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Accuracy of chest x-ray screening of silica-exposed miners for tuberculosis. 对暴露于二氧化硅的矿工进行胸部 X 射线肺结核筛查的准确性。
IF 2.4 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-29 DOI: 10.1093/occmed/kqae043
B Maboso, R I Ehrlich

Background: The World Health Organization recommends systematic chest X-ray (CXR) screening for tuberculosis (TB) in silica-exposed workers. However, evidence on the accuracy of CXR screening in such populations is lacking.

Aims: To measure the accuracy of CXR screening for active TB in silica-exposed miners, in a population with a high prevalence of silicosis, post-TB lung disease and HIV.

Methods: A secondary analysis of data from a miner screening programme in Lesotho was undertaken. We measured the performance of CXR (in participants with and without cough) for 'abnormalities suggestive of TB' against Xpert MTB/RIF (Xpert). The sample size was 2572 and positive Xpert prevalence was 3%.

Results: CXR alone had high sensitivity (0.93, 95% confidence interval [CI] 0.87-0.99), but low specificity (0.41, 95% CI 0.39-0.42). Requiring cough and a positive CXR increased specificity (0.79, 95% CI 0.77-0.81), resulting in reduced sensitivity (0.41, 95% CI 0.30-0.52). There was no difference in CXR accuracy by HIV status. However, specificity was markedly reduced in the presence of silicosis (from 0.70, 95% CI 0.68-0.72, to 0.03, 95% CI 0.02-0.04) or past TB history (from 0.59, 95% CI 0.56-0.62 to 0.27, 95% CI 0.25-0.29). Throughout, positive predictive value remained very low (5%) and negative predictive value very high (99%).

Conclusions: CXR screening accurately identifies TB-negative CXRs in this population, but post-TB lung disease and silicosis would result in a high proportion of Xpert-negative referrals and an increased risk of unneeded empirical treatment. Adapted screening algorithms, practitioner training and digital access to previous mining CXRs are needed.

背景:世界卫生组织建议对接触二氧化硅的工人进行系统的胸部 X 光(CXR)肺结核(TB)筛查。目的:在矽肺病、结核病后肺部疾病和 HIV 感染率较高的人群中,对暴露于二氧化硅的矿工进行活动性肺结核胸部 X 光筛查的准确性进行测量:对莱索托矿工筛查计划的数据进行了二次分析。我们对照 Xpert MTB/RIF (Xpert),测量了 CXR(有咳嗽和无咳嗽的参与者)对 "提示肺结核的异常情况 "的检测结果。样本量为 2572 份,Xpert 阳性率为 3%:结果:仅做 CXR 的灵敏度较高(0.93,95% 置信区间 [CI] 0.87-0.99),但特异性较低(0.41,95% 置信区间 0.39-0.42)。要求咳嗽和 CXR 阳性会增加特异性(0.79,95% CI 0.77-0.81),但会降低敏感性(0.41,95% CI 0.30-0.52)。艾滋病毒感染状况对 CXR 的准确性没有影响。但是,如果存在矽肺(从 0.70,95% CI 0.68-0.72 降至 0.03,95% CI 0.02-0.04)或既往结核病史(从 0.59,95% CI 0.56-0.62 降至 0.27,95% CI 0.25-0.29),特异性则明显降低。在整个筛查过程中,阳性预测值仍然很低(5%),阴性预测值很高(99%):结论:胸片筛查能准确识别肺结核阴性胸片,但肺结核后肺部疾病和矽肺会导致高比例的 Xpert 阴性转诊,增加不需要的经验性治疗的风险。因此需要对筛查算法进行调整,对从业人员进行培训,并通过数字化手段获取以往的采矿CXR。
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引用次数: 0
Mental health and employment outcomes in working-age US adults, 2010-2019. 2010-2019 年美国劳动适龄成年人的心理健康和就业结果。
IF 2.4 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-26 DOI: 10.1093/occmed/kqae054
J Jou, A Hicks, P J Johnson

Background: Individuals with severe mental illness experience greater unemployment and barriers to workforce re-entry. However, less is known about additional indicators of employment stability for individuals across mental illness severity.

Aims: This study aims to examine associations between mental illness severity, use and adequacy of mental health treatment, and indicators of employment stability.

Methods: In this repeated cross-sectional study, 2010-2019 data from the U.S. National Survey of Drug Use and Health were used to construct multivariate logistic regression models predicting the odds of part-time employment, past-year work interruption, number of past-year employers, and past-month health-related work absence by mental illness severity and adequacy of mental health treatment.

Results: Compared to individuals with no mental illness, those with any and severe mental illness had significantly higher odds of part-time employment (adjusted odds ratios [AORs] = 1.51 and 2.16, 95% confidence intervals [CIs] 1.4-1.6 and 2.0-2.3), multiple past-year employers (AORs = 1.78 and 2.34, CIs 1.7-1.9 and 2.1-2.6), past-year work interruption (AORs = 1.69 and 2.20, CIs 1.6-1.8 and 2.1-2.4), and >7 days of past-month work absence (AORs = 2.51 and 3.82, CIs 2.3-2.8 and 3.3-4.5). Among respondents with mental illness, perceived inadequacy of mental treatment predicted higher odds of all adverse employment outcomes.

Conclusions: Compared to those with no mental illness, individuals with mental illness of any severity have higher odds of employment instability. Policy and programmatic support aimed at addressing the needs of individuals with mental illness, including access to adequate mental health treatment, are needed to facilitate continued, competitive employment.

背景:患有严重精神疾病的人失业率更高,重新就业的障碍也更大。目的:本研究旨在探讨精神疾病严重程度、精神健康治疗的使用和充分性与就业稳定性指标之间的关联:在这项重复性横断面研究中,我们使用了 2010-2019 年美国全国药物使用与健康调查的数据,构建了多变量逻辑回归模型,根据精神疾病严重程度和精神健康治疗的充分性预测兼职就业、过去一年工作中断、过去一年雇主数量以及过去一个月与健康相关的缺勤几率:与无精神疾病的人相比,患有任何精神疾病和严重精神疾病的人从事兼职工作的几率明显更高(调整后的几率比 [AORs] = 1.51 和 2.16,95% 置信区间 [CIs] 1.4-1.6 和 2.0-2.3)。3)、过去一年有多个雇主(AORs = 1.78 和 2.34,CIs 1.7-1.9 和 2.1-2.6)、过去一年工作中断(AORs = 1.69 和 2.20,CIs 1.6-1.8 和 2.1-2.4)以及过去一个月缺勤超过 7 天(AORs = 2.51 和 3.82,CIs 2.3-2.8 和 3.3-4.5)。在患有精神疾病的受访者中,认为精神治疗不充分预示着出现所有不良就业结果的几率更高:结论:与没有精神疾病的人相比,患有任何严重程度精神疾病的人都有更高的就业不稳定性。我们需要政策和项目支持来满足精神病患者的需求,包括获得适当的心理健康治疗,以促进持续的、有竞争力的就业。
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引用次数: 0
Sleep quality according to chronotype in nurses working 8-hour shifts. 8 小时轮班护士的睡眠质量与时间类型有关。
IF 5.1 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-11 DOI: 10.1093/occmed/kqae029
H Yang, S Kim, S-H Yoo, Y Mun, M L Choi, J A Lee, E Song

Background: To date, studies have been focused on sleep disturbances of nurses working during night shifts. There is a lack of understanding regarding the sleep quality of nurses working in the rapid rotation system for each type of shift work.

Aims: To determine the relationship between chronotype and sleep quality according to shift type (i.e. day, evening and night shifts) in nurses working 8-hour rotating shifts.

Methods: A cross-sectional, descriptive study was conducted from two tertiary hospitals in South Korea from December 2021 to September 2022, including nurses working 8-hour rotating shifts (N = 74). They completed questionnaires to measure general, occupational and sleep-related characteristics, chronotype, insomnia severity and daytime sleepiness. Additionally, sleep parameters were collected from actigraphy and sleep diaries for 7 days.

Results: A total of 64% of nurses had an evening chronotype and 37% of nurses had an intermediate chronotype. Nurses had significantly less total sleep time and worsened sleep latency and efficiency during the day shift compared to other shift types. Compared to nurses with an intermediate chronotype, those with an evening chronotype had poorer sleep quality during day shift work.

Conclusions: Strategies to enhance nurses' sleep quality during day shifts should consider a two-level approach: individual approaches, such as improving sleep hygiene, and administrative approaches, such as establishing a chronotype-based shift system for scheduling.

背景:迄今为止,研究主要集中于夜班护士的睡眠障碍。目的:根据轮班类型(即白班、晚班和夜班)确定 8 小时轮班护士的时型与睡眠质量之间的关系:方法:2021 年 12 月至 2022 年 9 月,在韩国两家三级医院开展了一项横断面描述性研究,研究对象包括 8 小时轮班工作的护士(N = 74)。他们填写了调查问卷,以测量一般、职业和睡眠相关特征、慢性型、失眠严重程度和白天嗜睡情况。此外,还从动电仪和睡眠日记中收集了 7 天的睡眠参数:结果:共有 64% 的护士属于晚间时型,37% 的护士属于中间时型。与其他班次相比,白班护士的总睡眠时间明显减少,睡眠潜伏期和睡眠效率也有所下降。与中间时型的护士相比,晚间时型的护士在白班工作期间的睡眠质量更差:提高护士白班睡眠质量的策略应考虑两个层面:个人方法(如改善睡眠卫生)和管理方法(如建立基于时型的排班系统)。
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引用次数: 0
Work and Retirement Among Women: The Health and Employment After Fifty Study. 妇女的工作与退休:五十岁后健康与就业研究》。
IF 5.1 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-11 DOI: 10.1093/occmed/kqae035
G Palermo, S D'Angelo, G Ntani, G Bevilacqua, K Walker-Bone

Background: Women increasingly work beyond age 50+ but their occupational health is under-researched.

Aims: To investigate what jobs older contemporary women do, when they exit their jobs and what factors predict job exit.

Methods: Data came from the Health and Employment After Fifty cohort, which recruited women aged 50-64 at baseline in 2013-14 and has followed them up annually collecting: demographic, lifestyle and work information. Exits from employment were mapped longitudinally over five follow-ups. Time-to-first event Cox regression analyses were used to identify risk factors for job exit.

Results: At baseline, 4436 women participated, 64% of whom were working. The proportions of women working at 50-54, 55-60 and over 60 years were 86%, 79% and 38%, respectively. Amongst all women, after adjustment for age, managing comfortably financially and not coping with the mental demands of the job were associated with exit. Risk factors for job exit differed in the age bands: 50-54; 55-59 and >60 years, reflecting socio-economic status, markers of health (musculoskeletal pain and poor self-rated health) and work factors (under-appreciation, job dissatisfaction, temporary/permanent contracts, coping with work's physical demands).

Conclusions: Factors contributing to exit from work among older women differ by age group, after controlling for perceived financial position, age and mental demands of the job. A number of work characteristics predict job exit and suggest that employers can play an important role in supporting women to continue working until older ages. Identification and treatment of musculoskeletal pain could also enable work amongst older women.

背景:50 岁以上的女性越来越多地参加工作,但对她们的职业健康研究不足:目的:调查当代老年妇女从事哪些工作、何时离职以及哪些因素会影响她们的离职:数据来自 "五十岁后的健康与就业 "队列,该队列于 2013-14 年招募了 50-64 岁的基线女性,并每年对她们进行跟踪调查,收集人口、生活方式和工作信息。在五次随访中对离职情况进行了纵向调查。采用时间-首次事件考克斯回归分析来确定离职的风险因素:基线调查共有 4436 名妇女参加,其中 64% 的妇女有工作。50-54岁、55-60岁和60岁以上女性的工作比例分别为86%、79%和38%。在所有妇女中,在对年龄进行调整后,经济状况良好和无法应对工作的精神需求与离职有关。不同年龄段的离职风险因素有所不同:50-54岁、55-59岁和60岁以上年龄段的离职风险因素各不相同,反映了社会经济地位、健康指标(肌肉骨骼疼痛和自评健康不佳)和工作因素(不受重视、对工作不满意、临时/长期合同、应付工作的生理需求):结论:在控制了经济状况、年龄和工作的精神要求之后,导致老年妇女离职的因素因年龄组而异。一些工作特征可以预测离职情况,这表明雇主在支持妇女继续工作到老年方面可以发挥重要作用。识别和治疗肌肉骨骼疼痛也可以使老年妇女能够继续工作。
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引用次数: 0
Cardiovascular and lifestyle risk factors of mild cognitive impairment in UK veterans and non-veterans. 英国退伍军人和非退伍军人轻度认知障碍的心血管和生活方式风险因素。
IF 5.1 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-11 DOI: 10.1093/occmed/kqae027
R Akhanemhe, S A M Stevelink, A Corbett, C Ballard, H Brooker, B Creese, Dag Aarsland, Adam Hampshire, Neil Greenberg

Background: The link between poor cardiovascular health (CVH), lifestyle and mild cognitive impairment (MCI) has been well established in the general population. However, there is limited research exploring these associations in ageing UK veterans.

Aims: This study explored the risk of MCI and its association with nine CVH and lifestyle risk factors (including diabetes, heart disease, high cholesterol, high blood pressure, obesity, stroke, physical inactivity, the frequency of alcohol consumption and smoking) in UK veterans and non-veterans.

Methods: This prospective cohort study comprised data from the PROTECT study between 2014 and 2022. Participants comprised of UK military veterans and non-veterans aged ≥50 years at baseline. Veteran status was defined using the Military Service History Questionnaire. CVH and lifestyle risk factors were defined using a combination of self-report measures, medication history or physical measurements. MCI was defined as the presence of subjective and objective cognitive impairment.

Results: Based on a sample of 9378 veterans (n = 488) and non-veterans (n = 8890), the findings showed the risk of MCI significantly reduced in veterans with obesity, those who frequently consumed alcohol and were physically inactive compared to non-veterans. The risk of MCI significantly increased in veterans with diabetes (hazards ratio [HR] = 2.22, 95% confidence interval [CI] 1.04-4.75, P ≤ 0.05) or high cholesterol (HR = 3.11, 95% CI 1.64-5.87, P ≤ 0.05) compared to veterans without.

Conclusions: This study identified CVH and lifestyle factors of MCI in UK veterans and non-veterans. Further work is needed to understand these associations and the underpinning mechanisms which could determine intervention strategies to reduce the risk of MCI.

背景:在普通人群中,不良心血管健康状况(CVH)、生活方式与轻度认知障碍(MCI)之间的联系已被充分证实。目的:本研究探讨了英国退伍军人和非退伍军人患 MCI 的风险及其与九种心血管健康和生活方式风险因素(包括糖尿病、心脏病、高胆固醇、高血压、肥胖、中风、缺乏运动、饮酒频率和吸烟)之间的关系:这项前瞻性队列研究包括 PROTECT 研究在 2014 年至 2022 年间的数据。参与者包括基线年龄≥50 岁的英国退伍军人和非退伍军人。退伍军人身份通过兵役史问卷进行定义。心血管疾病和生活方式风险因素通过自我报告、用药史或身体测量相结合的方式进行定义。MCI的定义是存在主观和客观认知障碍:基于 9378 名退伍军人(n = 488)和非退伍军人(n = 8890)的样本,研究结果显示,与非退伍军人相比,肥胖、经常饮酒和缺乏运动的退伍军人患 MCI 的风险明显降低。与没有糖尿病的退伍军人相比,患有糖尿病(危险比 [HR] = 2.22,95% 置信区间 [CI] 1.04-4.75,P ≤ 0.05)或高胆固醇(HR = 3.11,95% CI 1.64-5.87,P ≤ 0.05)的退伍军人患 MCI 的风险明显增加:本研究确定了英国退伍军人和非退伍军人中导致 MCI 的心血管健康和生活方式因素。需要进一步开展工作,以了解这些关联及其基础机制,从而确定降低 MCI 风险的干预策略。
{"title":"Cardiovascular and lifestyle risk factors of mild cognitive impairment in UK veterans and non-veterans.","authors":"R Akhanemhe, S A M Stevelink, A Corbett, C Ballard, H Brooker, B Creese, Dag Aarsland, Adam Hampshire, Neil Greenberg","doi":"10.1093/occmed/kqae027","DOIUrl":"10.1093/occmed/kqae027","url":null,"abstract":"<p><strong>Background: </strong>The link between poor cardiovascular health (CVH), lifestyle and mild cognitive impairment (MCI) has been well established in the general population. However, there is limited research exploring these associations in ageing UK veterans.</p><p><strong>Aims: </strong>This study explored the risk of MCI and its association with nine CVH and lifestyle risk factors (including diabetes, heart disease, high cholesterol, high blood pressure, obesity, stroke, physical inactivity, the frequency of alcohol consumption and smoking) in UK veterans and non-veterans.</p><p><strong>Methods: </strong>This prospective cohort study comprised data from the PROTECT study between 2014 and 2022. Participants comprised of UK military veterans and non-veterans aged ≥50 years at baseline. Veteran status was defined using the Military Service History Questionnaire. CVH and lifestyle risk factors were defined using a combination of self-report measures, medication history or physical measurements. MCI was defined as the presence of subjective and objective cognitive impairment.</p><p><strong>Results: </strong>Based on a sample of 9378 veterans (n = 488) and non-veterans (n = 8890), the findings showed the risk of MCI significantly reduced in veterans with obesity, those who frequently consumed alcohol and were physically inactive compared to non-veterans. The risk of MCI significantly increased in veterans with diabetes (hazards ratio [HR] = 2.22, 95% confidence interval [CI] 1.04-4.75, P ≤ 0.05) or high cholesterol (HR = 3.11, 95% CI 1.64-5.87, P ≤ 0.05) compared to veterans without.</p><p><strong>Conclusions: </strong>This study identified CVH and lifestyle factors of MCI in UK veterans and non-veterans. Further work is needed to understand these associations and the underpinning mechanisms which could determine intervention strategies to reduce the risk of MCI.</p>","PeriodicalId":54696,"journal":{"name":"Occupational Medicine-Oxford","volume":" ","pages":"274-282"},"PeriodicalIF":5.1,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11165370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sinonasal cancer incidence in Lombardy, Italy, 2008-20. 2008-20 年意大利伦巴第大区的鼻窦癌发病率。
IF 5.1 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-11 DOI: 10.1093/occmed/kqae034
D Consonni, G Stoppa, A Binazzi, B Dallari, S Stella, S Rugarli, C Trobbiani, A Biggeri, D Catelan, C Mensi

Background: Epithelial sinonasal cancers (SNC) are rare tumours with recognized associations with known/suspected occupational carcinogens (wood/leather dust, nickel/chromium compounds and formaldehyde). In Italy, a national SNC registry organized as a network of regional registries was established by law in 2008.

Aims: To describe SNC time trends, occupational exposures and geographical distribution in Lombardy, North-West Italy, based on population registry data (2008-20).

Methods: The Lombardy SNC Registry records epithelial SNCs using various sources. Interviews to collect occupational history are performed using a standardized questionnaire. Using several standard populations, we calculated yearly crude and age-standardized rates (ASRs per 100,000 person-years). Standardized incidence ratios (SIR) at municipality level were calculated, and Bayesian models were fitted to produce smoothed SIR maps.

Results: We recorded 827 cases (553 men, 274 women). Crude (world standardized) ASRs were 0.9 (0.4) in men and 0.4 (0.2) in women, with no time trends. Interviews were obtained for 485 (88%) men and 223 (81%) women. Among men, 217 (45%) had been exposed to occupational carcinogens (wood/leather dust: 150/65 cases, 31%/13%), while only 36 women (16%) were exposed. Among 201 men with adenocarcinoma, exposure to wood/leather dust occurred in 103/50 cases (75%/50%). Areas with elevated SIRs associated with leather dust were found in the Western areas. Exposure to wood dust was more widespread.

Conclusions: This study found a high frequency of occupational exposures (wood and leather dust), particularly in men with SNC. Employment in shoe industries clustered in the Western part, while work in furniture industries was less spatially structured.

背景:鼻窦上皮癌(SNC)是一种罕见肿瘤,公认与已知/疑似职业致癌物(木材/皮革粉尘、镍/铬化合物和甲醛)有关。目的:根据人口登记数据(2008-20 年),描述意大利西北部伦巴第大区 SNC 的时间趋势、职业暴露和地理分布:伦巴第SNC登记处通过各种渠道记录上皮性SNC。采用标准化问卷进行访谈,收集职业史。我们利用几个标准人群,计算出每年的粗发病率和年龄标准化发病率(ASRs/100,000 人-年)。我们还计算了城市一级的标准化发病率(SIR),并通过贝叶斯模型拟合出平滑的 SIR 地图:我们记录了 827 个病例(553 名男性,274 名女性)。男性的粗略(世界标准化)ASR 为 0.9 (0.4),女性为 0.4 (0.2),没有时间趋势。对 485 名男性(88%)和 223 名女性(81%)进行了访谈。其中,217 名男性(45%)接触过职业致癌物(木屑/皮革粉尘:150/65 例,31%/13%),而只有 36 名女性(16%)接触过职业致癌物。在 201 例男性腺癌患者中,103/50 例(75%/50%)接触过木材/皮革粉尘。与皮革粉尘相关的 SIR 值升高的地区位于西部地区。接触木屑的情况更为普遍:这项研究发现,职业暴露(木屑和皮革粉尘)的频率很高,尤其是在患有 SNC 的男性中。在制鞋业工作的人主要集中在西部地区,而在家具业工作的人在空间上的分布则较少。
{"title":"Sinonasal cancer incidence in Lombardy, Italy, 2008-20.","authors":"D Consonni, G Stoppa, A Binazzi, B Dallari, S Stella, S Rugarli, C Trobbiani, A Biggeri, D Catelan, C Mensi","doi":"10.1093/occmed/kqae034","DOIUrl":"10.1093/occmed/kqae034","url":null,"abstract":"<p><strong>Background: </strong>Epithelial sinonasal cancers (SNC) are rare tumours with recognized associations with known/suspected occupational carcinogens (wood/leather dust, nickel/chromium compounds and formaldehyde). In Italy, a national SNC registry organized as a network of regional registries was established by law in 2008.</p><p><strong>Aims: </strong>To describe SNC time trends, occupational exposures and geographical distribution in Lombardy, North-West Italy, based on population registry data (2008-20).</p><p><strong>Methods: </strong>The Lombardy SNC Registry records epithelial SNCs using various sources. Interviews to collect occupational history are performed using a standardized questionnaire. Using several standard populations, we calculated yearly crude and age-standardized rates (ASRs per 100,000 person-years). Standardized incidence ratios (SIR) at municipality level were calculated, and Bayesian models were fitted to produce smoothed SIR maps.</p><p><strong>Results: </strong>We recorded 827 cases (553 men, 274 women). Crude (world standardized) ASRs were 0.9 (0.4) in men and 0.4 (0.2) in women, with no time trends. Interviews were obtained for 485 (88%) men and 223 (81%) women. Among men, 217 (45%) had been exposed to occupational carcinogens (wood/leather dust: 150/65 cases, 31%/13%), while only 36 women (16%) were exposed. Among 201 men with adenocarcinoma, exposure to wood/leather dust occurred in 103/50 cases (75%/50%). Areas with elevated SIRs associated with leather dust were found in the Western areas. Exposure to wood dust was more widespread.</p><p><strong>Conclusions: </strong>This study found a high frequency of occupational exposures (wood and leather dust), particularly in men with SNC. Employment in shoe industries clustered in the Western part, while work in furniture industries was less spatially structured.</p>","PeriodicalId":54696,"journal":{"name":"Occupational Medicine-Oxford","volume":" ","pages":"304-312"},"PeriodicalIF":5.1,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Healthcare worker burnout during a persistent crisis: a case-control study. 持续危机期间医护人员的职业倦怠:一项病例对照研究。
IF 2.4 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-11 DOI: 10.1093/occmed/kqae032
S Appelbom, A Nordström, A Finnes, R K Wicksell, A Bujacz

Background: During the immediate outbreak of the COVID-19 pandemic, burnout symptoms increased among healthcare workers. Knowledge is needed on how early symptoms developed during the persistent crisis that followed the first pandemic wave.

Aims: To investigate if high levels of burnout symptoms during the first pandemic wave led to high burnout and depressive symptoms up to a year later, and if participation in psychological support was related to lower levels of symptoms.

Methods: A longitudinal case-control study followed 581 healthcare workers from two Swedish hospitals. Survey data were collected with a baseline in May 2020 and three follow-up assessments until September 2021. The case group was participants reporting high burnout symptoms at baseline. Logistic regression analyses were performed separately at three follow-ups with case-control group assignment as the main predictor and burnout and depression symptoms as outcomes, controlling for frontline work, changes in work tasks and psychological support participation.

Results: One out of five healthcare workers reported high burnout symptoms at baseline. The case group was more likely to have high burnout and depressive symptoms at all follow-ups. Participation in psychological support was unrelated to decreased burnout and depressive symptoms at any of the follow-ups.

Conclusions: During a persistent crisis, healthcare organizations should be mindful of psychological reactions among staff and who they place in frontline work early in the crisis. To better prepare for future healthcare crises, preventive measures on burnout are needed, both at workplaces and as part of the curricula in medical and nursing education.

背景:在 COVID-19 大流行刚刚爆发时,医护人员的职业倦怠症状有所增加。目的:调查在第一波大流行期间,高水平的职业倦怠症状是否会导致一年后出现高水平的职业倦怠和抑郁症状,以及参与心理支持是否与降低症状水平有关:一项纵向病例对照研究对瑞典两家医院的 581 名医护人员进行了跟踪调查。收集的调查数据包括 2020 年 5 月的基线调查和 2021 年 9 月之前的三次随访评估。病例组为基线时报告高职业倦怠症状的参与者。在三次随访中分别进行了逻辑回归分析,以病例对照组分配为主要预测因素,以职业倦怠和抑郁症状为结果,并对一线工作、工作任务变化和心理支持参与情况进行了控制:结果:每五名医护人员中就有一人在基线时报告了严重的职业倦怠症状。在所有随访中,病例组更有可能出现高度职业倦怠和抑郁症状。参与心理支持与倦怠和抑郁症状的减少无关:在危机持续期间,医疗机构应注意员工的心理反应,以及在危机早期安排哪些人从事一线工作。为了更好地应对未来的医疗危机,需要在工作场所和医学与护理教育课程中采取预防职业倦怠的措施。
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引用次数: 0
Occupational exposures and sarcoidosis: a rapid review of the evidence. 职业暴露与肉样瘤病:证据快速回顾。
IF 2.4 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-11 DOI: 10.1093/occmed/kqae016
M Rezai, A Nayebzadeh, S Catli, D McBride

Background: Sarcoidosis is a rare, multisystem, inflammatory condition associated with the formation of granulomas. Diagnosis can be challenging because of non-specific symptoms complicating epidemiological investigations of its aetiology. Despite research efforts, a review of the current state of the evidence is needed.

Aims: To assess the evidence for an association between occupational exposures and the development of sarcoidosis. To determine if workers in any occupation are at a greater risk of developing sarcoidosis.

Methods: This rapid review follows the methodology suggested by the World Health Organization. Two electronic databases were systematically searched until April 2022. The methodological quality of the studies was critically appraised, and a best-evidence approach was used to synthesize the results.

Results: Titles and abstracts of 2916 articles were screened, with 67 full-text articles reviewed for eligibility. Among the 13 studies eligible for this review, none were of high quality (i.e. low risk of bias). Six studies exploring the association between sarcoidosis and a range of occupations and exposures, and one previous systematic review were of low quality reporting inconsistent findings. Six studies examined the risk of sarcoidosis associated with occupational silica exposure, two of which were of acceptable quality. Overall, the study methodologies and results were inadequate to support causal relationships.

Conclusions: There is limited evidence of acceptable methodological quality to assess the risk of sarcoidosis associated with occupational exposures. There is a growing body of research examining occupational exposure to silica and sarcoidosis. Additional high-quality confirmatory research is needed.

背景:肉样瘤病是一种罕见的多系统炎症,与肉芽肿的形成有关。由于肉样瘤病的症状不具特异性,使得对其病因的流行病学调查变得复杂,因此诊断具有挑战性。目的:评估职业暴露与肉样瘤病发病之间相关性的证据。确定从事任何职业的工人患肉样瘤病的风险是否更高:本快速综述采用世界卫生组织建议的方法。截至 2022 年 4 月,我们系统地检索了两个电子数据库。对研究的方法学质量进行了严格评估,并采用最佳证据法对结果进行综合:筛选了 2916 篇文章的标题和摘要,并对 67 篇全文进行了资格审查。在符合综述条件的 13 项研究中,没有一项是高质量的(即偏倚风险低)。有六项研究探讨了肉样瘤病与一系列职业和接触因素之间的关系,其中一项先前的系统综述质量较低,报告的结果不一致。六项研究探讨了肉样瘤病与职业性二氧化硅暴露的相关风险,其中两项研究的质量可以接受。总体而言,这些研究的方法和结果不足以支持因果关系:评估与职业暴露相关的肉样瘤病风险的方法质量可接受的证据有限。有关职业暴露于二氧化硅和肉样瘤病的研究越来越多。还需要更多高质量的确证研究。
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引用次数: 0
Vocational rehabilitation for Long Covid: a roadmap for recovery. Long Covid 的职业康复:康复路线图。
IF 5.1 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-06-11 DOI: 10.1093/occmed/kqae020
A Parkin, C Rayner, G Mir, R J O'Connor
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引用次数: 0
Culture, conditions and care support mental health of healthcare workers during crises. 文化、条件和护理有助于危机期间医护人员的心理健康。
IF 5.1 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-09 DOI: 10.1093/occmed/kqae002
J L Maple, M Whiteside, N Smallwood, M Putland, P Baldwin, M Bismark, W Harrex, D Johnson, L Karimi, K Willis

Background: The coronavirus disease 2019 (COVID-19) pandemic has presented immense challenges to health systems worldwide and significantly impacted the mental health of frontline healthcare workers.

Aims: This study drew on the experiences of frontline healthcare workers to examine organizational strategies needed to support the mental health and well-being of healthcare workers during times of crisis.

Methods: Semi-structured focus groups or individual interviews were conducted with healthcare workers to examine their perspectives on organizational strategies for enhancing staff mental health and well-being during crises. Data were analysed thematically. Following this, evidence for the identified strategies was reviewed to assess alignment with participant views and recommendations.

Results: Thirty-two healthcare workers from diverse disciplines (10 allied health, 11 nursing, 11 medical) participated in the study. Data analysis identified three broad themes contributing to supporting mental health and well-being. These themes can be encapsulated as the 'Three Cs'-culture (building an organizational culture that prioritizes mental health); conditions (implementing proactive organizational strategies during crises) and care (ensuring fit-for-purpose strategies to support mental health and well-being).

Conclusions: Study findings underscore the necessity of an integrated and systemic organizational approach to address mental health and well-being in the healthcare workplace. This approach must be long term with the components of the 'Three Cs', particularly cultural change and conditions, viewed as a part of a suite of strategies to ensure crisis preparedness. It is imperative that organizations collaborate with their staff, providing support and fostering a safe and inclusive work environment that ultimately benefits patients, their care and staff well-being.

背景:2019年冠状病毒病(COVID-19)大流行给全球卫生系统带来了巨大挑战,并严重影响了一线医护人员的心理健康。研究目的:本研究借鉴一线医护人员的经验,探讨在危机时期支持医护人员心理健康和福祉所需的组织策略:方法:对医护人员进行了半结构化焦点小组或个别访谈,考察他们对危机期间提高员工心理健康和幸福感的组织策略的看法。对数据进行了专题分析。随后,对已确定策略的证据进行审查,以评估与参与者观点和建议的一致性:32 名来自不同学科的医护人员(10 名专职医疗人员、11 名护理人员、11 名医疗人员)参与了研究。数据分析确定了有助于支持心理健康和幸福感的三大主题。这些主题可以概括为 "三C"--文化(建立一种优先考虑心理健康的组织文化)、条件(在危机期间实施积极的组织策略)和关怀(确保采取适合目的的策略来支持心理健康和幸福):研究结果强调,有必要采取综合、系统的组织方法来解决医疗工作场所的心理健康和幸福问题。这种方法必须是长期的,"三个 C "的组成部分,尤其是文化变革和条件,必须被视为确保危机准备的一整套战略的一部分。各组织必须与员工合作,提供支持,营造安全、包容的工作环境,最终使患者、护理工作和员工福祉受益。
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Occupational Medicine-Oxford
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