Occupational and Environmental Medicine最新文献

Objective: The objective of the present study was to develop a method for sampling and detecting an adenovirus-derived gene therapy (GT) vector on isolator worksurfaces.

Methods: We used a quantitative PCR (q-PCR) to detect the viral genome in standard dilutions of pure GT product and extracts of sampled surfaces. We compared three devices for surface sampling (a cotton compress, a cotton swab and a polyester flocked swab) and performed positive control, negative control and induced contamination tests for each.

Results: Our results showed that the GT pure product is detected by the q-PCR assay and is amplified throughout the range of dilutions. The mean difference between the expected and measured number of vector particles in the q-PCR assay was 1.27 log. The numbers of particles in the total extracted volume were 4.66×10⁸ for the polyester swab (7.8% of the initial quantity), 3.82×10⁸ for a cotton compress (6.4%) and 2.88×10⁷ for a cotton swab (4.8%).

Conclusion: These initial results suggest that viral monitoring of worksurfaces is feasible and will help us to validate the GT product supply chain.

Objective: We aimed to characterise self-reported military and occupational exposures including Agent Orange, chemical/biological warfare agents, solvents, fuels, pesticides, metals and burn pits among Veterans in the Department of Veterans Affairs Million Veteran Program (MVP).

Methods: MVP is an ongoing longitudinal cohort and mega-biobank of over one million US Veterans. Over 500 000 MVP participants reported military exposures on the baseline survey, and over 300 000 reported occupational exposures on the lifestyle survey. We determined frequencies of selected self-reported occupational exposures by service era, specific deployment operation (1990-1991 Gulf War, Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF)), service in a combat zone and occupational categories. We also explored differences in self-reported exposures by sex and race.

Results: Agent Orange exposure was mainly reported by Vietnam-era Veterans. Gulf War and OEF/OIF Veterans deployed to a combat zone were more likely to report exposures to burn pits, chemical/biological weapons, anthrax vaccination and pyridostigmine bromide pill intake as compared with non-combat deployers and those not deployed. Occupational categories related to combat (infantry, combat engineer and helicopter pilot) often had the highest percentages of self-reported exposures, whereas those in healthcare-related occupations (dentists, physicians and occupational therapists) tended to report exposures much less often. Self-reported exposures also varied by race and sex.

Conclusions: Our results demonstrate that the distribution of self-reported exposures varied by service era, demographics, deployment, combat experience and military occupation in MVP. Overall, the pattern of findings was consistent with previous population-based studies of US military Veterans.

The risk of developing Dupuytren's disease among workers exposed to occupational mechanical exposures has been reported in few systematic reviews, mainly related to vibration. Expanding the investigation to all occupational mechanical exposures is essential for advancing scientific knowledge, health policies and improving workplace safety. The aim of this systematic review and meta-analysis was to study the association between occupational mechanical exposures and Dupuytren's disease.We conducted a systematic review and meta-analysis using guidelines stated by PRISMA. The systematic literature search was performed in Medline, EMBASE, CINAHL, Cochrane Library and Web of Science databases in April 2023. Inclusion criteria were conducted using the PECOS. Two independent authors conducted the literature screening, data extraction and risk of bias assessment. In the meta-analyses, data was pooled using random-effects models and stratified by the risk of bias and study design. The level of evidence was evaluated using GRADE.The literature search identified 563 unique articles and 15 were deemed eligible for inclusion, categorised into hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. Exposure to hand-transmitted vibration showed an OR of 2.0 (95% CI 1.5 to 2.7, I²=64%), lifting/carrying loads had an OR of 1.5 (95% CI 1.1 to 2.0, I²=77%) and combined mechanical exposures had an OR of 2.1 (95% CI 1.4 to 3.1, I²=94%). When grading the level of evidence, we found moderate evidence for hand-transmitted vibration, while low evidence was found for lifting/carrying loads and combined mechanical exposures.We found an association between hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. The level of evidence was considered moderate for hand-transmitted vibration and low for lifting/carrying loads and combined mechanical exposures.

Objectives: In the Netherlands, a new regulation has been adopted for recognition and compensation of serious substance-related occupational diseases. A national advisory committee has a key task of providing advice on the protocols for operationalisation of individual causality assessment in this new context.

Methods: Protocol development involves gathering the best available population-level evidence on causality and using this evidence to determine individual causality. Here, the presumably plausible principle was adopted, which stipulates that uncertainties in individual causality should be weighed in favour of a fast and transparent one-time compensation for (ex-)workers.

Results: In monocausal diseases, a limited workplace exposure assessment is considered sufficient to determine whether individual causality is presumably plausible in the Dutch context. For multicausal occupational diseases, individual causality assessment is more complicated. Modelling of existing data on the exposure-response relation helps establish the probability of causation, that is, the risk of the disease attributable to a work-related exposure. This operationalisation, applied in some protocols, makes use of the probability of causation, while being prudent in establishing exposure limits. An example from asbestos and lung cancer is provided in this short report.

Conclusions: We propose a pragmatic approach to individual causality assessment of substance-related occupational diseases, considering statistical and diagnostic uncertainties. This approach substantiates protocols towards a one-time financial compensation without long-winding recognition procedures.

Objectives: Career duration is often used as a metric of neurotrauma exposure in studies of elite athletes. However, as a proxy metric, career length may not accurately represent causal factors, and associations with health outcomes may be susceptible to selection effects. To date, relationships between professional American-style football (ASF) career length and postcareer health remain incompletely characterised.

Methods: We conducted a survey-based cross-sectional cohort study of former professional ASF players. Flexible regression methods measured associations between self-reported career duration and four self-reported health conditions: pain, arthritis, mood and cognitive symptoms. We also measured associations between career duration and four self-reported ASF exposures: prior concussion signs and symptoms (CSS), performance enhancing drugs, intracareer surgeries and average snaps per game. Models were adjusted for age and race.

Results: Among 4189 former players (52±14 years of age, 39% black, 34% lineman position), the average career length was 6.7±3.9 professional seasons (range=1-20+). We observed inverted U-shaped relationships between career duration and outcomes (all p<0.001), indicating that adverse health effects were more common among men with intermediate career durations than those with shorter or longer careers. Similar findings were observed for play-related exposures (eg, CSS and snaps).

Conclusions: Relationships between ASF career duration and subsequent health status are non-linear. Attenuation of the associations among longer career players may reflect selection effects and suggest career length may serve as a poor proxy for true causal factors. Findings highlight the need for cautious use of career duration as a proxy exposure metric in studies of former athletes.

Objective: Working-age individuals have been disproportionately affected by the opioid crisis, prompting interest in the potential role of occupation as a contributor. This study aimed to estimate the risk of opioid-related poisonings and mental and behavioural disorders by occupation and industry within a cohort of 1.7 million formerly injured workers.

Methods: Workers were identified in the Occupational Disease Surveillance System, a system linking workers' compensation data (1983-2019) to emergency department and hospitalisation records (2006-2020) in Ontario, Canada. Cox proportional hazards models were used to estimate HRs and 95% CIs for hospital encounters for opioid-related poisonings and mental and behavioural disorders by occupation and industry compared with all other workers, adjusted for age, sex and birth year.

Results: In total, 13 702 opioid-related poisoning (p) events (n=10 064 workers) and 19 629 opioid-related mental and behavioural (mb) disorder events (n=11 755 workers) were observed. Elevated risks were identified among workers in forestry and logging (HR_p=1.45, 95% CI 1.09 to 1.94; HR_mb=1.70, 95% CI 1.34 to 2.16); processing (minerals, metals, clay, chemical) (HR_p=1.27, 95% CI 1.14 to 1.42; HR_mb=1.26, 95% CI 1.14 to 1.39); processing (food, wood, textile) (HR_p=1.12, 95% CI 1.01 to 1.24; HR_mb=1.19, 95% CI 1.09 to 1.31); machining (HR_p=1.13, 95% CI 1.04 to 1.21; HR_mb=1.17, 95% CI 1.09 to 1.25); construction trades (HR_p=1.57, 95% CI 1.48 to 1.67; HR_mb=1.59, 95% CI 1.51 to 1.68); materials handling (HR_p=1.32, 95% CI 1.22 to 1.43; HR_mb=1.22, 95% CI 1.13 to 1.31); mining and quarrying (HR_mb=1.68, 95% CI 1.34 to 2.11); and transport equipment operating occupations (HR_p=1.18, 95% CI 1.09 to 1.27). Elevated risks were observed among select workers in service, sales, clerical and health. Findings by industry were similar.

Conclusions: Results provide additional evidence that opioid-related harms cluster among certain occupational groups. Findings can be used to strategically target prevention and harm reduction activities in the workplace.

Objective: This descriptive study aimed to measure the excess all-cause mortality potential years of working life lost (PYWLL) in the working-age population of six Ibero-American countries in 2020 and 2021.

Methods: This study was based on all-cause deaths for the age group 15-69 years for men and women in six countries: Colombia, Costa Rica, México, Peru, Portugal and Spain. The expected PYWLL was the average value determined from the previous 5 years (2015-2019). To estimate the excess of PYWLL, the expected PYWLL was subtracted from the observed PYWLL values for 2020 and 2021, separately.

Results: In the four Latin American countries, the excess PYWLL per death was approximately double (between 12 and 16 years) that of the two European countries (between 3 and 9 years).

Conclusions: The loss of working-age individuals will probably have a profound social and economic recovery impact, affecting families and communities. The informal employment and labour market structures may be contributing to the adverse effects of the pandemic in the region. Investing in universal, comprehensive and sustainable health and social protection systems in the Latin American countries is crucial to build resilience against current and future crises.