Occupational and Environmental Medicine最新文献

Objectives: Environmental lead is a persistent hazard that disproportionately affects children. Keys are known sources of lead exposure in children, but little is known about the specific lead content or frequency of lead in keys. We identified differences in lead concentration and frequency across items with different physical characteristics.

Methods: This study tested a convenience sample of keys and keychain objects using an X-ray Fluorescence (XRF) analyzer.

Results: The mean lead concentration across 362 objects tested was 1722 ppm (SD 3657 ppm; range 95.5-44 400 ppm). Lead was present in the majority (64%) of objects tested. Door keys had the highest concentration of lead (mean 2646 ppm; SD 3701 ppm). Door keys had significantly more lead than both vehicle keys (p<0.0001) and electronic fobs (p=0.0004). Gold-coloured keys contained significantly more lead than silver-coloured keys (p<0.0001). Copied keys were significantly more likely to contain detectable levels of lead compared with original keys (p<0.0001); however, this relationship was not significant when controlling for key type. There was a positive association between key age and lead concentration (p=0.009).

Conclusion: Keys were less likely to contain lead if they were silver-coloured; car keys or electronic fobs; and newer. However, several categories of keys with less lead contained high lead levels, and the majority of items tested (64%) contained more lead than limits on lead in keys that were implemented in Minnesota after data collection (90 ppm). The levels of lead identified highlight the need for public education and potential additional regulatory guidelines for keys.

Background: Occupational exposure to irritants is associated with poor asthma control, but the long-term clinical characteristics of irritant-induced occupational asthma (IIA) are poorly known.

Objective: To evaluate whether any distinguishable features contribute to IIA patients' poor outcomes and whether clinical characteristics change over time.

Methods: We re-evaluated 28 IIA patients with a median of 6.8 years (IQR 4.6-11.1) after their diagnosis at the Finnish Institute of Occupational Health in 2004-2018. We measured their lung function, non-specific bronchial hyper-responsiveness, inflammation profile and exercise capacity using an ergometric bicycle test. The participants also underwent an Asthma Control Test (ACT) and responded to questionnaires assessing their laryngeal hypersensitivity (LHQ) and dysfunctional breathing (Nijmegen Questionnaires, NQ).

Results: At follow-up, 22 (79%) participants used inhaled corticosteroids, 4 (14%) had asthma exacerbation within 1 year, 11 (39%) had ACT<20 (ie, poor asthma symptom control), 7 (26%) had abnormal spirometry and 8 (36%) had a positive methacholine challenge test result. 17 (61%) participants showed at least one elevated eosinophilic inflammation marker. Six (23%) had an abnormal LHQ score and 7 (26%) had an abnormal NQ score. 15 (58%) participants showed reduced physical capacity that was related to extensive asthma medication, poor asthma symptom control and acute IIA phenotype. A higher ACT score was the only significant change between diagnosis and follow-up (p=0.014).

Conclusion: Most of the IIA patients had normal lung function at follow-up, which had only changed a little over time. Reduced physical capacity was a common finding and appears to be related to poor asthma symptom control.

Background: SARS-CoV-2 infection rates vary by occupation, but the association with work-related characteristics (such as home working, keyworker or furlough) are not fully understood and may depend on ascertainment approach. We assessed infection risks across work-related characteristics and compared findings using different ascertainment approaches.

Methods: Participants of 14 UK-based longitudinal cohort studies completed surveys before and during the COVID-19 pandemic about their health, work and behaviour. These data were linked to the National Health Service digital health records, including COVID-19 diagnostic testing, within the UK Longitudinal Linkage Collaboration (UK LLC) research environment. Poisson regression modelled self-reported infection and diagnostic test confirmed infection within each cohort for work-related characteristics. Relative Risk (RR) were then combined using random effects meta-analysis.

Results: Between March 2020 and March 2021, 74 757 individuals completed 167 302 surveys. Overall, 15 174 survey responses self-reported an infection, whereas 3053 had a linked positive test. Self-reported infection risk was greater in keyworkers versus not (RR=1.24 (95% CI 1.17, 1.31), among non-home working (1.08 (0.98, 1.19)) or some home working (1.06 (0.97, 1.17)) versus all home working. Part-time workers versus full time (0.94 (0.89, 0.99)) and furlough versus not (0.93 (0.88, 0.99)) had reduced risk. Results for the linked positive test outcome were comparable in direction but greater in magnitude, for example, a 1.85 (1.56, 2.20) in keyworkers.

Conclusion: The UK LLC provides new opportunities for researchers to investigate risk factors, including occupational factors, for ill-health events in multiple largescale UK cohorts. Risk of SARS-CoV-2 infection and COVID-19 illness appeared to be associated with work-related characteristics. Associations using linked diagnostic test data appeared stronger than self-reported infection status.

Objectives: This study aims to investigate (1) the microbial community composition by work characteristics and (2) the association between microbial genera level and inflammatory markers among recycling workers.

Methods: In this cross-sectional study, inhalable dust was collected with personal samplers from 49 production (86 samples) and 10 administrative workers (15 samples). Four groups of micro-organisms were identified down to species-level (aerobic and anaerobic bacteria, and fungi grown at 25°C and 37°C). Inflammatory markers were measured in serum collected at the end of the work shift. Microbial community composition was investigated using redundancy analysis and heatmaps. Associations between the most prevalent microbial genera and inflammatory markers were explored by mixed-effects regression.

Results: Community composition of all groups of micro-organisms except fungi (37°C) differed between production and administrative workers and by type of waste and season among the production workers. Overall, Bacillus, Staphylococcus, Aspergillus and Penicillium were the most prevalent genera. CC16 concentrations increased with Penicillium genus level, C reactive protein and serum amyloid A with Staphylococcus, interleukin 2 (IL-2) and tumour necrosis factor with Bacillus, and IL-8 with Aspergillus. IL-1B decreased with Staphylococcus genus level. Remaining analyses showed no statistically significant associations between microbial genera level and inflammatory markers.

Conclusions: Recycling workers are exposed to different compositions of microbial species than administrative workers depending on the type of waste handled and season. Specific systemic inflammatory effects were suggested for a limited number of microbial genera that need to be corroborated by future studies.

Objectives: To identify trajectories of work ability from pre-COVID to post-COVID-19 pandemic period and to examine work unit characteristics associated with these trajectories.

Methods: The study population was a cohort of Finnish public sector employees (n=54 651) followed from 2016 until 2022. We used trajectory analysis to identify trajectories of work ability and multinomial regression to examine their associations with prepandemic work unit characteristics and pandemic-related changes at workplaces.

Results: We identified three trajectories of work ability: (1) suboptimal work ability decreasing over time (12%); (2) relatively consistent good work ability (73%) and (3) consistent optimal work ability (15%). The strongest associations with belonging to the suboptimal work ability trajectory were found for employees in work units characterised by high job strain (OR 2.29, 95% CI 1.82 to 2.88), poor team climate (OR 0.74, 95% CI 0.64 to 0.86) and low organisational justice (OR 0.64, 95% CI 0.57 to 0.72) when compared with the most optimal trajectory. The least favourable work ability trajectory was also associated with team reorganisation (OR 1.22, 95% CI 1.04 to 1.44) and a low share of those working from home (OR 0.86, 95% CI 0.78 to 0.94) during the pandemic.

Conclusion: Prepandemic psychosocial risk factors and pandemic-induced changes at work were associated with poor and declining work ability during the COVID-19 pandemic. Employers and occupational health services should better identify and support vulnerable employees to enhance their work participation.

Objectives: Studies assessing the association of adult cancers with extremely low frequency (ELF) magnetic fields (MF) have provided inconclusive results, probably affected by limitations such as low exposure levels, confounding and various forms of bias. This study investigated the association between residential ELF MF exposure and adult cancer using a design that avoids the main limitations of previous studies.

Methods: Persons who have lived in buildings with indoor transformer stations during the period 1971-2016 formed the study cohort. Their MF exposure was assessed based on the location of their apartment in relation to the transformer room. Information on their cancer diagnoses was obtained from the Finnish Cancer Registry. SIR with 95% CI was calculated to investigate the association of MF exposure with overall cancer and specific cancers.

Results: The SIR for all primary sites was 1.01 (95% CI 0.93 to 1.09). An increased risk of digestive organ cancers was observed among the exposed persons, with a SIR of 1.23 (95% CI 1.03 to 1.46). The highest SIR was observed for gallbladder cancer (3.92, 95% CI 1.44 to 8.69). Increased risk of testicular cancer was observed among men exposed to MF during childhood, but this is likely to be due to confounding associated with living on the lowest floors. No other significant associations were observed for other primary cancer sites studied.

Conclusions: Overall cancer risk was not affected by residential MF exposure. The increased risk of digestive organ cancers among MF-exposed persons is a novel finding requiring confirmation in further studies.

Objectives: It is not fully known what explains educational inequalities in early labour market exits. This study aims to examine the mediating effect of exposure to unfavourable working conditions, measured by low job control and high physical workload, on the association between education and early labour market exit among men.

Methods: This register-based study included all men born 1951-1953, who underwent Swedish military conscription in late adolescence and had a registered educational level in 2005 (n=115 998). These men were followed from ages 53-55 to 64 regarding early labour market exit (disability pension, long-term sickness absence, long-term unemployment, early old-age retirement with and without income). Mediation analysis was used to examine the role of job control and physical workload in explaining the educational differences in early exit. Factors measured in childhood and late adolescence were included as confounders.

Results: The proportion mediated by job control was around 17% and for physical workload around 22% for the least educated men for exit through disability pension, long-term sickness absence and long-term unemployment. For early old-age retirement with and without income, working conditions were not mediating factors, except for job control mediating up to 18% for exit through early old-age retirement with income.

Conclusions: Job control and physical workload seem to be important factors explaining the educational differences in most early exit routes, also after accounting for early life factors. These results indicate the importance of improving working conditions to decrease inequalities in early labour market exit and prolong working life.

Introduction: Previous studies suggest respirable crystalline silica (RCS) is an important driver of resurgent pneumoconiosis among US coal miners. Although greater attention has been focused on dust exposures in underground coal miners, surface miners are also at risk of severe disease. This study explores RCS exposure in this population.

Methods: We analysed 91 950 respirable quartz samples from 4127 US surface coal mines from 1982 to 2023. We calculated the geometric mean of respirable quartz concentration for each mine-year combination. Then, for each calendar year, we averaged the geometric means across all mines. We used generalised estimating equation models with a natural logarithm link function and Poisson distribution to evaluate the marginal effects of mine characteristic variables on the mass concentration of respirable quartz based on individual dust sample results.

Results: Drillers and bulldozer operators had annual mean respirable quartz exposures as high as 0.58 and 0.32 mg/m3, respectively, while other occupations combined had exposure of 0.08 mg/m³. The mean mine-level respirable quartz mass concentrations decreased substantially over time for all three occupation groups. Drillers or bulldozer operators, mine location in Central Appalachia and lack of a mine safety committee were predictive of higher respirable quartz mass concentrations.

Conclusions: These data demonstrate exceptionally high RCS overexposures among certain groups of surface coal miners, particularly drillers and bulldozer operators in the 1980s and 1990s. Despite recent improvement in RCS levels, these data underscore the importance of continued medical surveillance of current and former surface coal miners.

Objectives: According to the International Agency for Research on Cancer, styrene is probably carcinogenic for lymphohaematopoietic neoplasms, with insufficient evidence for other cancer sites. We compared mortality and cancer incidence (for the first time) in a UK cohort occupationally exposed to high levels of styrene to that of the general population of England and Wales.

Methods: The follow-up for mortality ran from 1969 to 2022, while the follow-up for cancer incidence ran from 1971 to 2020. Standardised mortality ratios (SMRs) and standardised incidence ratios (SIRs) were calculated for cancer and non-cancer outcomes. Additional analyses compared mortality and cancer incidence with respect to the median age at and time since first exposure.

Results: A total of 1319 males contributed 53 687 person-years of follow-up in the all-cause mortality analysis. Mortality analyses did not indicate any clear increased risks. There was an indication of higher mortality of cancers of the trachea, bronchus or lung (SMR=1.30 (95% CI 0.99 to 1.70)). Mortality from lymphatic and haematopoietic neoplasms was elevated in those first exposed younger than 25 years of age (SMR=2.20 (95% CI 1.12 to 3.92)). The SIR analysis suggested reduced cancer incidence for all malignant neoplasms combined (SIR=0.85 (95% CI 0.76 to 0.96)). The incidence of lymphatic and haematopoietic neoplasms, especially myeloid proliferations and neoplasms, was elevated in those first exposed before 25 years old.

Conclusions: This study provides some limited evidence in support of styrene being a cause of lymphohaematopoietic, particularly myeloid neoplasms and lung cancers. This cohort is contributing to an ongoing international study to help clarify these associations.

Introduction: French medical students can access occupational medicine after passing the residency examination. Few studies have looked at the lack of attractiveness of occupational medicine, contributing to the demographic decline of occupational physicians (OPs). The purpose of this study was to explore the stereotypes of OPs by their colleagues at different levels of formation to understand the determinants of the current lack of attractiveness.

Methods: An anonymous survey was sent to medical students, residents and graduated physicians in March and April 2021. After filling a part about socio-demographic data, participants were asked to give four words about OP, based on the hierarchical evocation method. A descending hierarchical classification method was used to classify words according to their lexical proximity. Then, the corpus' central core was defined by prototypical analysis.

Results: 268 students (107 medical students and 161 residents) and 136 graduated physicians completed the questionnaire. The most important class was about 'negative stereotypes of OP'. In the prototypical analysis, the central core was composed of both words relative to the « OP's skills » and a majority of words concerning 'OP's negative stereotypes'.

Conclusion: This study confirmed that OPs suffer from negative stereotyping by their colleagues. Better communication of their functions throughout medical school would improve their image in the medical community.