Journal of Occupational Medicine and Toxicology最新文献

Background: Currently, the most widely used method to determine lumbar intervertebral disc degeneration is MRI. However, the evaluation of imaging signs of disc degeneration involves several subjective assessments. The aim of this study was to investigate differences in radiological assessments between two independent reports of the same MRI, emphasizing that the identical images were assessed twice by different raters.

Materials: MRI of the lumbar and cervical spine of a population-based random sample of women and a sample of female nurses, geriatric nurses and care workers as a subgroup with a relatively high level of work-related stress on the lumbar spine was performed. Each MRI was then assessed by two radiologists from the corresponding clinic that had examined the participant. Ten criteria were assessed: three continuous and seven categorical parameters. Agreement was assessed with bias and dispersion figures or agreement and Cohen's kappa for categorical parameters.

Results: Double diagnosis of 318 participants with available MR images of the cervical and lumbar spine were performed. The results show that there is remarkable consensus on some parameters as well as substantial disagreement on others-the agreement of the two reports for categorical parameters, as measured by Cohen's kappa, ranges from 0.04 to 0.57. For continuous measurements, the percentage difference ranges from 8 to 24%; it depends on the extent of the subjectivity of the parameter to be rated.

Conclusion: The interrater reliability of MRI readings of the lumbar spine is greater when clearly defined parameters and measurement methods are used. Therefore, it should be investigated which easy to use rating scales can be implemented in daily clinical practice to make reports more reliable and useful for clinicians. One way to reduce subjectivity might be the use of reference images.

Background: This study examines trends in delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) positivity rates in pre-employment urine drug screenings at a single university-based hospital occupational medicine clinic from 2017 to 2022, following California's recreational cannabis legalization in 2016, with sales beginning officially on January 1, 2018.

Methods: Retrospective analysis of 21,546 de-identified urine drug screenings from 2017 to 2022 was conducted. Initial screening used instant urine drug immunoassays (50 ng/mL cutoff for THC-COOH), followed by confirmatory gas chromatography-mass spectrometry (15 ng/mL cutoff). Positivity rates were calculated annually, and descriptive statistics summarized age and gender distributions among positive cases. The Cochran-Armitage trend test assessed temporal trends.

Results: Of 21,546 screenings, 92 (0.44%) were THC-COOH-positive. The positivity rate increased from 0.12% (4/3,215) in 2017 to 0.94% (45/4,784) in 2022 (Cochran-Armitage, Z = 5.19, p < 0.001), a 683.33% relative increase (absolute change: 0.82%). Among positive cases, 76% were aged 20-39 (mean: 29.00 years, SD = 9.5), and the female proportion rose from 25.00 to 62.22%. Median THC-COOH levels ranged from 60.00 to 176.50 ng/mL (overall: 145.0, IQR: 309.5).

Conclusion: THC-COOH positivity rates increased significantly post-legalization, potentially influenced by increased cannabis use. Urine tests detect past use, not impairment, highlighting the need for impairment-focused testing per Assembly Bill 2188 (2024). Missing total sample demographic data limit age/gender subgroup analyses.

Aim: To assess the association between WRIMC and perceived stress among physicians through the lens of 'occupational context' and psycho-physiological stressors as mediators.

Methods: A cross-sectional study was conducted in Albania in January 2025 including a representative sample of 367 physicians (≈ 66% females; overall response rate: ≈90%). A structured 36-item questionnaire included demographic characteristics, WRIMC exposure and related psycho-physiological stressors and the Perceived Stress Scale (PSS). Multivariable-adjusted ordinal logistic regression was used to assess the direct association between WRIMC-related exposures and PSS scores, whereas mediation analysis was used to assess indirect effects using the perceived impact of work on stress level and psycho-physiological stressors as mediators.

Results: Physicians had moderate-to-high exposure frequencies to work-related phone usage, instant messages and calling, app-based instant messaging, WRIMC beyond work hours, during vacations or after 22:00 o'clock. WRIMC via apps, irritability due to WRIMC interruptions, guilt over not responding to WRIMC and mental fatigue due to WRIMC were identified as ordinal correlates of perceived stress (β = 0.48, β = 0.65, β = 0.33 and β = 0.37, respectively). The perceived impact of work served as a partial mediator (β = 1.07) between WRIMC and PSS scores, though a direct effect of WRIMC on PSS was also observed (β = 2.57). Physicians' age was a negative covariate in both indirect and direct effects.

Conclusions: Physicians are highly exposed to WRIMC which may be associated with certain psycho-physiological stressors. The perceived occupational stress context of instant messaging and calling might represent a significant pathway beyond technostress per se, which may be interconnected with or distinct from work-related stress.

Background: Occupational COVID-19 remains a challenge among healthcare personnel (HCP).

Methods: This study documents three COVID-19 outbreaks that occurred among vaccinated HCP within a single health care system (HCS) in California, USA in June and August 2023. The Employee Health (EH) unit for the HCS conducted surveillance with structured interviews, identifying outbreaks in real-time.

Results: In June, 10 of 25 staff (40%) at a rural outpatient clinic that serves the HCS contracted COVID-19. One week later, 10 of 90 staff (11%) at a second outpatient clinic were infected, with half the cases were staff of a single close-knit team. In August, a team-building retreat of staff from the main hospital of the HCS resulted in 15 of 23 participants (65%) contracting COVID-19. The combined attack rate for these outbreaks was 25% (95% CI: 18-32%).

Discussion: These outbreaks, despite high vaccination rates among the employees, reveal gaps in infection control, underscoring the need for stricter masking, improved ventilation, and rigorous surveillance testing. Rapid response to outbreaks and reinforcing education on symptom-based work exclusions are critical to preventing transmission among health care workers (HCWs) and their patients.

Background: Occupational exposure to pesticides has been linked to hepatobiliary diseases, particularly liver cancer and cholangiocarcinoma (CCA). In Thailand, pesticides are crucial for agriculture, enhancing crop protection and yields. This study aimed to determine the association between pesticide exposure and the prevalence of hepatobiliary diseases among agricultural workers in Northeastern Thailand.

Methods: The abdominal ultrasonographic findings of the CCA risk population were retrieved from the Isan cohort. Biological monitoring data on pesticide exposure were collected via serum cholinesterase testing from 8 provinces in Northeast Thailand, including Khon Kaen, Roi Et, Udon Thani, Nong Bua Lamphu, Kalasin, Buriram, Nakhon Phanom, and Sakon Nakhon provinces during 2016-2024. Data was analyzed using descriptive and inferential statistics with the STATA version 11.0 program.

Results: Of the 917 agricultural workers, the average age was 54.88 years (SD = 8.53), 552 were female (60.20%), and 365 were male (39.80%). The highest prevalence of hepatobiliary disease (46.03%) and abnormal serum cholinesterase levels (89.42%) among agricultural workers was observed in Sakon Nakhon province. The prevalence of abnormal serum cholinesterase in males (84.11%) was higher than in females (65.76%) (p < 0.001). Multiple logistic regression analyses showed a significantly positive association between abnormal serum cholinesterase levels and hepatobiliary diseases among agricultural workers (OR_adj = 3.64, 95% CI = 2.46-5.38, p < 0.001).

Conclusions: Our study highlights the association between pesticide exposure, indicated by abnormal serum cholinesterase levels, and an increased risk of hepatobiliary diseases. This finding underscores the importance of targeted interventions and public health policies that focus on educating agricultural workers on safe pesticide handling, promoting awareness campaigns, and implementing surveillance efforts to reduce exposure and mitigate the burden of hepatobiliary diseases, particularly in high-risk populations.

Background: During the Sudan war, healthcare workers have encountered extraordinary challenges, including physical assaults and the immense strain of delivering care with critically limited resources. These conditions are likely to intensify burnout among healthcare professionals. This study aimed to determine the prevalence of burnout among Sudanese healthcare workers and investigate the coping mechanisms they employ during the ongoing conflict.

Methods: A cross-sectional study was conducted among Sudanese healthcare workers using the standardized Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Multivariable linear regression analysis was conducted to identify independent predictors of burnout domains. A significance level of p < 0.05 was considered for all statistical tests.

Results: High emotional exhaustion was reported by 13.7% of participants, while 56.5% experienced high depersonalization, and only 4.4% reported low levels of personal accomplishment. The leading coping mechanism was talking with friends and family, adopted by 28.8% of participants, while 15.5% turned to spiritual or religious practices.

Conclusion: Sudanese healthcare workers demonstrate high levels of burnout, particularly in the depersonalization domain, with talking to friends and family being the most commonly used coping mechanism. Future research is needed to explore the unique stressors faced by healthcare workers in conflict-affected settings like ours.

Objective: This study aimed to investigate the impact of occupational thermal exposure on shift workers, specifically whether cold exposure elicits distinct physiological responses and thermoregulatory recovery across different tasks and shift types.

Methods: Observational study at two factories processing prawns in Northern Norway in which 32 shift-working seafood handlers with different task responsibilities were followed for a single shift (morning, evening, night). The participants answered questionnaires regarding thermal exposures at work and related symptoms; these were compared to answers from 12 administration workers. Personal thermal loggers measured the range of temperature exposures associated with four different seafood handler work tasks. Pre- and post-shift plasma levels of FGF21, GDF15 and cytokines were analysed using immunoassays. As a proxy for thermoregulatory response across different shift types, hand temperature was measured repeatedly before and after breaks using a thermal imaging camera.

Results: Most seafood handlers reported subjective impact from cold exposure. Cold working conditions of ≤ 10 ℃ were measured across all shifts and three different seafood handling tasks. The morning shift-seafood handlers displayed lower plasma FGF21 post-shift vs. pre-shift; the evening and night shifts showed no difference. GDF15 levels remained unchanged regardless of shift types but were positively correlated with age. Night shift was associated with increased plasma IL6 post-shift vs. pre-shift. Thermoregulatory responses showed a positive linear relationship with break duration but did not differ between shifts.

Conclusions: The findings suggest that exposure levels are closely linked to specific tasks and shifts, with thermoregulatory responses varying by task type and time of day.