Occupational and Environmental Medicine最新文献

Objective: We assessed upper-aero digestive tract disorders in World Trade Center (WTC) patients seen in the Otolaryngology - Head and Neck Surgery Department of a large New York City hospital system and the association between WTC exposure and sinonasal surgery for chronic rhinosinusitis (CRS).

Methods: Retrospective review of medical records of all WTC patients seen between July 2002 and December 2023. Primary exposure was measured by arrival date and exposure length to the disaster site. Primary outcomes were upper-aero digestive tract disorders and sinonasal surgery.

Results: 3118 WTC patients were reviewed. Of these, 1162 (37.3%) had CRS. CRS patients were more likely female (p=0.03) and had higher proportion of comorbid obstructive sleep apnoea (OSA) (p<0.0001), allergic rhinitis (p<0.0001) and gastro-oesophageal reflux disease (p<0.0001). 355 (31.0%) CRS patients underwent sinonasal surgery. Relative to the medically managed patients, surgical CRS patients were younger at time of 9/11 (p=0.006), had a higher proportion of comorbid OSA (p=0.02) and earlier exposure (arrival date 11 September-13 September prior to rainfall) (p=0.001). CRS patients with early exposure demonstrated significantly greater odds of undergoing sinonasal surgery compared with those with late exposure (adjusted OR 1.61; 95% CI 1.2 to 2.3).

Conclusions: Earlier arrival at WTC site increased the risk of needing surgery for responders with CRS. Higher levels of irritant exposure prior to rainfall on 14 September 2001 may have caused significant epithelial injury to the sinonasal mucosa of WTC patients, leading to an elevated prevalence of CRS requiring surgical intervention.

Objectives: The impact of extreme weather on frailty trajectories in older adults remains unclear. This study explored the associations between cold spells/heat waves and frailty trajectories among this population.

Methods: A total of 6582 older adults who completed four survey waves of the Japan Gerontological Evaluation Study in 2010, 2013, 2016 and 2019 were included. Frailty was assessed using the Kihon Checklist, and frailty trajectories were identified using group-based trajectory models. The cumulative number of days participants were exposed to cold spells and heat waves was calculated. Multinomial logistic regression models were applied to examine associations between extreme temperature exposure and frailty trajectories, with adjusted ORs and 95% CIs estimated.

Results: Three frailty trajectories were extracted and labelled as frailty worsening, frailty maintenance and frailty improvement. Of the 6582 participants, 20.8%, 49.8% and 29.4% were subsequently classified into the above three trajectories. Every 1-day increment of cold spell that participants suffered was associated with 5.4% (95% CI 1.040 to 1.067) increased risk of frailty worsening after adjustment for covariables; similarly, for each additional day of heat wave participants were exposed to, the risk of frailty maintenance and frailty worsening raised by 1.6% (95% CI 1.004 to 1.028) and 4.5% (95% CI 1.032 to 1.058), respectively.

Conclusions: Cold spells and heat waves are linked to higher frailty worsening risk in older adults, emphasising the need for targeted public health interventions.

Objective: To investigate the association between hairdresser exposures and hormone-related conditions.

Methods: Using data from 50 800 eligible Sister Study participants (enrolled 2003-2009, aged 35-74 years), we estimated ORs and 95% CIs for associations between ever working as a hairdresser (n=1803) and prevalent fibroids, endometriosis, hysterectomy and oophorectomy. We estimated HRs and 95% CI for incident fibroids, endometriosis, breast, uterine and ovarian cancers among ever hairdressers versus never hairdressers. We also examined associations of hormone-related diseases and professional use of products such as bleach, perms, chemical straighteners, permanent hair colour, hairspray, barbicide, formaldehyde and alcohol, comparing data from 985 long-term hairdressers who worked ≥2 years to non-long-term hairdressers (never workers and those working <2 years).

Results: Ever-hairdressers were more likely than never-hairdressers to have had a prebaseline hysterectomy (OR=1.23: 95% CI 1.11 to 1.36). Hysterectomies were more common among long-term hairdressers with more frequent applications of perms, chemical straighteners and permanent hair colour compared with less frequent applicators or never hairdressers. Ever-hairdressers had higher rates of incident endometriosis (477 cases, HR=1.61: 95% CI 1.08 to 2.38) compared with never-hairdressers, but there were no notable associations between working as a hairdresser and fibroids (1805 cases, HR=1.04: 95% CI 0.80 to 1.34), breast cancer (4628 cases, HR=0.98: 95% CI 0.83 to 1.16), ovarian cancer (300 cases, HR=1.33: 95% CI 0.77 to 2.29) or uterine cancer (447 cases, HR=1.04: 95% CI 0.60 to 1.77). In race-stratified analyses, Black hairdressers were more likely to be diagnosed with fibroids than Black never-hairdressers (201 cases, HR=1.56: 95% CI 0.93 to 2.62).

Conclusions: Hairdresser occupation was associated with increased odds of hysterectomy and increased rates of incident endometriosis and possibly fibroids among Black women.

Chest X-ray (CXR) is widely used for silicosis diagnosis, despite concerns regarding sensitivity. We investigated the diagnostic accuracy of CXR for silicosis screening compared with CT, high-resolution CT (HRCT) and autopsy, and modelled the relationship between CXR sensitivity and disease severity.Medline, Embase, Scopus and Web of Science databases were searched on 2 July 2024 (PROSPERO registration: CRD42024513830). Meta-analyses were performed by reference standard and at increasing reference test severity cut-offs. The Quality Assessment of Diagnostic Accuracy Studies-2 tool assessed risk of bias. In scenarios of fixed and relative sensitivity, according to disease severity, we estimated missed silicosis cases and the number needed to screen (NNS) in hypothetical populations of low (5%), medium (15%) and high (30%) silicosis prevalence.Twenty studies included 2156 participants and 1105 silicosis cases. CXR had moderate sensitivity (0.76; 95% CI 0.63 to 0.86, I²=84%) and high specificity (0.89, 95% CI 0.77 to 0.95, I²=57%) compared with HRCT in 12 studies, and low sensitivity (0.50, 95% CI 0.45 to 0.55, I²=0%) and high specificity (0.91, 95% CI 0.87 to 0.93, I²=20%) compared with autopsy in two studies. CXR sensitivity increased with higher reference test severity cut-offs. Clinically relevant numbers of cases were missed in fixed and relative sensitivity scenarios; increased prevalence and less severe disease resulted in more missed cases and a lower NNS.Silicosis severity and reference test type both plausibly influence CXR sensitivity. Assuming either fixed or relative sensitivity results in missed silicosis cases. Judicious HRCT screening is likely to improve case detection.

Objectives: Occupational factors affect SARS-CoV-2 infection risk, but the occupational factors associated with Long COVID (LC) are unknown. We aimed to address this issue using individual data in a population-based cohort.

Methods: In the prospective COVICAT study, 2020-2023, Catalonia, Spain, we examined the association between occupational determinants and LC. Among subjects with previous SARS-CoV-2 infection, those employed in the pandemic and with occupational information were analysed. Different metrics, including four job-exposure matrices, were used to evaluate individual occupational risk factors for LC (postinfection symptoms ≥3 months). Poisson models were used to estimate adjusted risk ratios (RRs) and 95% CIs.

Results: Among 2054 workers (1308 women, 746 men) aged 40-69 years, 486 developed LC (23.7%). Workers in jobs at high COVID-19 risk according to all metrics including health/social care, education, retail, transport and security showed higher LC risk. The main drivers of increased risk were close contact with colleagues and the public (RR up to 1.50; 95% CI 1.18 to 1.91), no social distance at workplace (up to 1.46; 95% CI 1.16 to 1.84), rare or no use of facemask (1.41; 95% CI 1.09 to 1.83) and commute by public transport (1.58; 95% CI 1.20 to 2.08). Working on-site during the pandemic was also associated with a higher LC risk compared with teleworking (1.57; 95% CI 1.19 to 2.09). Individual non-occupational risk factors for LC included female sex, comorbidities, obesity, number and severity of acute infections; vaccination and older age were protective.

Conclusions: In a population-based cohort, several occupational factors increased LC risk. Focused preventive strategies are warranted to avoid the associated public health burden. LC should be recognised and compensated as an occupational disease.

Objectives: Using a case-control design, we examined the association between occupational asbestos exposure and risk of peritoneal mesothelioma in the general population in Italy.

Methods: From the National Mesothelioma Registry, we selected cases (2000-2021) with life-time occupational history. Controls were 3045 from three case-control studies (region-sex-age-matched, performed in six regions), one in 2002-2004 (2116 population controls) and two in 2012-2016 (718 population and 211 hospital controls). For all subjects, exposure assignment was based on a quantitative job-exposure matrix (SYN-JEM). Qualitative expert-based evaluation was available for all cases, but only in 2012-2016 for 929 controls. We estimated ORs and 90% CIs using logistic regression models adjusted for residence, gender, period and age.

Results: In complete analyses (1591 cases, all years/regions), the OR for ever exposure was 3.66 (CI 3.21 to 4.18, 45.4% cases and 27.8% controls exposed). Among the exposed, median cumulative exposure (fibres/mL-years) was 1.4 (max 20.0) in cases and 1.1 (max 10.9) in controls. The OR was 1.55 (1.48 to 1.62) per log₁₀-transformed cumulative exposure. In analyses restricted to 290 cases (same years/regions of controls), ORs were 3.35 (2.57 to 4.37, 43.8% cases exposed) for ever exposure and 1.52 (1.39 to 1.65) for cumulative exposure. ORs for ever asbestos exposure using expert-based evaluation were particularly high, 4.32 (3.50 to 5.34, 53.9% cases and 26.4% controls exposed) in complete analyses (778 cases) and 6.35 (4.58 to 8.81, 57.1% cases exposed) in restricted analyses (245 cases), but are known to be more prone to bias.

Conclusions: Peritoneal mesothelioma showed clear associations with asbestos exposure using different exposure assessment methods.

Objectives: Cleaning work involves potential exposures to physical, chemical, biological and psychosocial hazards, which might increase the risk of birth defects. Yet, there is limited research focused on maternal occupation in cleaning jobs and the risk of birth defects. We investigated the association between maternal occupation in cleaning-related jobs during early pregnancy and selected birth defects in the National Birth Defects Prevention Study, a case-control study from 1997 to 2011.

Methods: Mothers self-reported job details, which were classified by occupational epidemiologists into cleaner or non-cleaner occupations. Cases were live births or stillbirths with at least one of 19 eligible birth defects ascertained from state surveillance systems, while controls were randomly selected live births without structural defects. We estimated adjusted ORs with 95% CIs from multivariable logistic regression for associations between maternal cleaning occupations and birth defects, controlling for eight covariates identified a priori.

Results: Of the 28 936 mothers, 1109 (868 cases/241 controls) were assigned a primary occupational code as a cleaner during early pregnancy. In total, 9 of the 19 included birth defects had elevated ORs (>1.5), ranging from 1.58 for anophthalmia/microphthalmia to 2.65 for oesophageal atresia/stenosis; six had CIs that excluded the null (anencephaly, glaucoma, anotia/microtia, cleft lip and palate, oesophageal atresia/stenosis, small intestinal atresia/stenosis).

Conclusions: We observed that maternal occupation in cleaning-related jobs was associated with several specific birth defects in various body systems. Future studies should explore specific chemical and physical exposures under these cleaning occupations and the association with birth defects.

Objectives: We evaluated the relationship between cumulative occupational ionising radiation exposure and gastrointestinal cancer mortality in a cohort of US radiologic technologists (USRT).

Methods: Among 106 072 USRT cohort participants who were cancer-free at completion of the baseline questionnaire (1983-1998, representing completion of the first (1983-1989) or second questionnaire (1994-1998) as baseline), protracted low- to moderate-dose occupational ionising radiation exposure was evaluated in relation to gastrointestinal cancer mortality over the follow-up period (through 2021). Poisson regression was used to calculate linear excess relative rates (ERR) of gastrointestinal cancer mortality per 100 mGy colon-absorbed dose (mean=15 mGy; range 0-754 mGy), lagged 10 years, adjusting the baseline mortality rate for attained age, sex, birth cohort, race and other potential confounders (alcohol consumption, smoking, body mass index, non-steroidal anti-inflammatory drug (NSAID) use).

Results: Over follow-up (mean=31.4 years), 570 pancreatic, 504 colon, 171 liver, 131 oesophageal, 106 stomach and 73 rectal cancer deaths were identified. In the full cohort, no significant dose-response relationships were observed for pancreatic, colon, liver, oesophageal or rectal cancer mortality. A non-significant positive association for stomach cancer mortality was observed in a model minimally adjusted for attained age, sex and birth cohort; however, this association was attenuated after additionally adjusting for race and NSAID use (ERR/100mGy=1.56; 95% CI <0 to 159). Evidence for effect modification for stomach cancer mortality was observed by birth year (P-interaction=0.002) and year first worked (0.004), although based on small number of deaths, most positive associations within categories were not statistically significant.

Conclusions: In this nationwide cohort of radiologic technologists, cumulative occupational ionising radiation exposure was not clearly associated with mortality from specific gastrointestinal cancers. Studies with cancer incidence follow-up and pooled analyses of ionising radiation-exposed populations may provide more comprehensive and robust dose-response estimates for specific gastrointestinal cancers.

Objective: Atrazine, an herbicide widely used in US agriculture, has been associated with kidney cancer and non-malignant kidney disease. However, the potential mechanisms underlying these associations remain unclear. We evaluated atrazine use and biomarkers of kidney function and nephrotoxicity among male farmers in the Biomarkers of Exposure and Effect in Agriculture Study.

Methods: Our investigation included three groups of farmers defined based on atrazine use: (1) both recent (last 3 months) and past use (continuous users; n=83); (2) high lifetime use (≥178.5 lifetime days) but no recent use (former high users; n=88) and (3) never/low lifetime use (<50 lifetime days) and no recent use (never/low users; n=75). Biomarkers were measured in serum (creatinine, cystatin C, urea nitrogen, uric acid) and urine (kidney injury molecule-1 (KIM-1), albumin, creatinine). The 2021 CKD-EPI creatinine-cystatin C equation was used to calculate estimated glomerular filtration rate (eGFRcr-cys). We estimated the percentage difference (95% CI) in each marker across groups using multivariable linear regression.

Results: Compared with farmers with never/low atrazine use, continuous users had statistically significantly lower eGFRcr-cys (-9.4%; 95% CI -16.1% to -2.2%) and higher serum creatinine (9.4%; 95% CI: 1.6% to 17.9%) and cystatin C (10.8%; 95% CI 2.0% to 20.4%); no associations with these markers were observed for the former high users. We also observed higher uric acid for both former high and continuous users and lower urea nitrogen for former high users, although these associations were not statistically significant. Urine albumin-creatinine ratio and KIM-1 levels did not differ across groups.

Conclusions: Our findings add to the evidence that continued atrazine use is associated with diminished kidney function.