Occupational and Environmental Medicine最新文献

Objectives: To estimate the impact of occupational injury and illness on opioid-related mortality while accounting for confounding by preinjury opioid use.

Methods: We employed a retrospective cohort study design using Washington State workers' compensation data for 1994-2000 injuries linked to US Social Security Administration earnings and mortality data and National Death Index (NDI) cause of death data from 1994 to 2018. We categorised injuries as lost-time versus medical-only, where the former involved more than 3 days off work or permanent disability. We determined death status and cause of death from NDI records. We modelled separate Fine and Gray subdistribution hazard ratios (sHRs) and 95% CIs for injured men and women for opioid-related and all drug-related mortality through 2018. We used quantitative bias analysis to account for unmeasured confounding by preinjury opioid use.

Results: The hazard of opioid-related mortality was elevated for workers with lost-time relative to medical-only injuries: sHR for men: 1.53, 95% CI 1.41 to 1.66; for women: 1.31, 95% CI 1.16 to 1.48. Accounting for preinjury opioid use, effect sizes were reduced but remained elevated: sHR for men was 1.43, 95% simulation interval (SI) 1.20 to 1.69; for women: 1.27, 95% SI 1.10 to 1.45.

Conclusions: Occupational injuries and illnesses severe enough to require more than 3 days off work are associated with an increase in the hazard of opioid-related mortality. The estimated increase is reduced when we account for preinjury opioid use, but it remains substantial. Reducing work-related injuries and postinjury opioid prescribing and improving employment and income security may decrease opioid-related mortality.

Objectives: Since the US Supreme Court's Dobbs v. Jackson decision, 17 states have imposed near-total abortion bans. These bans may negatively impact health and well-being of obstetrician-gynaecologists (OB-GYNs), due to high levels of work-related stress that the laws have created for them. The goal of the present study is to evaluate the impacts of post-Dobbs v. Jackson state abortion bans on occupational health and well-being of OB-GYNs.

Methods: The Study of OB-GYNs in Post-Roe America is a qualitative study of 54 OB-GYNs practising in 13 of the 14 states with near-total abortion bans as of March 2023. Using volunteer sampling methods, participants were recruited for semistructured qualitative interviews via videoconference from March to August 2023.

Results: Thematic analysis of interview transcripts identified six major domains of health and well-being impacts of state abortion bans on OB-GYNs: anxiety and depression, burden of negative emotions, burn-out, coping-related health behaviours, sleep disruption and personal relationships.

Conclusions: State abortion bans following the 2022 Dobbs decision may impact the health and well-being not only of pregnant patients but also of their providers. These provider health impacts include mental health and burn-out but also extend to physical health outcomes and the work-life interface.

Objectives: The objectives of this study were to examine post COVID-19 syndrome (PCS) among healthcare workers (HCWs) in England and explore risk factors for the condition.

Methods: Data were collected by National Health Service (NHS) CHECK, a longitudinal study exploring HCWs' mental and physical well-being during and after the COVID-19 pandemic. NHS CHECK collected data at four timepoints: the baseline survey between April 2020 and January 2021, and then three follow-up surveys at approximately 6, 12 and 32 months post baseline. PCS data were collected at 12 and 32 months, while risk factor data were from baseline. HCWs were asked what COVID-19 symptoms they experienced and for how long and were classified as having PCS if they had any symptom for ≥12 weeks. Multilevel regressions were used to examine risk factors for PCS.

Results: This study included 5248 HCWs. While 33.6% (n=1730) reported prolonged COVID-19 symptoms consistent with PCS, only 7.4% (n=385) reported a formal diagnosis of PCS. Fatigue, difficult concentrating, insomnia and anxiety or depression were the most common PCS symptoms. Baseline risk factors for reporting PCS included screening for common mental disorders, direct contact with COVID-19 patients, pre-existing respiratory illnesses, female sex and older age.

Conclusions: While a third of HCWs reported prolonged COVID-19 symptoms consistent with PCS, a smaller percentage reported a formal diagnosis of the condition. We replicate findings that direct contact with COVID-19 patients, older age, female sex, pre-existing respiratory illness and symptoms of common mental disorders are associated with increased risk of PCS.

Objectives: This study investigates the impact of different work paces on cardiorespiratory outcomes, perceived effort and carried load (CL) in industrial workers.

Methods: A randomised cross-over trial was conducted at a mid-sized steel company. We included 12 healthy industrial workers (8 females, age: mean 44±SD 9 years, height: 1.70±0.08 m, body mass: 79.5±13.4 kg) with at least 6 months of working experience. All participants performed 5 min of piece work at 100% (P100), 115% (P115) and 130% (P130) of the company's internal target yielded in a randomised order, separated by 5 min familiarisation breaks. The primary outcome was energy expenditure (EE), calculated from a respiratory gas exchange using a metabolic analyser. Secondary outcomes were total ventilation, oxygen uptake, carbon dioxide release, respiratory exchange ratio, heart rate and rating of perceived effort (0-10). Furthermore, the metabolic equivalent and the CL were calculated. Data were analysed with repeated measure analyses of variance.

Results: For EE, a large 'pace' effect with a small difference between P100 and P130 (165.9±33.4 vs 178.8±40.1 kcal/hour^-1, p=0.008, standard mean difference, SMD=0.35) was revealed. Additionally, a large difference in CL between all paces (p<0.001, SMD≥1.10) was revealed. No adverse events occurred.

Conclusions: Cardiorespiratory outcomes rise with increased work pace, but the practical relevance of these differences still needs to be specified. However, the CL will add up over time and may impact musculoskeletal health in the long term.

Objective: This follow-up study of uranium processing workers at the Fernald Feed Materials Production Center examines the relationship between radiation exposure and cancer and non-cancer mortality among 6403 workers employed for at least 30 days between 1951 and 1985.

Methods: We estimated cumulative, individual, annualised doses to 15 organs/tissues from external, internal and radon exposures. Vital status and cause of death were ascertained in 2017. The analysis employed standardised mortality ratios, Cox proportional hazards and Poisson regression models. Competing risk analysis was conducted for cardiovascular disease (CVD) mortality risk given several assumptions about risk independent of competing outcomes. Emphysema was examined to assess the potential for confounding by smoking.

Results: Vital status was confirmed for 98.1% of workers, with 65.1% deceased. All-cause mortality was less than expected in salaried but not hourly workers when compared with the US population. A statistically significant dose response was observed between external (but not total or internal) lung dose and lung cancer mortality (HR at 100 mGy adjusted for internal dose=1.45; 95% CI=1.05 to 2.01). Significantly increased HRs at 100 mGy dose to heart were observed for CVD (1.27; 95% CI=1.07 to 1.50) and ischaemic heart disease (1.30; 95% CI=1.07 to 1.58). CVD risk remained elevated regardless of competing risk assumptions. Both external and internal radiation were associated with emphysema.

Conclusions: Lung cancer was associated with external dose, though positive dose responses for emphysema imply residual confounding by smoking. Novel use of competing risk analysis for CVD demonstrates leveraging retrospective data for future risk prediction.

Introduction: We aimed to describe the occupational pattern of opioid overdose deaths in Maryland between 2018 and 2022 and determine the occupations at higher risk of opioid overdose death.

Methods: The sample included undetermined or unintentional opioid overdose deaths among those aged 16 years or older in Maryland, drawn from the State Unintentional Drug Overdose Reporting System. We calculated population-based incidence overdose rates by occupation, stratified by sex and race. We further calculated the incidence rate ratios (IRRs) comparing each occupation with all other groups combined and estimated the IRRs among males versus females and non-Hispanic whites versus other racial/ethnic groups.

Results: The pooled sample included 11 455 opioid overdose decedents (72% male and 55% non-Hispanic whites) of whom 80% were employed. The three occupation groups with the highest incidence rates were 'construction and extraction', 'transportation and material moving' and 'installation/maintenance and repair' with 291, 137 and 133 deaths per 100 000 workers in these respective occupational groups. Incidence rates were significantly higher in males than females in all categories except those 'Not in Labour Force' (IRR=0.51, p<0.001). Non-Hispanic whites relative to other racial/ethnic groups had a lower incidence of opioid overdose death in 'Military-Specific' occupations (IRR=0.53, p=0.031).

Conclusion: Opioid overdose deaths vary by type of occupation and certain occupations are at higher risk of overdose death. The findings highlight the need for priority setting in the implementation and expansion of existing strategies to target the workers most impacted by opioid overdose.

Objectives: We investigated whether UK military personnel exposed to sarin during the 'Service Volunteer Programme' at Porton Down had increased rates of mortality or cancer incidence over a 52-year follow-up.

Methods: A historical cohort study assembled from UK military records, comprising male veterans exposed to sarin during the 'Service Volunteer Programme' at Porton Down, UK (n=2975) and a comparison group of similar veterans who did not attend (n=2919). Mortality and cancer incidence data were obtained from national registries up to December 2019. Analysis was conducted using Cox regression adjusted for age, year of birth and service characteristics.

Results: Over a median follow-up of 52.2 years (range 2 days to 74.6 years), 1598 (53.7%) sarin-exposed veterans and 1583 (54.3%) non-exposed veterans died. Adjusted HRs for all-cause mortality were raised for any sarin exposure (HR=1.08, 95% CI 1.01 to 1.16), two or more exposures (HR=1.25, 95% CI 1.04 to 1.49) and higher doses (air >15 mg.min/m³) (HR=1.15, 95% CI 1.02 to 1.30). For cause-specific mortality, sarin exposure was associated with deaths from 'other' circulatory diseases (excludes ischaemic and cerebrovascular diseases) (HR=1.41, 95% CI 1.06 to 1.87) and alcohol-attributable deaths (HR=2.66, 95% CI 1.40 to 5.07). There was no association between sarin exposure and overall cancer incidence (HR=1.01, 95% CI 0.93 to 1.10), but cancer incidence was higher for alcohol-related neoplasms (HR=1.24, 95% CI 1.01 to 1.51).

Conclusions: Sarin exposure was associated with increased rates of mortality over a 50-year follow-up. The strongest associations were observed for deaths attributable to alcohol and 'other' circulatory diseases.

Goals: To describe the exposure to psychosocial risks at work and the consumption of psychotropic drugs and opioids among women working as cleaners; and to analyse the association between their exposure to psychosocial risks and drug use.

Methods: Observational cross-sectional study based on an online survey (collected during April and May 2021) from the wage-earning population in Spain. In this study, only women working in manual occupations were included (n=3430). Working conditions and drug consumption of cleaning workers were compared with those of other manual workers through bivariate analysis. The adjusted prevalence ratios and the corresponding 95% CIs were estimated using Poisson regression models with robust variance.

Results: Cleaning workers were older and had more problems making ends meet than other manual workers and were significantly more exposed to low possibilities for development (85.2 (95% CI 81.8 to 88.0)), high strain (51.9 (95% CI 47.3 to 55.9)) and low social support from colleagues (72.0 (95% CI 68.1 to 75.7)) and supervisors (61.7 (95% CI 57.3 to 65.6)). They also scored higher prevalence rates for the use of tranquillisers (37.7 (95% CI 32.0 to 43.3)) and opioids (33.3 (95% CI 27.9 to 38.6)) consumption indicators. This consumption was associated significantly with high strain exposure and high insecurity over working conditions.

Discussion: Under the umbrella of the 2012 labour reform, cleaning companies shift the pressure and burden they have on ordinary cleaning staff in the form of low wages and precarious working conditions. Our results imply that addressing adverse working conditions, mainly high strain and insecurity over working conditions, may significantly contribute to reducing the gender and social inequalities among cleaning workers.