Occupational and Environmental Medicine最新文献

Background: The Warmth & Wellbeing pilot scheme provided home energy efficiency measures to people aged 55 years and over with chronic respiratory conditions in Dublin, Ireland from 2016 to 2020. We performed an observational study to evaluate the impact of the pilot scheme on health and well-being.

Methods: 955 people were recruited to the research, of which 545 had the following before-and-after data: self-reported general health and winter thermal comfort through a questionnaire and the EuroQol-5 Dimension (EQ-5D), St George's Respiratory Questionnaire (SGRQ) and 36-Item Short Form Survey (SF-36) instruments, and monthly drug prescriptions. We analysed before-and-after differences using standard parametric methods.

Results: Health service contacts decreased after intervention, with general practitioner consultations over 6 months decreasing by 1.10 (95% CI 0.75, 1.44) and emergency room visits for respiratory conditions decreasing by 0.13 (95% CI 0.06, 0.21). Participants reported improvements in thermal comfort, temperature control, ability to pay fuel bills and comfort with inviting visitors to their home. There were improvements in physical health, general health, energy/fatigue and social well-being across most dimensions of EQ-5D, SGRQ and SF-36. For example, the EQ-5D summary score decreased by 5.36 (95% CI 2.68, 8.04). Monthly drug prescriptions in the year before intervention decreased by 0.14 (95% CI 0.06, 0.23) in the year afterwards. Most changes persisted for at least 2 years.

Conclusions: Dublin's Warmth & Wellbeing pilot scheme resulted in improvements in self-reported health and probable reductions in health service contacts and drug prescriptions. The health rationale supports targeted home energy efficiency programmes as part of climate change and energy objectives.

Objectives: Lifting is a common self-reported aggravating factor associated with individuals experiencing low back pain (LBP). However, there is a paucity of longitudinal studies with multiple measures on lifting spinal kinematics, pain, disability and pain-related cognitions. This study investigated the relationship between changes in these factors in people with lifting-related chronic LBP undergoing cognitive functional therapy (CFT).

Methods: 141 people with chronic LBP aggravated by lifting received a course of CFT over 13 weeks (average 4.8 sessions) and performed the same lifting task before each treatment session. Measures included range of motion (ROM) and velocity from trunk and pelvis inertial measurement units independently and the relative angle between units (lumbar angle). Participants reported (1) average pain intensity, (2) pain-related disability and (3) pain-related cognitions (pain catastrophising and pain self-efficacy) via online questionnaires at baseline, 3, 6 and 13 weeks. Multivariate multilevel models evaluated associations between individual rates of changes over time for three selected kinematic measures (trunk velocity, trunk ROM or lumbar ROM) with pain, disability, pain catastrophising and pain self-efficacy.

Results: Increased trunk velocity showed potentially large correlations with reduced disability (r=-0.60, 95% CI: -0.90, 0.09) and improved pain self-efficacy (r=0.64, 95% CI: -0.17, 0.93) over time, although there was statistical uncertainty for these estimates.

Conclusions: In people with lifting-related LBP undergoing CFT, increased trunk velocity during lifting showed potentially large correlations with reductions in disability and improvements in pain self-efficacy. These findings highlight the potential clinical importance of trunk velocity as both a monitoring measure and treatment target.

Objectives: Understanding of long-term lung cancer risks from radon decay products (RDP) exposure derives largely from studies of uranium miners. We aimed to compare mortality for lung and other cancers to the general population, to estimate excess absolute rate (EAR) and excess relative rate (ERR) from RDP exposure, and to estimate the joint effects of RDP and cigarette smoking in extended follow-up of a cohort of 4137 male uranium miners from the US Colorado Plateau.

Methods: We extended mortality follow-up through 2016 and re-evaluated RDP exposure against original work history and mine records. We calculated standardised mortality ratios (SMRs) compared with a regional population, evaluated EAR of lung cancer mortality using standardised rate ratios and modelled ERR using Cox proportional hazards regression. We evaluated interactions of RDP with smoking pack-years, attained age (AA) and time-since-exposure (TSE).

Results: There were 695 lung cancer deaths, including 146 among never-smokers and light smokers. The overall SMR was >4; the EAR per unit RDP exposure increased substantially with smoking pack-years and decades of follow-up. Lung cancer ERR decreased with AA and TSE. ERR attenuation at high exposure rates was smaller than observed elsewhere. Joint effects of RDP and smoking were submultiplicative but greater-than-additive, appearing closer to multiplicative at lower RDP exposures. Pancreas was the only other site showing a significantly positive ERR per unit exposure.

Conclusions: Excess rates of lung cancer mortality persist throughout the lifespan among this cohort of uranium miners. Information about RDP-smoking interactions is of interest for occupational and general population exposure.

Objectives: Studies on accelerometer-measured daily physical activity behaviour, especially among hybrid and remote workers, are scarce. We compared daily occupational and non-occupational physical activity and sedentary time among manual, in-office, hybrid and remote workers. In addition, physical activity behaviour during remote and office workdays among hybrid workers was compared.

Methods: Daily physical activity behaviour was collected with wrist-worn accelerometers on ≥4 days from 133 Finnish workers (31 years, 61% women). Participants were divided into four groups according to their work modes: manual (n=32), in-office (n=49), hybrid (n=35) and remote workers (n=17). Differences in physical activity and sedentary time during workdays (separately for occupational and non-occupational time) between the groups were examined using generalised linear models. Linear mixed models were used for intra-individual differences among hybrid workers.

Results: Workdays' occupational physical activity and sedentary time differed between the work mode groups (p<0.0001); the manual workers accumulated the highest occupational physical activity, while both hybrid and remote workers accumulated the highest occupational sedentary time. No differences in non-occupational behaviours were observed. Among hybrid workers, occupational sedentary time tended to be higher (26 min, 95% CI -2 to 53) during remote versus office workdays, but non-occupational behaviours were similar.

Conclusions: Remote work is associated with the lowest physical activity and the highest sedentary time compared with other work modes. Strategies to promote physical activity during remote workdays may be needed.

Objectives: We investigated associations between occupational noise and gestational diabetes mellitus, pregnancy-related hypertension (including pre-eclampsia/eclampsia), preterm birth and small for gestational age (SGA) infants.

Methods: Data were analysed for 7889 singleton, live-born infants without major birth defects or chromosomal disorders and their mothers from the National Birth Defects Prevention Study from 1997 to 2011. Typical maternal occupational noise exposure in all jobs held from 1 month prior to conception through the end of pregnancy was estimated by expert rater and categorised as quiet (<60 A-weighted decibels (dBA)), low (60-75 dBA), moderate (76-84 dBA) or loud (>85 dBA). Multiple logistic regression was used to estimate associations (adjusted ORs and 95% CIs) between noise exposure levels and outcomes.

Results: Approximately 77.4% of pregnant workers had quiet levels of occupational noise exposure, 11.0%, 10.1% and 1.5% had low, moderate and loud exposure levels, respectively. Compared with quiet levels of noise, pregnant workers exposed to low levels of noise had decreased odds of delivering an SGA infant (adjusted OR (aOR)=0.72; 95% CI 0.53 to 0.99) and those exposed to moderate levels had increased odds of delivering an SGA infant (aOR=1.37; 95% CI 1.05 to 1.77). No other significant associations were observed.

Conclusion: Maternal occupational noise exposure below the 85 dBA threshold recognised as hazardous may be associated with SGA among infants. Elevated point estimates (>1) were observed for the highest noise exposure category and all outcomes, though CIs were wide and statistical significance was not attained. Further research is warranted to address existing knowledge gaps.

Objectives: To determine the effects of work exposures on fertility in tradeswomen.

Methods: Women apprenticed in welding and electrical trades across Canada were recruited (2011-2017) to a prospective cohort and contacted every 6 months for up to 5 years. At each contact, participants provided information on conceptions, sexual activity, birth control and pregnancy attempts. Occupational exposures to ergonomic factors and, for welders, to metals and dust in welding fume were estimated from task-specific questionnaires. The OR of clinical infertility for work in welding was estimated. Time ratios (TR), relative times to conception, were estimated for first pregnancy in an accelerated failure time (AFT) regression with a log normal distribution of the hazard, to assess the relation of exposure to conception.

Results: 885 women were recruited, 447 in welding and 438 in electrical trades. 96 reported a period of clinical infertility (prevalence 10.8%) with 70/96 infertile since joining the trade. There was no excess in welders (OR=0.81 95% CI 0.49 to 1.33). 372 women were nulliparous and met selection criteria for further analysis. In the final multivariable model for welders, TR was increased with working >8 days without a rest day (TR=3.06 95% CI 1.03 to 9.05), reporting hand-arm vibration for >1 h/day (TR=3.06 95% CI 1.13 to 8.34) and with increasing aluminium exposure (TR=1.38 95% CI 1.05 to 1.80). Among electrical workers, TR was increased in those working above shoulder height for ≥2 h/day (TR=1.88 95% CI 1.19 to 2.97).

Conclusion: Work in welding did not increase the risk of clinical infertility, but time to first pregnancy reflected preventable work exposures.

Objectives: This is the first study to use real-life electronic medical record data from occupational health (OH) primary care to evaluate how often physicians assess and confirm diagnoses' work relatedness (the definition implying causal or aggravating factors at work) in relation to the physicians' expertise, allocated appointment time and type of diagnosis.

Methods: We analysed registered data on face-to-face appointments with an occupational physician (n=70 163) at a Finnish OH service provider in 2020-2022, using cross tabulations and logistic regression to estimate the likelihood of assessments and conclusions that the diagnoses are work related, depending on whether the physician was specialised in OH, the appointment duration and the diagnoses' International Classification of Diseases-10 (ICD-10) categories.

Results: The work relatedness of diagnoses was assessed in 58.1% of appointments, most likely when appointments were longer and diagnoses belonged to the ICD-10 categories of injuries, mental disorders and rarely used 'other reasons for visiting healthcare' category. The main diagnosis was considered work related in 8.9% of the appointments, more likely when the physician was an OH specialist and the appointments were longer. In the adjusted models, the highest ORs (OR, 95% CI) for the diagnoses being classed as work related were in cases of mental disorders (5.82, 5.01 to 6.76), musculoskeletal diseases (7.46, 6.66 to 8.35) and injuries (18.14, 16.06 to 20.48).

Conclusion: Although a requirement, work relatedness was assessed in less than 60% of the appointments in OH primary care. Work-related diseases were rarely confirmed. Further research is required to find factors that could improve such assessments.