Occupational and Environmental Medicine最新文献

Objectives: This study examines work participation (WP) and disability pension (DP) among patients diagnosed with post-traumatic stress disorder (PTSD) at Danish Departments of Occupational Medicine. The aim was to identify WP trajectories and determine whether occupation is associated with poor labour market attachment.

Methods: A nationwide longitudinal study was conducted on register data from patients diagnosed with PTSD at Departments of Occupational Medicine in Denmark from 2000 to 2015. WP was operationalised as a score (WPS, Work Participation Score) derived from the proportion of weeks in employment relative to the possible number of work weeks per year. WPS is dichotomised as low (≤75%) or high (>75%). Group-based trajectory models were used to identify patterns of WP. Logistic regression was used to investigate the effect of occupation on WPS and DP.

Results: Among 1187 patients, 58% had low WPS and 43% entered DP after 3 years. Three trajectories were identified from prediagnosis to postdiagnosis: sustained low WPS (12.5%), shift from high to low WPS (50.7%) and near-full recovery (36.8%). Patients in the occupations 'plant and machine operator and assemblers' (OR=3.25; 95% CI: 1.28 to 8.23) and 'prison guards' (OR=2.50; 95% CI: 1.23 to 5.08) had higher odds of low WPS, but only 'prison guards' (OR=1.84; 95% CI: 0.97 to 3.49) had potentially higher odds of receiving DP after 3 years.

Conclusions: Work-related PTSD is associated with a high risk of low WPS after 3 years. Specific occupations are associated with poorer labour market attachment, underscoring the need for prevention and recovery interventions.

Trial registration number: NCT04459793.

Objective: This study investigates the effect of three crosswalk methods of the Diesel Exhaust in Canada Job-Exposure Matrix (DEC-JEM) on lung cancer risk among Ontario workers.

Methods: Ontario workers (2 364 427 identified through workers' compensation claims (1983-2019)) were followed for cancer diagnoses through linkage with the Ontario Cancer Registry (1964-2019). DEC-JEM is coded in North American Industry Classification System 2002 and National Occupation Classification-Statistics 2006 as an industry-occupation intersection structure, while the cohort is coded in Standard Industry Classification (SIC) 1970 and Canadian Classification and Dictionary of Occupations (CCDO). Three different methods were used to crosswalk. Cox-proportional hazards models of lung cancer were used to estimate HRs and 95% CIs, adjusted for age, birth year and sex. Results were validated against the CANadian Job-Exposure Matrix (CANJEM), coded directly into SIC1970-CCDO intersections.

Results: DEC-JEM₂ and DEC-JEM₃ had similar case counts and exposure distributions for each exposure level and threshold, notably lower than DEC-JEM₁. Increased lung cancer risk was observed using all methods. Differences in risk between methods were most noticeable at higher exposure levels, while little difference was observed among low exposed groups. DEC-JEM₃ had the highest risk. Risks mostly differed between DEC-JEM and CANJEM, particularly higher exposure levels (high, very high).

Conclusions: Crosswalk decisions can change a JEM's exposure distribution, determine which cases get classified as exposed and influence disease risk estimates. Future crosswalks should consider unexposed matches and a weighted average exposure for one-to-multiple matches. This study's crosswalk methods provide opportunities to save resources while improving exposure assessment.

Objectives: To support occupational physicians (OPs) in the execution of preventive tasks, a peer coaching intervention was developed and implemented in existing peer groups. The aim of this study was to examine the effects of the intervention on OPs' execution of preventive tasks in practice.

Methods: A total of 41 peer groups, including 231 OPs, participated in this cluster randomised controlled trial, of which 21 groups were assigned to the intervention group (N=106) and 20 to the control group (N=125). The intervention consisted of three peer coaching meetings aimed to promote the execution of preventive tasks. Data regarding the execution of preventive tasks, measured as percentage of their working time and hours allocated to specific preventive tasks, were collected at baseline, 6-month and 12-month follow-up. The effect of the intervention was examined by linear multilevel analysis.

Results: Both the intervention and control group increased the percentage of working time allocated to prevention, from 14% at baseline to 17% at 12-month follow-up, but no significant differences between the study groups were found. For specific preventive tasks, the intervention group increased their time allocated to giving secondary prevention advice by 5 monthly hours compared with baseline.

Conclusions: The intervention was found not to have an effect on the percentage of working time allocated to prevention, possibly due to contextual factors. However, intervention effects were found for giving secondary preventive advice. Future studies should focus on the willingness of employers and occupational health and safety to invest in prevention and refinement of the intervention under study.

Trial registration number: ISRCTN15394765.

Objectives: Lead poisoning is a public health concern, particularly for workers in high-risk industries like fishnet sinker manufacturing. This study evaluated the impact of safety interventions based on the Theory of Planned Behaviour (TPB) on safety behaviours and blood lead levels (BLLs) of fishnet sinker workers in Thailand.

Methods: A 6-month quasi-experimental study was conducted in two fishing-net sinker manufacturing villages in Nakhon Si Thammarat, southern Thailand, involving 60 workers assigned to an intervention group (n=30) or a control group (n=30). The intervention promoted protective behaviours such as hand washing, wearing masks, changing clothes after work, washing work clothes separately and cleaning work areas with a wet towel. Behavioural changes were assessed using TPB constructs, and a structural equation model was used to validate their relationships with behaviours. Lead surface contamination and BLLs were measured before and after the intervention.

Results: After 6 months, the intervention group demonstrated significant improvements in self-reported safety behaviours. Median lead surface contamination remained unchanged (-1.9 µg/100 cm², p=0.918) and mean BLLs were maintained at preintervention levels (+0.6 µg/dL, p=0.431). In contrast, the control group showed no significant improvement in safety behaviours, experienced a notable increase in mean BLLs (+2.7 µg/dL, p=0.003) and had no significant change in lead surface contamination (+6.9 µg/100 cm², p=0.229).

Conclusions: The findings suggest that TPB-based interventions improve safety behaviours and prevent further increases in occupational lead exposure. These low-cost, resource-based strategies show potential for adaptation in similar high-risk industries, contributing to workplace safety and public health protection.

Objectives: To identify factors associated with an increased risk of low back pain (LBP)-related sick leave and to develop prognostic models for both the likelihood and duration of such leave.

Methods: A total of 7262 actively working adults were recruited consecutively during their annual check-ups. Seventy-seven variables were assessed, including sociodemographic, clinical, work-related, LBP-related and psychosocial factors. Outcomes included the occurrence of LBP-related sick leave and the number of days on leave over an 18-month follow-up period. Multivariable prognostic models were developed RESULTS: During the follow-up, 535 participants (7.4%, 95% CI 6.8 to 8.0) took LBP-related sick leave, of whom 162 were off work for ≥30 days. Predictors of taking sick leave were older age, not being self-employed, a usual LBP episode duration >14 days, higher job insecurity, greater self-expectations of taking sick leave and stronger perceived economic consequences of being on leave. Predictors of longer sick leave (≥ 30 days) were not being self-employed and experiencing LBP while in bed. The models demonstrated good calibration but poor discrimination (C-statistics: 0.607 and 0.604).

Conclusion: Predicting LBP-related sick leave and its duration among the general Spanish workforce remains challenging. Psychosocial and economic variables outweigh clinical or biological predictors. Self-employment is the only factor associated with a lower risk of both sick leave and being off work for ≥30 days.

Trial registration number: NCT00667316.

Objectives: Despite reducing exposures to wood dust, woodworkers remain at increased risk of asthma. There have been no recent studies of wood dust exposure, respiratory symptoms or asthma in British woodworkers. This cross-sectional study examined factors associated with asthma in British woodworkers across exposure groups.

Methods: Participants answered a reporter-delivered work and respiratory questionnaire, and underwent fractional exhaled nitric oxide (FE_NO), spirometry and specific IgE measurements. Wood dust exposure was assigned through a job-exposure matrix. Multiple regression evaluated associations between asthma and factors including exposure, atopy and current asthma symptoms (CAS).

Results: A total of 269 woodworkers participated. Median wood dust exposure was 2.00 mg/m³ (IQR 1.14 mg/m³). CAS, work-related respiratory symptoms (WRRS) and eosinophilic airway inflammation (FE_NO>40 ppb) were common, present in 46%, 11% and 19% of the cohort, respectively. Atopic woodworkers were more likely to have nasal symptoms (OR 2.13, 95% CI 1.18 to 3.85, p<0.05), WRRS (OR 2.78, 95% CI 1.11 to 6.92, p<0.05), asthma (OR 3.40, 95% CI 1.49 to 7.81, p<0.01) and FE_NO>40 ppb (OR 2.00, 95% CI 1.03 to 3.88, p<0.05). No effect was seen for airflow obstruction. Symptomatic workers were more likely to have WRRS and asthma (OR 4.29, 95% CI 2.12 to 8.69, p<0.001) but not FE_NO>40 ppb or airflow obstruction. A dose-response effect with wood dust exposure was not seen.

Conclusions: Asthma symptoms were prevalent among British woodworkers, even at low exposure levels. Atopy was associated with asthma, particularly among symptomatic woodworkers. Further studies should phenotype woodworkers at risk of asthma and inform approaches to reduce risk.

Objectives: Using consecutive waves of a Danish nationwide survey, we investigated in a quasi-experimental design whether changes in positive leadership behaviours were associated with subsequent changes in depressive symptoms and risk of antidepressant treatment.

Methods: Sample 1 consisted of 6062 workers participating in 2012, 2014 and 2016. Sample 2 consisted of 15 619 workers participating in either 2012-2014 or 2016-2018. We measured leadership behaviours by an eight-item scale and depressive symptoms by the Major Depression Inventory (MDI) and linked register data on purchase of antidepressants. Using linear and logistic regression, we adjusted for covariates and estimated the association between changing levels of leadership behaviours and subsequent depressive symptoms and onset of antidepressant treatment.

Results: In sample 1, changing from high to low levels of exposure to positive leadership behaviours from 2012 to 2014 was associated with a higher MDI score in 2016 (sample 1, regression coefficient: 1.12, 95% CI 0.68 to 1.56), whereas changing from low to high levels was associated with a lower MDI score (-1.84, 95% CI -2.51 to -1.17). In sample 2, ORs for antidepressant treatment ranged from 1.06 to 1.21 with wide CIs that included unity.

Conclusions: This study suggests that a decrease in positive leadership behaviours has a hazardous effect on workers' level of depressive symptoms, whereas an increase has a beneficial effect. There were no clear associations with antidepressant treatment.

Several studies have synthesised the health impacts of occupational heat exposure, yet previous reviews were limited in scope and only focused on specific diseases, high-risk industries or selected countries. This scoping review aimed to summarise global epidemiological evidence on health outcomes associated with occupational heat exposure, examine factors that may modify heat-health associations among workers and identify knowledge gaps to inform the development of more effective jurisdiction-specific heat policies.A search strategy reflecting heat, worker and health was applied to Ovid MEDLINE, Ovid EMBASE, CINAHL and Web of Science, and grey literature of EuropePMC, ProQuest and SafetyLit, to retrieve studies investigating associations between occupational heat exposure and illness and injury. Studies were independently reviewed by two reviewers to assess eligibility. A narrative synthesis approach was used to compare, contrast and synthesise the most relevant findings.This review included 92 studies that estimated associations between heat and various health outcomes, including workplace illness and injury, heat-related illness and deaths, kidney diseases, cardiovascular diseases, cancer, abnormal bone mineral density, skin diseases, eye diseases, infertility and mortality. The included studies presented conflicting evidence on heat-health associations: some observed stronger risks with rising temperatures, some observed smaller positive or reduced risks at extreme temperatures and others reported no associations. The discrepancies may be explained by differences in heat measurements and outcome ascertainments, methodological limitations, geographical variations and the varying impacts of demographic, work-related and individual factors.Jurisdiction-specific heat policies are needed to protect workers from acute and chronic health conditions.

Objectives: Over 600 UK Armed Forces personnel and civilians were seriously injured in the conflict in Afghanistan. We examined whether combat injury, and limb loss specifically, reduced the likelihood of employment after leaving the UK Armed Forces and to what extent this was mediated by pain and mobility.

Methods: Combat-injured participants who were aeromedically evacuated to a UK hospital while on deployment to Afghanistan and subsequently left the UK Armed Forces (n=406) and a comparison group of uninjured personnel who had left the military (n=107) were drawn from an existing cohort (the ADVANCE study). Current employment was determined by self-report questionnaire, and pain and mobility mediating variables were taken from the EuroQol EQ-5D 5-Level measure.

Results: 21.2% of the injured group were not in paid employment, compared with 14.3% of the uninjured comparison group; this difference was not statistically significant. Unmediated analyses showed that although those with amputation injuries had an increased risk of being unemployed compared with the comparison group, this was not statistically significant. For those who were injured without limb loss, compared with the comparison group, there were indirect effects on employment through both mobility (adjusted risk ratio (aRR) 1.32, 95% CI 1.11 to 1.69) and pain (aRR 1.10, 95% CI 1.01 to 1.31).

Conclusions: In this severely injured cohort, combat injury does not result in a significantly reduced rate of post-military employment. Any potential relationship between injury and employment for those injured without limb loss compared with the uninjured is due in part to the mediating effects of mobility and pain.