Occupational Medicine-Oxford最新文献

Background: Exposure to benzene is a widespread occupational hazard that has been associated with haematopoietic neoplasms. The increasing awareness of the health effects that can arise from extended dermal contact with aromatic hydrocarbons, such as benzene, may elevate the risk of skin cancer.

Aims: This study addresses the association between occupational benzene exposure and its incidence and mortality, encompassing non-melanoma skin cancer (NMSC), including basal cell carcinoma and squamous cell carcinoma, as well as cutaneous melanoma (CM).

Methods: After removing duplicates, we screened 5652 articles from four different sources (Embase, Pubmed, Scopus and IARC Monographs), retrieving 29 independent studies on occupational benzene exposure and skin cancer. The meta-analysis used a random-effects model, overall and stratifying by gender, publication year, outcome, geographic region, industry type and study design.

Results: The analysis encompasses 18 risk estimates on CM and 21 on either NMSC or not-specified skin cancer (NM/NS) mostly from Europe and North America and predominantly from oil industry cohorts. There was no association with either CM (relative risk [RR] = 0.99, 95% confidence interval [CI] 0.81; 1.21) or NM/NS (RR = 1.19, 95% CI 0.94; 1.50), except for a positive association between employment in the chemical industry and NM/NS risk. There was no evidence of publication bias for either type of cancer (P = 0.70 and P = 0.08).

Conclusions: Our meta-analysis found no association between occupational benzene exposure and skin cancer. Further research should aim to describe the association of benzene exposure with skin cancer in less developed countries and among various occupations.

Background: The disproportionate impact of coronavirus disease (COVID-19) on healthcare workers has been highlighted; however, there is a lack of evidence regarding other high-risk occupations and industries.

Aims: This study estimated the risk of severe COVID-19 among a large cohort of workers in Ontario, Canada.

Methods: This study used a cohort of 1.2 million workers identified using workers' compensation claims records (1983-2019). Identified workers were linked with emergency department (ED) visits and hospitalizations (2020-2021). Cases coded as U0.71 (virus detected, confirmed case) were identified from ED visits and hospitalizations. Hazard ratios (HRs) and 95% confidence intervals (CI95%) for COVID-19 for each occupational group compared to all other workers in the cohort were calculated, adjusting for age and birth year. Standardized incidence ratios and 95% CI, comparing workers to the general population of Ontario were also calculated, adjusting for age, sex, year and region.

Results: A total of 10 322 severe COVID-19 cases among workers were identified through ED visits and hospitalizations. Workers in material handling (HR=1.32, CI95%=1.21-1.43), medicine and health (HR=1.27, CI95%=1.18-1.37), processing (food, water, textile) (HR=1.23, CI95%=1.12-1.36) and machining occupations (HR=1.11, CI95%=1.02-1.20) had some of the highest risks of COVID-19 when compared to all other workers in the cohort. Findings were somewhat consistent when comparing workers to the general population of Ontario.

Conclusions: Certain groups of workers in this cohort demonstrated elevated risks of severe COVID-19. The findings align with previous studies and emphasize the need to include occupational surveillance methods in future pandemic preparedness in Canada.

Background: Healthcare workers (HCWs) report higher rates of long coronavirus disease (COVID) (LC) than other occupational groups. It is still unclear whether LC is a lifelong condition. Workforce shortfalls are apparent due to sick leave, reduced hours and lower productivity.

Aims: To investigate the lived experience of LC on a range of HCWs, including impact on health-related quality-of-life (HRQL), use of health services, working and personal lives and household finances.

Methods: Longitudinal mixed methods with online surveys and qualitative interviews 6-months apart. HCWs including healthcare professionals, ancillary and administration staff who self-report LC were recruited through social media and National Health Service channels. Interviewees were purposively sampled from survey responses.

Results: The first survey was completed by 471 HCWs (S1) and 302 (64%) the follow-up (S2). A total of 50 HCWs were interviewed initially and 44 at second interview. All participants experienced various relapsing, remitting, changing and prolonged LC symptoms (mean 7.1 [SD 4.8] at S2) and a third reported day-to-day activities 'limited a lot'. Most participants were working in a reduced capacity: reduced hours, different role or location. Healthcare was limited, and often unsatisfactory. Participants feared reinfection, their future, ability to work and financial security (59% (n = 174) at S2). They experienced stigma, distress, grief for their former self and some felt unsupported, however, as awareness of LC grew some experienced improved understanding and support.

Conclusions: Most participants continued working, managing complex and dynamic symptoms effecting their everyday life and ability to work. Most did not report significant improvements over time and feared for their future and financial security.

Background: Preceding studies of environmental and occupational risk factors of sarcoidosis yielded inconsistent findings.

Aims: We aimed to ascertain the occupational risk factors for sarcoidosis in a case-control study.

Methods: A total of 237 sarcoidosis patients with a histologically confirmed diagnosis were matched with 474 controls for sex and age (median 49, interquartile range 37; 60 years) recruited from the university hospitals and outpatient centres in Belarus, Kazakhstan and the Russian Federation. Ever and cumulative (considering years and hours per week) exposure to 24 occupational factors were analysed using logistic regression.

Results: In the overall sample of 711 subjects, 50% were females and any occupational exposure was more prevalent in cases compared to controls (60% versus 40%, P < 0.001). Current daily smoking as opposed to ex-smoking was associated with the lower risk of the outcome. Adjusted for smoking, age, sex and a few other exposures, ever-exposure to hay in agriculture (odds ratio (OR) 3.64 (95% confidence interval (CI) 1.26; 10.50)), engine exhausts (OR 2.94 (95% CI 1.14; 7.54)) and printing equipment (OR 1.66 (95% 1.03; 2.68)) was associated with sarcoidosis. The effect was also positive for cumulative exposure to hay in agriculture (OR 2.02 (95% CI 1.00; 4.07)), stone dust (OR 1.07 (95% CI 1.01; 1.14)) and engine exhausts (OR 1.18 (95% CI 1.03; 1.38)) and was stronger in never-smokers and subjects 40 years and older.

Conclusions: Widespread occupational exposures may increase the risk of sarcoidosis, but further research is needed to elucidate the complex interplay of environmental and occupational factors in the epidemiology of sarcoidosis.

Background: Systemic sclerosis (SSc) is the connective tissue disease with the highest individual mortality. Crystalline silica is known to be an occupational risk factor for SSc. To assess past crystalline silica exposure, we aimed to study the validity of a job exposure matrix (JEM) to assess occupational exposure to crystalline silica compared to specific occupational interviews in two populations of SSc patients.

Aims: To demonstrate the reliability of JEM for the assessment of occupational exposure to hazards such as silica, in severe rare disorders like SSc.

Methods: Patients from two university hospital centres underwent standardized assessment of occupational silica exposure and collected job histories through face-to-face interviews. A JEM from the French program Matgéné was used to assess silica exposure and compared to the standardized interview results. Standard metrics were computed for evaluate the accuracy of JEM.

Results: 67 participants from Rennes, and 119 from Tours were included, with respectively 10.5% and 18.0% of patients with silica exposure based on the results of the interview. The JEM with 50% probability cut-off had a good performance when compared with the classic assessment method. A cumulative exposure index from JEM over 250 had an area under the curve between 0.76 and 0.79 and also a very high positive likelihood ratio (17.14 and 10.29).

Conclusions: Despite limitations inherent to JEMs and associated validation methods, the JEM used in this setting provided accurate results to assess occupational exposure to crystalline silica for clinical purposes such as in SSc patients, especially to detect positive cases.