to factors outside the workplace. In a recent review, the population attributable risk for adult onset asthma being caused by occupational exposures was 17.6%. Occupational asthma can lead to decreased quality of life, sickness absence and increased costs for the patient, the employer and society. Common causes of occupational asthma include exposure to high molecular weight (HMW) agents such as wheat, latex and animal proteins, or to low molecular weight (LMW) agents such as di-isocyanates, acid anhydrides, platinum salts and plicatic acid. There are no systematic reviews of controlled studies of workplace interventions for occupational asthma. Therefore, we conducted a Cochrane systematic review to evaluate the effectiveness of workplace interventions on the outcome of occupational asthma.
We searched...]]>
To investigate whether an evidence-based intervention could reduce the incidence of hand eczema in a cohort of Danish hairdressing apprentices during their training, as hairdressing apprentices are known to have a high risk of developing hand eczema.
This study was a clinically controlled, prospective intervention study. Within 2 weeks of starting their training, 502 hairdressing apprentices were enrolled in the study on occupational hand eczema. Approximately half of the apprentices were assigned to an intervention group and received an evidence-based training program developed for this study and delivered by teachers specially trained in the prevention of hand eczema; the other half received normal training and served as a control group. All apprentices completed self-administered questionnaires including questions regarding hand eczema, use of gloves and degree of wet work, and were all clinically examined for hand eczema three times during the 18-month study period. The three examinations were scheduled as school visits and consisted of a baseline examination and two follow-up examinations approximately 8 and 18 months later.
More apprentices from the intervention group used gloves during wet work procedures and significantly fewer developed hand eczema compared with apprentices from the control group (p=0.04). A logistic regression model showed that atopic dermatitis had a significant influence on the development of hand eczema in the cohort irrespective of the intervention.
We were able to increase the use of gloves and reduce the incidence of hand eczema in hairdressing apprentices by implementing a training program in hairdressing schools.
Studies of workers in two US cohorts of asbestos textile workers exposed to chrysotile (North Carolina (NC) and South Carolina (SC)) found increasing risk of lung cancer mortality with cumulative fibre exposure. However, the risk appeared to increase more steeply in SC, possibly due to differences in study methods. The authors conducted pooled analyses of the cohorts and investigated the exposure-disease relationship using uniform cohort inclusion criteria and statistical methods.
Workers were included after 30 days of employment in a production job during qualifying years, and vital status ascertained through 2003 (2001 for SC). Poisson regression was used to estimate the exposure-response relationship between asbestos and lung cancer, using both exponential and linear relative rate models adjusted for age, sex, race, birth cohort and decade of follow-up.
The cohort included 6136 workers, contributing 218 631 person-years of observation and 3356 deaths. Cumulative exposures at the four study facilities varied considerably. The pooled relative rate for lung cancer, comparing 100 f-yr/ml to 0 f-yr/ml, was 1.11 (95% CI 1.06 to 1.16) for the combined cohort, with different effects in the NC cohort (RR=1.10, 95% CI 1.03 to 1.16) and the SC cohort (RR=1.67, 95% CI 1.44 to 1.93).
Increased rates of lung cancer were significantly associated with cumulative fibre exposure overall and in both the Carolina asbestos-textile cohorts. Previously reported differences in exposure-response between the cohorts do not appear to be related to inclusion criteria or analytical methods.
The objective of this study was to compare the incidence of work-related injury and illness presenting to Ontario emergency departments to the incidence of worker's compensation claims reported to the Ontario Workplace Safety & Insurance Board over the period 2004–2008.
Records of work-related injury were obtained from two administrative data sources in Ontario for the period 2004–2008: workers' compensation lost-time claims (N=435 336) and records of non-scheduled emergency department visits where the main problem was attributed to a work-related exposure (N=707 963). Denominator information required to compute the risk of work injury per 2 000 000 work hours, stratified by age and gender was estimated from labour force surveys conducted by Statistics Canada.
The frequency of emergency department visits for all work-related conditions was approximately 60% greater than the incidence of accepted lost-time compensation claims. When restricted to injuries resulting in fracture or concussion, gender-specific age differences in injury incidence were similar in the two data sources. Between 2004 and 2008, there was a 14.5% reduction in emergency department visits attributed to work-related causes and a 17.8% reduction in lost-time compensation claims. There was evidence that younger workers were more likely than older workers to seek treatment in an emergency department for work-related injury.
In this setting, emergency department records available for the complete population of Ontario residents are a valid source of surveillance information on the incidence of work-related disorders. Occupational health and safety authorities should give priority to incorporating emergency department records in the routine surveillance of the health of workers.
Ferrario et al investigated the effect of occupational class on the incidence of coronary heart disease by a 12-year follow-up study and concluded that higher HRs of coronary heart disease incidence rates were observed in manual workers, professionals and administrators, and self-employed workers compared with non-manual workers adjusted by age.
Occupational workload has been associated with an increased risk of osteoarthritis (OA), but only little research has been conducted among female workers. The objective of this study was to analyse if men and women in farming, construction or healthcare work have increased risk of developing OA of the hip or knee.
A follow-up study based on register data of the whole Danish working population in the period 1981 to 2006 followed up for hip or knee OA during 1996 to 2006. Cumulative years in occupation were calculated for assessment of dose–response relationship. Gender-specific analyses were carried out with Cox regression models using age as timescale and adjusting for calendar period, income, unemployment and previous knee injury, and done separately for hip and knee OA.
Male floor layers and bricklayers and male and female healthcare assistants had the highest risks of knee OA, and farmers had the highest risk of hip OA. Male farmers had increased risk of hip OA already after 1–5 years in occupation (HR, 1.63) and a dose–response-related risk of hip OA (HR up to 4.22). Generally, the risk of OA increased with cumulative years in the occupation in both men and women.
Occupations with heavy physical workload present a strong risk for hip and knee OA in both men and women, and the risks increase with cumulative years in occupation and noticeable hip OA among male farmers.
The aim of this study was to assess cancer incidence in a cohort of woodworkers exposed to softwood dust in a Lithuanian wooden joinery products factory.
The study population consisted of 1518 workers (1080 men and 438 women) employed in the factory for at least 1 year between 1947 and 1996 and living in Lithuania on 1 January 1978, when the follow-up for cancer incidence began. The follow-up period for cancer was 1978–2007. Cancer risk was assessed by standardised incidence ratios (SIR) with reference to the national population.
Overall cancer incidence was not increased among woodworkers. However, the number of mouth and pharynx cancer cases among male woodworkers was significantly increased compared with expected numbers (SIR 2.19, 95% CI 1.17 to 3.74). A higher risk was found for cancer of the buccal cavity than for pharyngeal cancer (SIRs 2.83 and 1.45, respectively). The SIR for larynx cancer was also elevated (SIR 1.39, 95% CI 0.64 to 2.64) among men, while the number of lung cancer cases was higher than expected only among women (SIR 2.07, 95% CI 00.57 to 5.31).
This results of this study support the hypothesis that exposure to softwood dust may increase the risk of oral and pharyngeal cancer. No support was found for an increased risk of other respiratory cancers among workers exposed to softwood dust.
Mergers and acquisitions (M&A) activities are increasing and may negatively affect workers mental health. However, the impact of M&A on the risk of developing a mental disorder, rather than psychiatric symptoms, has not been investigated. The objectives of this study were to estimate and compare the 12-month incidence of depressive and anxiety disorders in workers who had and who had not experienced M&A in the last year.
Employees aged 25 and 64 years old were randomly selected from the community and were followed for 1 year (n=3280). Questions about their experience in M&A in the past 12 months were asked. WHO's Composite International Diagnostic Interview–Auto 2.1 was used to assess depressive and anxiety disorders. The 12-month prevalence and 1-year incidence of mental disorders were estimated and compared in relation to M&A.
Participants who were exposed to M&A had a significant higher 1-year incidence of generalised anxiety disorder (GAD) (6.7%) than the unexposed (2.4%). They were not different in the incidence of major depressive disorder. The exposed participants were 2.8 times more likely to have had a GAD than others and were about 2.4 times more likely to have developed any anxiety disorders over 1 year.
M&A may lead to increased risk of GAD, which may, in return, evolve into major depression. Governments, employers and health professionals should be aware of this and work out plans to reduce the negative health outcomes of M&A.
This study aimed to determine the prevalence of Dupuytren's disease in men and its relationship with work exposure, particularly heavy manual work with and without significant use of vibrating tools, using data from a surveillance program for musculoskeletal disorders.
This cross-sectional study was conducted in France between 2002 and 2005. Dupuytren's disease was diagnosed clinically by one of 83 occupational physicians. Exposure in relation to work status and occupational risk factors was assessed with a self-administered questionnaire, and categorised according to vibration exposure (defined as use of vibrating tools for ≥2 h/day), heavy manual work without vibration exposure (defined as use of hand tools for ≥2 h/day (use of vibrating tools for ≥2 h/day excluded) and Borg scale ≥15/20) and no such exposure. Bivariate and multivariate associations using logistic models were recorded in men and in those with >10 years in the same job.
Of 2161 men, 1.3% (n=27) had Dupuytren's disease (mean age 47.1±6.7 years). Heavy manual work without vibration exposure was significantly associated with the condition (adjusted OR (aOR) 3.9; 95% CI 1.3 to 11.5) adjusted on age and diabetes), as was use of vibrating tools (aOR 5.1; 2.1 to 12.2). These associations remained significant among subjects with >10 years in the same job, with increases in aOR of 6.1 (1.5 to 25.0) and 10.7 (3.4 to 34.6), respectively.
Despite the limited number of cases, occupational exposure, including both vibration exposure and heavy manual work without significant vibration exposure, was associated with Dupuytren's disease.
An immense body of knowledge has been created by establishing various job-exposure matrices (JEMs) to assess occupational exposures in community- and industry-based cohort studies. These JEMs could be made available to occupational epidemiologists using knowledge-sharing technologies, thereby saving considerable amounts of time and money for researchers investigating occupation-related research questions. In this paper, the authors give an example of how a detailed JEM can be easily transformed into a job-specific module (JSM) for use in community-based studies.
OccIDEAS is operationalised as a web-based software, combining the use of JSMs with an individual expert exposure assessment to assess occupational exposures in various industries according to a set of predefined rules. The authors used a JEM focusing on endocrine-disrupting chemicals from a German study on testicular cancer in the automobile industry to create a JSM in OccIDEAS.
The JEM was easily translated into OccIDEAS requiring about 50 h of work by an epidemiologist familiar with the German JEM to learn about the OccIDEAS structure, establish the required set of exposure rules and to translate the JEM into OccIDEAS. Language did not represent an obstacle for translation either. To make the data available in an international context, an interpreter had to translate the German tasks and exposures after they were coded into OccIDEAS.
JEMs which are constructed based on identifying tasks that determine exposure can be easily transformed into a JSM. Occupational epidemiologists are invited to contribute to the international scope of OccIDEAS by providing their previously established JEMs to make existing data on occupational exposures widely available to the epidemiological community.
Paraquat is commonly used worldwide as major herbicide. The objective of this study was to investigate the association among farmers between occupational paraquat exposure and respiratory health effects.
A cross-sectional survey of health effects related to an oil spill was conducted in South Korea from 2008 to 2009. For this analysis, a total of 2882 full-time farmers were selected from the overall sample. Data collection included an interviewer-administered questionnaire and spirometry testing. Logistic regression analysis and linear regression analysis were performed to evaluate the relationship between paraquat exposure and respiratory health outcomes after adjustment for potential confounders.
The risks of self-reported physician-diagnosed asthma, chronic obstructive pulmonary disease and allergic rhinitis were non-significantly increased among paraquat-applying farmers compared with non-paraquat-applying farmers. Although the results of a pulmonary function test fell within normal limits, a decline in forced vital capacity and forced expiratory volume in one second was apparent among paraquat-applying farmers compared with non-paraquat-applying farmers. Forced vital capacity (β=–5.20, p<0.001) and forced expiratory volume in one second (β=–1.89, p=0.010) significantly decreased with each unit increase in years of paraquat application. Paraquat-applying farmers showed a significant exposure–response relationship between restrictive ventilatory defects and paraquat application years (p trend=0.015) or lifetime days of application (p trend=0.007).
Our findings suggest a possible association between paraquat application and adverse respiratory health effects among farmers.
The aim of the study was to investigate if perceived muscular tension predicts future neck–shoulder symptoms and arm–wrist–hand symptoms in symptomfree office workers.
Data were used of a prospective cohort of 1951 office workers with a follow-up duration of 2 years (the Prospective Research On Musculoskeletal disorders among Office workers (PROMO) study). Perceived muscular tension and covariates were measured using self-report at baseline and at 1-year follow-up. Symptoms were assessed every 3 months using self-report. According to their perceived muscular tension, participants were classified into three groups: ‘never tensed’, ‘sometimes tensed’ and ‘often tensed’. Neck–shoulder cases and arm–wrist–hand cases were identified based on the transition of ‘no’ or ‘sometimes’ pain to ‘regular’ or ‘prolonged’ pain. Generalised estimating equations were used to estimate rate ratios (RRs) for becoming a new case.
Perceived muscular tension predicted future neck–shoulder symptoms and arm–wrist–hand symptoms, even when adjusted for symptoms in the past. The RRs for perceived muscular tension in relation to future neck–shoulder symptoms were higher than for future arm–wrist–hand symptoms. Participants who were sometimes or often tensed had a 2.9 and 4.4 times higher risk, respectively, of becoming a future neck–shoulder case than those who were never tensed. For arm–wrist–hand symptoms, the risk of becoming a future case was 1.5 and 2.3, respectively.
Perceived muscular tension predicted future neck–shoulder symptoms and arm–wrist–hand symptoms. Future research should further explore the concept of perceived muscular tension and what role it has in the onset of symptoms in order to make use of it in interventions to prevent symptoms.
We evaluated costs for workers' compensation (WC) injuries of a musculoskeletal (MS) nature in a large tertiary care hospital and an affiliated community hospital in the 13 years surrounding an institution-wide shift to a ‘minimal manual patient-lifting environment’ supported with inpatient mechanical lift equipment.
Negative binomial regression was used to model adjusted and discounted payment rates based on full-time equivalents (FTEs), and payment ratios. The risk of higher cost was assessed based on type of injury (patient-handling vs non-patient-handling), hospital, job, age, gender, institutional tenure and time since the implementation of lift equipment. Lagging was used to evaluate the latency of the intervention effect.
Patient-handling injuries (n=1543) were responsible for 72% of MS injuries and 53% of compensation costs among patient care staff. Mean costs per claim were 5 times higher for those over age 45 than those <25 years of age. Physical and occupational therapy aides had the highest cost rates ($578/FTE) followed by nursing aides ($347/FTE) and patient transporters ($185/FTE). There was an immediate, marked decline in mean costs per claim and costs per FTE following the policy change and delivery of lift equipment.
The observed patterns of changes in cost likely reflect the effects of activities other than use of lift equipment, including targeted efforts to close WC claims and an almost simultaneous policy that shifted cost responsibility to the budgets of managers on individual units. Inference was facilitated through the use of longitudinal data on the workgroups and an internal injury comparison.
Vaccinating healthcare workers (HCWs) against influenza is one of the most important methods of decreasing influenza transmission among at-risk patients in healthcare facilities. However, despite recommendations, the rate of uptake of influenza vaccine among HCWs remains low. The objective of this meta-analysis was to determine the most important predictors of seasonal influenza vaccine acceptance among HCWs in hospitals.
A literature search of PubMed and Embase resulted in 4586 hits. Screening of the titles, abstracts and full text identified 13 studies eligible for inclusion in the meta-analysis. Based on the crude data, pooled risk ratios (Mantel-Haenszel risk ratios, mhRR) and their 95% CIs were calculated using Mantel-Haenszel analysis to estimate the associations of predictors with influenza vaccination status.
Knowing that the vaccine is effective (mhRR 2.22; 95% CI 1.93 to 2.54), being willing to prevent influenza transmission (mhRR 2.31; 95% CI 1.97 to 2.70), believing that influenza is highly contagious (RR 2.25; 95% CI 1.66 to 3.05), believing that influenza prevention is important (mhRR 3.63; 95% CI 2.87 to 4.59) and having a family that is usually vaccinated (RR 2.32; 95% CI 1.64 to 3.28) were statistically significantly associated with a twofold higher vaccine uptake. We therefore recommend targeting these predictors when developing new influenza vaccination implementation strategies for hospital HCWs.
Idiopathic oSCC is not uncommon, but when it occurs in a husband and wife who worked in, and lived above, their own dry cleaning business, an active dry cleaning agent must be considered as the potential aetiological factor.
A 65-year-old man presented with a 6-month history of dyspepsia and epigastric pain without dysphagia or weight loss. He owned a dry cleaning shop and lived in the same premises for 30 years. He smoked a pipe for 35 years. Upper gastrointestinal endoscopy showed an oesophageal tumour at 33 cm, and staging CT confirmed lower oesophageal tumour without evidence of lymphadenopathy or distant metastasis. He underwent transhiatal oesophagectomy and the final...]]>
We report the case of a 44-year-old man who has been working as a mechanic for 19 years. He presented with chronic eczema on his hands and forearms, which first appeared 3 years ago. His personal and family history was negative for skin diseases and atopy.
The patient had several eczematous and lichenificated patches with intense itching on the dorsum of the hands, flexor surface of wrists and forearms (
The aim of the study was to estimate associations between aerobic fitness among men at age 18–19 years and work absence due to musculoskeletal sickness 5–15 years later.
All 321 975 men born between 1967 and 1976 in Norway were identified and followed up in several national registers. Men who completed an aerobic fitness test at military conscription during 1985–1995 (N=227 201) were followed from 2000 through 2003 with respect to a first musculoskeletal absence. Cox regression was conducted to estimate HRs between aerobic fitness (high, medium, poor) and musculoskeletal absence.
A total of 26 061 men had a musculoskeletal absence (absolute risk 0.115). Absence was associated with fitness level. Associations were confounded by other conscript characteristics (intellectual capacity, body mass index, musculoskeletal condition) and parental education level and were restricted to non-injury absence. With high fitness as reference, the adjusted non-injury HR estimates were 1.18 (95% CI 1.12 to 1.24) and 1.39 (1.31 to 1.47) for medium and poor fitness, respectively. Poor fitness men were more likely to achieve low educational attainment and employment in high-absence industries and enterprises. The impact of intellectual capacity and parental education level on absence was considerably larger than the effect from fitness. A subset analysis with fitness data of better quality yielded moderately stronger associations.
Aerobic fitness among conscripts was moderately associated with non-injury musculoskeletal absence 5–15 years later. However, the overall impact of intellectual capacity and parental education appears to be greater than that of aerobic fitness.
To assess whether experts can provide high-quality answers to occupational safety and health (OSH) questions in online Question & Answer (Q&A) networks.
The authors evaluated the quality of answers provided by qualified experts in two Dutch online networks: ArboAntwoord and the Helpdesk of the Netherlands Center for Occupational Diseases. A random sample of 594 answers was independently evaluated by two raters using nine answer quality criteria. An additional criterion, the agreement of answers with the best available evidence, was explored by peer review of a sample of 42 answers. Reviewers performed an evidence search in Medline.
The median answer quality score of ArboAntwoord (N=295) and the Netherlands Center for Occupational Diseases Helpdesk (N=299) was 8 of 9 (IQR 2). The inter-rater reliability of the first nine quality criteria was high ( 0.82 –0.90, p<0.05). A question answered by two or more experts had a greater probability of a high-quality score than questions answered by one expert (OR 4.9, 95% CI 2.7 to 9.0). Answers most often scored insufficient on the use of evidence to underpin the answer (36% and 38% for the networks, respectively) and on conciseness (35% and 31%, respectively). Peer review demonstrated that 43%–72% of the answers in both online networks were in complete agreement with the best available evidence.
OSH experts are able to provide quality answers in online OSH Q&A networks. Our answer quality appraisal instrument was feasible and provided information on how to improve answer quality.
To evaluate the role of physical workload in low back pain (LBP) among adolescents.
Working history and physical workload factors at 18 years were assessed for 1984 members of the Northern Finland Birth Cohort 1986. The associations between work characteristics and LBP were analysed by multinomial logistic regression. Those with and without LBP at 18 years of age were compared in two subsamples. The incidence of LBP was studied among the 986 subjects without LBP at 16 years of age. Persistence of LBP was studied among the 728 subjects with LBP at 16 years of age. Latent class analysis (LCA) was used to form natural clusters of workload factors and their associations with LBP were investigated using log-binomial regression.
753 (75%) subjects without LBP at 16 years of age had been working during the 2-year follow-up period. The average duration of work was 6.2 months. In adolescent girls, working regularly or irregularly and duration of work exposure were associated with incident LBP. Of specific physical workload factors, only awkward trunk postures were associated with incident LBP in both genders (RR 1.2 in girls and 1.7 in boys). The work exposure patterns in adolescent girls and boys were different. In the LCA, subjects in a cluster with high exposure to awkward trunk postures or an overall physically demanding job had a higher likelihood of incident LBP in both genders (RR 1.3–1.9). None of the specific workload factors or clusters was associated with persistent LBP.
Physical workload factors constitute a risk for LBP even in adolescents.
Previous studies on the effects of angiotensinogen (AGT) gene polymorphisms and chronic exposure to occupational noise on the risk of hypertension have mainly been cross-sectional or prevalent case–control studies, where temporality constitutes problems. The present study was to assess longitudinally both independent and joint effects of AGT gene polymorphisms and chronic exposure to occupational noise on occurrence of hypertension.
The authors conducted a 20-year prospective cohort study of 1301 aviation workers in Taiwan. The study population included 912 workers without hypertension at baseline. The outcome of interest was the development of hypertension during the study period. The studied determinants were three AGT genotypes (TT, TM and MM) and four exposure categories according to the levels of noise representing high (>80 dBA), medium (80–65 dBA), low exposure (64–50 dBA) and the reference level (49–40 dBA).
In Poisson regression adjusting for confounders, AGT (TT vs MM adjusted incidence rate ratio (IRR) 1.77, 95% CI 1.24 to 2.51) and noise exposure (high and medium combined) during 3–15 years (adjusted IRR 2.35, 95% CI 1.42 to 3.88) were independent determinants of hypertension. Furthermore, the risk of hypertension increased with noise exposure (adjusted IRR 3.73, 95% CI 1.84 to 7.56) among TT homozygotes but not among those with at least one M allele (Rothman synergy index=1.05).
The results evidence further the independent effects of AGT gene polymorphisms and exposure to occupational noise. Our finding also suggests that workers carrying TT variant allele have higher risk of hypertension under chronic exposure to occupational noise.
Elevated ozone levels have been associated with cardiovascular morbidity and mortality. We investigated the effects of ozone on heart rate (HR) and repolarisation parameters in potentially susceptible populations.
Between March 2007 and December 2008, 363 ECG recordings including >2000 1 h intervals were measured in 64 individuals with type 2 diabetes or impaired glucose tolerance and in 46 healthy individuals with a potential genetic predisposition on the detoxification pathways from Augsburg, Germany. Associations between 1 h averages of ozone and HR, Bazett-corrected QT-interval (QTc), T-wave amplitude and T-wave complexity were analysed using additive mixed models. A variable indicating season and participants' location during the 1 h ECG recordings (summer and outdoors vs winter or indoors) was used as a potential ozone effect modifier.
We observed concurrent and 1–4 h lagged increases in HR of 0.5–0.7% for each 20 μg/m3 increase in ozone. These effects were stronger (1.0–1.2%) when participants were outdoors during the summer. We detected in all participants a concurrent (–1.31%; 95% CI –2.19% to –0.42%) and 1 h lagged (–1.32%; –2.19% to –0.45%) T-wave flattening. Elevated ozone levels were associated with 1 h (2.12%; 0.81 to 3.52) and 2 h lagged (1.89%; 0.55% to 3.26%) increases in T-wave complexity. However, no effects were seen for QTc. Ozone effects were generally more pronounced in individuals with metabolic disorders than a potential genetic predisposition.
Changes in repolarisation might contribute to underlying pathophysiological changes associated with the link between elevated ozone levels and reported adverse cardiovascular outcomes.
To compare the hearing of gold miners with and without tuberculosis (TB) to determine the effect of TB and its associated risk profile on hearing.
Audiological and medical surveillance data of 2698 South African gold miners for 2001–2009 were analysed in a retrospective cohort design. Hearing thresholds for the air conduction frequencies (0.5, 1, 2, 3, 4, 6, 8 kHz) in both ears were analysed together with biographical and occupational data. Subjects were divided into two experimental (single TB treatment, n=911 and multiple TB treatment, n=376) and one control group (n=1411). Comparisons between groups included (1) change from baseline to most recent audiogram, (2) most recent hearing thresholds and (3) most recent thresholds in a subset of noise exposed and unexposed groups.
Hearing thresholds for the TB groups were significantly (p<0.01) elevated compared to the control group, after correcting for time between baseline and most recent audiogram, threshold at baseline and age at test. Pair-wise comparisons demonstrated the largest threshold differences between the control and multiple TB group. Changes in mean thresholds across TB treatment groups were independent of noise exposure. Hearing thresholds over time also deteriorated significantly more (p<0.01) in workers with TB (single and multiple treatment) than in workers without TB.
Gold miners with TB, especially with more than one episode of TB, demonstrate significantly poorer hearing thresholds and more pronounced decline in hearing over time independent of noise exposure. The exact cause is likely a complex interaction between TB, including treatment, and its associated risk profile.
To explore the relationship between stomach cancer (SC), by histological type, and occupations and occupational exposures.
The authors conducted a hospital-based case–control study in south-east Spain. Subjects were 399 incident histological confirmed SC cases (241 intestinal and 109 diffuse adenocarcinomas) and 455 controls frequency matched by sex, age and province of residence. Occupation was coded according to the Spanish National Classification of Occupations 1994. Occupational exposures were assessed by the FINJEM Job Exposure Matrix. ORs were estimated by unconditional logistic regression adjusting for matching variables and education, smoking, alcohol and diet.
In men, statistically significant increased risk of the diffuse subtype was found for ‘cooks’ (OR 8.02), ‘wood-processing-plant operators’ (OR 8.13) and ‘food and related products machine operators’ (OR 5.40); for the intestinal subtype, a borderline association was found for ‘miners and quarry workers’ (OR men 4.22, 95% CI 0.80 to 22.14). Significant increased risk was observed between the diffuse subtype of SC and the highest level of exposure to ‘pesticides’ (ORH both sexes 10.39, 95% CI 2.51 to 43.02, ptrend=0.02) and between the intestinal subtype and asbestos (ORH men 3.71, 95% CI 1.40 to 9.83, ptrend=0.07). Restricted analyses of exposures of 15 years and longer showed significant associations between the diffuse subtype and the exposure to ‘wood dust’ (OR men 3.05).
This study supports the relationship previously suggested between SC and occupational exposure to dusty and high temperature environments. Several occupations may also increase the risk of diffuse SC but not the intestinal subtype.
Exposure to silica dust may cause inflammatory responses, primarily in the lungs, although systemic effects have also been reported. Alveolar inflammation can be demonstrated by increased alveolar concentration of nitric oxide (NO), but information on the effects of silica dust on exhaled NO is sparse. Inflammatory mediators including cytokines are known to take part in silica-induced processes, but the role of adipokines has not been studied previously.
The aim of the study was to investigate the pulmonary and systemic inflammatory responses to occupational exposure to silica dust.
The authors examined 94 silica-exposed workers and 35 healthy volunteers. The authors also measured alveolar NO concentration, bronchial NO flux and the plasma levels of proinflammatory cytokines, interleukin (IL)-6 and IL-8, and the adipokines, adipsin, leptin, adiponectin and resistin.
After adjusting for age, body mass index and pack-years of tobacco smoking, silica exposure was associated with significantly higher levels of alveolar NO (p=0.001), indicating inflammatory effects of silica in the peripheral lung. In addition, increased plasma concentrations of IL-6, adiponectin, adipsin and resistin were significantly associated with silica exposure (p=0.002, p=0.034, p<0.001 and p=0.048, respectively).
In conclusion, measurement of alveolar NO concentration and plasma cytokine and adipokine levels seems to offer a modern means to demonstrate the inflammatory effects of exposure to silica. These measures might be useful in finding subjects with a significant immune response to silica particles and thus at higher risk of developing silicosis or other immunological diseases associated with exposure to silica, but further research is needed.
We questioned 100 patients with UCC for occupational task and smoking history. Our institute is the regional tertiary referral centre for pelvic oncology and serves a...]]>
I invite readers for a discussion about the nature of the many alleged cases of CTS in this and other studies. I question the applied diagnostic criteria and suspect ailments other than CTS in some workers and that inaccurate diagnostics may affect their future health.
A previous study of CTS demonstrated a striking discrepancy between the symptoms, physical findings and electrophysiological abnormalities.
The case definition
Undergraduate medical teaching in occupational health (OH) is a challenge in universities around the world. Case-based e-learning with an attractive clinical context could improve the attitude of medical students towards OH. The study question is whether case-based e-learning for medical students is more effective in improving knowledge, satisfaction and a positive attitude towards OH than non-case-based textbook learning.
Participants, 141 second year medical students, were randomised to either case-based e-learning or text-based learning. Outcome measures were knowledge, satisfaction and attitude towards OH, measured at baseline, directly after the intervention, after 1 week and at 3-month follow-up.
Of the 141 participants, 130 (92%) completed the questionnaires at short-term follow-up and 41 (29%) at 3-month follow-up. At short-term follow-up, intervention and control groups did not show a significant difference in knowledge nor satisfaction but attitude towards OH was significantly more negative in the intervention group (F=4.041, p=0.047). At 3-month follow-up, there were no significant differences between intervention and control groups for knowledge, satisfaction and attitude.
We found a significant decrease in favourable attitude during the internship in the experimental group compared with the control group. There were no significant differences in knowledge or satisfaction between case-based e-learning and text-based learning. The attitude towards OH should be further investigated as an outcome of educational programmes.
This systematic review informed evidence-based guidelines for the management of occupational dermatitis, with a particular focus on healthcare workers.
A multidisciplinary guideline group formulated questions about the management of healthcare workers with dermatitis. Keywords derived from these questions were used in literature searches. We appraised papers and developed recommendations using the Scottish Intercollegiate Guideline Network (SIGN) methodology.
Literature searches identified 1677 papers; 11 met the quality standard (SIGN grading ++ or +). A small body of evidence indicated that dermatitis is more likely to be colonised with micro-organisms than normal skin, but there was insufficient evidence about the risk of transmission to patients. There was limited evidence that using alcohol gel for hand decontamination is less damaging to skin than antiseptics or soap. A small body of evidence showed that conditioning creams improve dermatitis, but are not more effective than their inactive vehicle. A small inconsistent body of evidence showed that workplace skin care programmes improve dermatitis.
Healthcare workers should seek early treatment for dermatitis and should be advised about the risk of bacterial colonisation. Work adjustments should be considered for those with severe or acute dermatitis who work with patients at high risk of hospital-acquired infection. Healthcare workers with dermatitis should follow skin care programmes, and use alcohol gel where appropriate for hand decontamination. Further research should explore whether healthcare workers with dermatitis are more likely to transmit infection to their patients, and whether health surveillance is effective at reducing dermatitis.
Although all truck drivers spend a substantial part of their working day behind the wheel, they are not a homogeneous group as the remaining tasks can differ enormously from one driver to another. Hence, it is useful to...]]>
The objectives this study were (1) to investigate correlations between measures of psychosocial workplace stress as measured in separate years by the Job Content Questionnaire (JCQ) and Effort–Reward Imbalance (ERI) scales; (2) to establish a valid measure of psychosocial job stress with its components (by identifying the individual and interactive associations of job stress components) and (3) to use the component measures to assess the risk of psychosocial strain at work on fatigue.
The JCQ and ERI from the annual survey of the GAZEL cohort established in 1989 initially with 20 624 respondents were used to investigate the associations of workplace stress on mental and physical fatigue in two separate years (1998 and 2006). First, the JCQ measures from separate years (1997 and 1999) were combined to create a measure for the same year as ERI (1998). The new measure was validated for internal and external consistency. Using logistic regression, the subcomponents of stress (upper tertiles of psychological demands, physical demands, decision latitude, social support, effort, reward, ERI and overcommitment) were tested for associations with the highest reporting of mental and physical fatigue.
By combining JCQ responses from 1997 to 1999, we were able to increase the amount of information available on psychosocial factors in 1998. Psychometric properties of the workplace stress scales also showed expected factor loadings. Workplace psychosocial factors had greater associations with fatigue among men than women. Although psychosocial factors became less predictive of fatigue at 8 years of follow-up, associations between fatigue and psychosocial components (overcommitment, social support and rewards) remained significant.
These analyses continue to validate the various subcomponents scales of workplace stress as measured by the JCQ and effort–reward imbalance model in GAZEL. They also highlight the importance of psychosocial work factors in the experience of overall fatigue even after an 8-year follow-up.