Steven Ronsmans, Benoit Nemery, Nico De Crem, Birgit Weynand
{"title":"Silicosis, Sarcoidosis, or Both? Rethinking Disease Labels in Light of Co-Occurrence","authors":"Steven Ronsmans, Benoit Nemery, Nico De Crem, Birgit Weynand","doi":"10.1002/ajim.23730","DOIUrl":"https://doi.org/10.1002/ajim.23730","url":null,"abstract":"","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 6","pages":"487-490"},"PeriodicalIF":2.7,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The healthy worker survivor bias may vary by sex. This study investigated three component associations necessary for this bias to determine the origins of sex differences in this bias among male and female workers.
Methods
We analyzed a data set of 93,918 South Korean diagnostic medical radiation workers registered in the National Dose Registry from 1996 to 2011, linked with mortality and cancer incidence data. Component associations were assessed using Cox regression to estimate hazard ratios (HRs) and logistic regression with generalized estimating equations to estimate odds ratios (ORs).
Results
A significant association between prior cumulative exposure and employment status was observed for all-cause mortality in male (HR 1.06, 95% CI 1.02–1.10), whereas an inverse association was noted in female workers (HR 0.82, 95% CI 0.78–0.87). Adjusted ORs for employment status and subsequent exposure for all-cause mortality, as well as HRs for employment status and survival time, demonstrated associations in the same direction in both males and females.
Conclusions
Our findings demonstrate that sex-specific differences in healthy worker survivor bias were primarily driven by the association between prior exposure and employment status. To improve bias mitigation in occupational cohort studies, sex-specific components should be incorporated.
健康工人幸存者偏见可能因性别而异。本研究调查了这种偏见所必需的三个组成部分的关联，以确定这种偏见在男性和女性工人中性别差异的起源。方法我们分析了1996年至2011年在国家剂量登记处注册的93,918名韩国诊断医疗放射工作者的数据集，与死亡率和癌症发病率数据相关。采用Cox回归估计风险比（hr），采用广义估计方程进行logistic回归评估优势比（ORs）。结果在男性全因死亡率中，既往累积暴露与就业状况之间存在显著相关性（HR 1.06, 95% CI 1.02-1.10），而在女性全因死亡率中存在负相关（HR 0.82, 95% CI 0.78-0.87）。调整就业状态和随后暴露导致的全因死亡率的ORs，以及就业状态和生存时间的hr，在男性和女性中都显示出相同方向的关联。我们的研究结果表明，健康工人幸存者偏见的性别差异主要是由先前暴露与就业状况之间的关联驱动的。为了改善职业队列研究中的偏倚缓解，应纳入性别特异性成分。
{"title":"Component Associations of the Healthy Worker Survivor Bias in Medical Radiation Workers","authors":"Won Jin Lee, Jaeho Jeong, Young Min Kim","doi":"10.1002/ajim.23727","DOIUrl":"https://doi.org/10.1002/ajim.23727","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The healthy worker survivor bias may vary by sex. This study investigated three component associations necessary for this bias to determine the origins of sex differences in this bias among male and female workers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed a data set of 93,918 South Korean diagnostic medical radiation workers registered in the National Dose Registry from 1996 to 2011, linked with mortality and cancer incidence data. Component associations were assessed using Cox regression to estimate hazard ratios (HRs) and logistic regression with generalized estimating equations to estimate odds ratios (ORs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A significant association between prior cumulative exposure and employment status was observed for all-cause mortality in male (HR 1.06, 95% CI 1.02–1.10), whereas an inverse association was noted in female workers (HR 0.82, 95% CI 0.78–0.87). Adjusted ORs for employment status and subsequent exposure for all-cause mortality, as well as HRs for employment status and survival time, demonstrated associations in the same direction in both males and females.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings demonstrate that sex-specific differences in healthy worker survivor bias were primarily driven by the association between prior exposure and employment status. To improve bias mitigation in occupational cohort studies, sex-specific components should be incorporated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 6","pages":"552-556"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeremy T. Hua, Carlyne D. Cool, Einat Fireman Klein, Yochai Adir, Lukas J. Lee, Lauren M. Zell-Baran, Robert A. Cohen, Richard C. Kraus, E. Brigitte Gottschall, Silpa D. Krefft, Charles Van Hook, Cecile S. Rose
Sarcoidosis is a multisystem inflammatory disease of unknown etiology. Growing evidence indicates that occupational exposure to respirable crystalline silica (RCS) is associated with an increased incidence of sarcoidosis. Yet a diagnosis of sarcoidosis rarely prompts investigation to identify preventable exposures. We sought to elucidate features that identify this important clinical syndrome of silicosarcoidosis. We assembled a multinational case series of workers with sarcoidosis who also reported occupational RCS exposure. We characterized clinical and histopathologic findings using a standardized instrument. We also assessed lung specimens using a novel quantitative microscopy technique to measure birefringent dust density in silicosarcoidosis cases and compared them to control groups. We identified 35 silicosarcoidosis cases (97% male, mean age 48 years) from the United States, Israel, and Taiwan who reported 21 ± 9 years of RCS exposure. On histology scoring, 25/29 (86%) had granulomas and 17/18 (94%) with evaluable lung tissue had lymphocytic inflammation and/or lymphoid aggregates. Common lung interstitial findings included silicotic nodules (39%), mixed-dust macules/nodules (44%), and birefringent dust (50%). Quantitative birefringent dust density was significantly greater (p < 0.001) in silicosarcoidosis cases compared with healthy controls (147 ± 179 vs. 12 ± 9 particles/mm2) but lower than in coal miners with silica-related progressive massive fibrosis (623 ± 777). We found significant differences in the frequency of histologic abnormalities in large versus small biopsy specimens, with fewer findings of RCS exposure in smaller tissue samples. The use of the term silicosarcoidosis should enhance recognition of this significant exposure-related granulomatous lung disease and will help guide clinical management that addresses exposure prevention in combination with appropriate pharmacologic treatment.
{"title":"Silicosarcoidosis: Histologic and Clinical Features of an Occupational Granulomatous Disease","authors":"Jeremy T. Hua, Carlyne D. Cool, Einat Fireman Klein, Yochai Adir, Lukas J. Lee, Lauren M. Zell-Baran, Robert A. Cohen, Richard C. Kraus, E. Brigitte Gottschall, Silpa D. Krefft, Charles Van Hook, Cecile S. Rose","doi":"10.1002/ajim.23724","DOIUrl":"https://doi.org/10.1002/ajim.23724","url":null,"abstract":"<p>Sarcoidosis is a multisystem inflammatory disease of unknown etiology. Growing evidence indicates that occupational exposure to respirable crystalline silica (RCS) is associated with an increased incidence of sarcoidosis. Yet a diagnosis of sarcoidosis rarely prompts investigation to identify preventable exposures. We sought to elucidate features that identify this important clinical syndrome of silicosarcoidosis. We assembled a multinational case series of workers with sarcoidosis who also reported occupational RCS exposure. We characterized clinical and histopathologic findings using a standardized instrument. We also assessed lung specimens using a novel quantitative microscopy technique to measure birefringent dust density in silicosarcoidosis cases and compared them to control groups. We identified 35 silicosarcoidosis cases (97% male, mean age 48 years) from the United States, Israel, and Taiwan who reported 21 ± 9 years of RCS exposure. On histology scoring, 25/29 (86%) had granulomas and 17/18 (94%) with evaluable lung tissue had lymphocytic inflammation and/or lymphoid aggregates. Common lung interstitial findings included silicotic nodules (39%), mixed-dust macules/nodules (44%), and birefringent dust (50%). Quantitative birefringent dust density was significantly greater (<i>p</i> < 0.001) in silicosarcoidosis cases compared with healthy controls (147 ± 179 vs. 12 ± 9 particles/mm<sup>2</sup>) but lower than in coal miners with silica-related progressive massive fibrosis (623 ± 777). We found significant differences in the frequency of histologic abnormalities in large versus small biopsy specimens, with fewer findings of RCS exposure in smaller tissue samples. The use of the term silicosarcoidosis should enhance recognition of this significant exposure-related granulomatous lung disease and will help guide clinical management that addresses exposure prevention in combination with appropriate pharmacologic treatment.</p>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 6","pages":"491-507"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23724","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bakari Ibrahim, Nicole Le Moual, Guillaume Sit, Marcel Goldberg, Bénédicte Leynaert, Céline Ribet, Nicolas Roche, Raphaëlle Varraso, Marie Zins, Rachel Nadif, Laurent Orsi, Orianne Dumas
Background
Disinfectants and cleaning products (DCPs) are important asthma risk factors among healthcare workers. However, healthcare work involves heterogenous cleaning tasks and co-exposure to many chemicals. These multidimensional aspects have rarely been considered. We aimed to identify patterns of occupational exposure to DCPs and study their associations with asthma.
Methods
CONSTANCES is a French population-based cohort of ≈220,000 adults. Current asthma and asthma symptom score were defined by questionnaire at inclusion (2012–2021). Healthcare workers completed a supplementary questionnaire on their current/last held occupation, workplace, and cleaning activities that were used in unsupervised learning algorithms to identify occupational exposure patterns. Logistic and negative binomial regression models, adjusted for potential confounders, were used to assess associations with asthma outcomes.
Results
In 5512 healthcare workers, four occupational exposure clusters were identified: Cluster1 (C1, 42%, reference), mainly characterized by low exposed nurses and physicians; C2 (7%), medical laboratory staff moderately exposed to common DCPs (chlorine/bleach, alcohol); C3 (41%), nursing assistants and nurses highly exposed to a few DCPs (mainly quaternary ammonium compounds); and C4 (10%), nurses and nursing assistants highly exposed to multiple DCPs (e.g., glutaraldehyde, hydrogen peroxide, and acids). Among women (n = 3734), C2 (mean score ratio [95% CI]: 1.31 [1.02; 1.68]) and C3 (1.18 [1.03; 1.36]) were associated with higher asthma symptom score, and an association was suggested between C3 and current asthma (odds ratio 1.22 [0.99; 1.51]).
Conclusion
In a large population of healthcare workers, four DCP exposure patterns were identified, reflecting the heterogeneity of healthcare jobs. Two patterns, including one characterized by laboratory workers, were associated with greater asthma symptoms in women.
{"title":"Occupational Exposure Patterns to Disinfectants and Cleaning Products and Its Association With Asthma Among French Healthcare Workers","authors":"Bakari Ibrahim, Nicole Le Moual, Guillaume Sit, Marcel Goldberg, Bénédicte Leynaert, Céline Ribet, Nicolas Roche, Raphaëlle Varraso, Marie Zins, Rachel Nadif, Laurent Orsi, Orianne Dumas","doi":"10.1002/ajim.23725","DOIUrl":"https://doi.org/10.1002/ajim.23725","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Disinfectants and cleaning products (DCPs) are important asthma risk factors among healthcare workers. However, healthcare work involves heterogenous cleaning tasks and co-exposure to many chemicals. These multidimensional aspects have rarely been considered. We aimed to identify patterns of occupational exposure to DCPs and study their associations with asthma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>CONSTANCES is a French population-based cohort of ≈220,000 adults. Current asthma and asthma symptom score were defined by questionnaire at inclusion (2012–2021). Healthcare workers completed a supplementary questionnaire on their current/last held occupation, workplace, and cleaning activities that were used in unsupervised learning algorithms to identify occupational exposure patterns. Logistic and negative binomial regression models, adjusted for potential confounders, were used to assess associations with asthma outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 5512 healthcare workers, four occupational exposure clusters were identified: Cluster1 (C1, 42%, reference), mainly characterized by low exposed nurses and physicians; C2 (7%), medical laboratory staff moderately exposed to common DCPs (chlorine/bleach, alcohol); C3 (41%), nursing assistants and nurses highly exposed to a few DCPs (mainly quaternary ammonium compounds); and C4 (10%), nurses and nursing assistants highly exposed to multiple DCPs (e.g., glutaraldehyde, hydrogen peroxide, and acids). Among women (<i>n</i> = 3734), C2 (mean score ratio [95% CI]: 1.31 [1.02; 1.68]) and C3 (1.18 [1.03; 1.36]) were associated with higher asthma symptom score, and an association was suggested between C3 and current asthma (odds ratio 1.22 [0.99; 1.51]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In a large population of healthcare workers, four DCP exposure patterns were identified, reflecting the heterogeneity of healthcare jobs. Two patterns, including one characterized by laboratory workers, were associated with greater asthma symptoms in women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 6","pages":"516-530"},"PeriodicalIF":2.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23725","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adrian Loerbroks, Haiou Yang, Jos A. Bosch, Julia Salandi, Stefanie Keymel, Jian Li
Background
Prior work has linked work stressors to asthma. However, research related to gender-specific associations remains sparse and yielded mixed results. We aimed to address this gap.
Methods
We drew on cross-sectional data from the 2015 National Health Interview Survey (individual-level response rate = 79.7%). Included were participants in employment who were aged 18–70 (n = 18,701). Work-to-family conflict, workplace bullying, and job insecurity were assessed as work stressors. Asthma was defined based on self-reports of a lifetime diagnosis by a doctor or other health professional. To account for the complex sampling design, variance estimation was used to compute weighted descriptive statistics and odds ratios (ORs) as well as corresponding 95% confidence intervals (CIs) using multivariable logistic regression. To test for interaction, interaction terms for work stressors and gender were included in additional models.
Results
In the full sample, work-to-family conflict, workplace bullying and job insecurity showed positive associations with asthma (OR = 1.20, 95%CI = 1.03–1.40; OR = 1.45, 95%CI = 1.17–1.80; and OR = 1.20, 95%CI = 0.99–1.45, respectively). We did not observe meaningful gender differences in the magnitudes of the ORs. All interaction terms were not statistically significant.
Conclusions
Work stressors were positively associated with asthma, but there was no evidence of gender differences. Prospective studies are needed to determine the potential temporal relation of these associations.
{"title":"Work Stressors and Asthma in Female and Male US Workers: Findings From the National Health Interview Survey","authors":"Adrian Loerbroks, Haiou Yang, Jos A. Bosch, Julia Salandi, Stefanie Keymel, Jian Li","doi":"10.1002/ajim.23722","DOIUrl":"https://doi.org/10.1002/ajim.23722","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Prior work has linked work stressors to asthma. However, research related to gender-specific associations remains sparse and yielded mixed results. We aimed to address this gap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We drew on cross-sectional data from the 2015 National Health Interview Survey (individual-level response rate = 79.7%). Included were participants in employment who were aged 18–70 (<i>n</i> = 18,701). Work-to-family conflict, workplace bullying, and job insecurity were assessed as work stressors. Asthma was defined based on self-reports of a lifetime diagnosis by a doctor or other health professional. To account for the complex sampling design, variance estimation was used to compute weighted descriptive statistics and odds ratios (ORs) as well as corresponding 95% confidence intervals (CIs) using multivariable logistic regression. To test for interaction, interaction terms for work stressors and gender were included in additional models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the full sample, work-to-family conflict, workplace bullying and job insecurity showed positive associations with asthma (OR = 1.20, 95%CI = 1.03–1.40; OR = 1.45, 95%CI = 1.17–1.80; and OR = 1.20, 95%CI = 0.99–1.45, respectively). We did not observe meaningful gender differences in the magnitudes of the ORs. All interaction terms were not statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Work stressors were positively associated with asthma, but there was no evidence of gender differences. Prospective studies are needed to determine the potential temporal relation of these associations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 6","pages":"508-515"},"PeriodicalIF":2.7,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The few prospective studies on the associations between psychosocial work factors and occupational injury in the general working population provide little information on multiple exposures, injury severity, and gender differences. This study aimed to address these points.
Methods
The study was based on prospective data from the nationwide Working Conditions survey on a representative sample of the working population in France. A total of 17,486 employees (7302 men, 10,184 women) were followed over one or two 3-year periods from 2013 to 2019. Occupational exposures were measured at the beginning of each period and included 20 psychosocial work factors, 4 working time/hours factors, and 4 physical work factors. Logistic and Hurdle models were used to study their prospective associations with occupational injury and its severity, as assessed by work absence due to injury and its duration.
Results
Most psychosocial work factors predicted occupational injury. Almost all associations persisted in adjusted models, that is, after controlling for covariates and the other occupational factors that were also predictive of occupational injury. No gender differences were found for these prospective associations. For all types of occupational factors, dose–response associations were found between the number of exposures and injury. However, most occupational factors were not predictive of injury severity.
Conclusions
Occupational exposures, and psychosocial work factors in particular, predicted the occurrence of occupational injury more than its severity. Occupational injury prevention programmes should focus on various aspects of the work environment, including psychosocial work factors, and should particularly target multiple exposures.
{"title":"Exposure to Psychosocial Work Factors and Occupational Injury and Its Severity: Prospective Associations Among Employees in the French National Working Conditions Survey","authors":"Sandrine Bertrais, Isabelle Niedhammer","doi":"10.1002/ajim.23723","DOIUrl":"https://doi.org/10.1002/ajim.23723","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The few prospective studies on the associations between psychosocial work factors and occupational injury in the general working population provide little information on multiple exposures, injury severity, and gender differences. This study aimed to address these points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was based on prospective data from the nationwide Working Conditions survey on a representative sample of the working population in France. A total of 17,486 employees (7302 men, 10,184 women) were followed over one or two 3-year periods from 2013 to 2019. Occupational exposures were measured at the beginning of each period and included 20 psychosocial work factors, 4 working time/hours factors, and 4 physical work factors. Logistic and Hurdle models were used to study their prospective associations with occupational injury and its severity, as assessed by work absence due to injury and its duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most psychosocial work factors predicted occupational injury. Almost all associations persisted in adjusted models, that is, after controlling for covariates and the other occupational factors that were also predictive of occupational injury. No gender differences were found for these prospective associations. For all types of occupational factors, dose–response associations were found between the number of exposures and injury. However, most occupational factors were not predictive of injury severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Occupational exposures, and psychosocial work factors in particular, predicted the occurrence of occupational injury more than its severity. Occupational injury prevention programmes should focus on various aspects of the work environment, including psychosocial work factors, and should particularly target multiple exposures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 6","pages":"543-551"},"PeriodicalIF":2.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephen Barker, Annalee Yassi, Jerry Spiegel, Barry Kistnasamy, Rodney Ehrlich
Background
Computer-aided detection (CAD) is emerging as an adjunct to the use of the chest X-ray (CXR) in screening for pulmonary tuberculosis (TB). CAD for silicosis, a fibrotic lung disease due to silica dust and a strong risk factor for TB, is at an earlier stage of development and, unlike TB, depends on expert human reading for validation. For all CAD systems, an important step is the choice of threshold for classifying images as positive or negative for the disease in question. The objective of this article is to present an analytic approach to the choice of threshold in using CAD systems for silicosis.
Methods
Drawing on receiver operating curve data from a published study on agreement between CAD and two expert readings of silicosis, two criteria for choosing the sensitivity/specificity combination were compared—the Youden Index and a minimum sensitivity of 90%. We explore the impact of criterion selection, silicosis definition, and reader on the choice and interpretation of threshold, as well as the influence of positive predictive value (PPV) derived from screen prevalence. We present a novel technique for using two CAD thresholds to distinguish images with a high likelihood of being of positive or negative from those characterized by uncertainty.
Results
The sample was 501 CXR images from ex-gold miners. Derived thresholds varied across the two criteria, as well as across silicosis definition and expert reader. Varying the notional disease prevalence produced large differences in PPV and, therefore, proportions of false positives. The implications of these variations affecting threshold choice are described for three use cases—annual screening of active miners, outreach screening of former miners, and adjudication of claims for silicosis compensation.
Conclusion
In applying CAD to silicosis, users need to establish the use case, their preference for the sensitivity/specificity trade-off, and the silicosis definition, as well as considering the effect of disease prevalence. System developers need to take inter-reader variation in validation exercises into account and present this information transparently. A two-threshold model has potential utility in situations of high screening volume where there is a significant cost associated with referral for confirmation of diagnosis.
{"title":"Determining Thresholds for Computer-Aided Detection for Silicosis—An Analytic Approach","authors":"Stephen Barker, Annalee Yassi, Jerry Spiegel, Barry Kistnasamy, Rodney Ehrlich","doi":"10.1002/ajim.23720","DOIUrl":"10.1002/ajim.23720","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Computer-aided detection (CAD) is emerging as an adjunct to the use of the chest X-ray (CXR) in screening for pulmonary tuberculosis (TB). CAD for silicosis, a fibrotic lung disease due to silica dust and a strong risk factor for TB, is at an earlier stage of development and, unlike TB, depends on expert human reading for validation. For all CAD systems, an important step is the choice of threshold for classifying images as positive or negative for the disease in question. The objective of this article is to present an analytic approach to the choice of threshold in using CAD systems for silicosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Drawing on receiver operating curve data from a published study on agreement between CAD and two expert readings of silicosis, two criteria for choosing the sensitivity/specificity combination were compared—the Youden Index and a minimum sensitivity of 90%. We explore the impact of criterion selection, silicosis definition, and reader on the choice and interpretation of threshold, as well as the influence of positive predictive value (PPV) derived from screen prevalence. We present a novel technique for using two CAD thresholds to distinguish images with a high likelihood of being of positive or negative from those characterized by uncertainty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sample was 501 CXR images from ex-gold miners. Derived thresholds varied across the two criteria, as well as across silicosis definition and expert reader. Varying the notional disease prevalence produced large differences in PPV and, therefore, proportions of false positives. The implications of these variations affecting threshold choice are described for three use cases—annual screening of active miners, outreach screening of former miners, and adjudication of claims for silicosis compensation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In applying CAD to silicosis, users need to establish the use case, their preference for the sensitivity/specificity trade-off, and the silicosis definition, as well as considering the effect of disease prevalence. System developers need to take inter-reader variation in validation exercises into account and present this information transparently. A two-threshold model has potential utility in situations of high screening volume where there is a significant cost associated with referral for confirmation of diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 5","pages":"464-472"},"PeriodicalIF":2.7,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lynda S. Robson, Cynthia Chen, Cameron A. Mustard, Faraz Vahid Shahidi, Victoria Landsman, Peter M. Smith, Aviroop Biswas
Background
Methods of delivering occupational safety and health (OSH) training have shifted from in-person to online. Widespread delivery of a standardized OSH training course in three modalities in the province of Ontario, Canada allowed measurement of differences in their effectiveness.
Methods
Learners (N = 899) self-selected into face-to-face (F2F) instructor-led learning, online instructor-led synchronous distance learning, or online self-paced e-learning. Pre- and post-training surveys collected information on knowledge and other measures. Multiple regression analyses compared modalities on knowledge achievement (0%–100% scale; the primary outcome), engagement, perceived utility, perceived applicability, self-efficacy, and intention-to-use.
Results
F2F learners achieved a statistically significant 2.5% (95% CI: 0.3%, 4.7%) higher post-training knowledge score than distance learners (Cohen's d = 0.23, which is considered small). A statistically insignificant difference of 0.4% (95%: −1.4%, 2.3%) was seen between e-learners and distance learners. Collaborating training providers regarded these differences as not meaningful in practice. Statistically significant differences between modalities were seen for engagement, perceived utility, and self-efficacy. Scores of F2F learners were more favorable than scores of distance learners, which were, in turn, more favorable than scores of e-learners.
Conclusions
This study provides evidence that there are small to no differences among F2F, distance and e-learning in their ability to ensure knowledge achievement among learners. This finding is likely generalizable to other well-designed short-term OSH training aimed at acquiring new knowledge. More research is needed to understand whether there are important differences across these modalities in basic OHS skill acquisition and transfer of learning to the workplace.
背景：提供职业安全与健康（OSH）培训的方法已经从面对面转向在线。在加拿大安大略省以三种方式广泛提供标准化职业安全与卫生培训课程，可以衡量其有效性的差异。方法：学习者（N = 899）自行选择参加面对面（F2F）教师主导的学习，在线教师主导的同步远程学习或在线自定进度的电子学习。培训前后的调查收集了有关知识和其他措施的信息。多元回归分析比较知识成就的模式(0%-100%量表；主要结果)、参与、感知效用、感知适用性、自我效能和使用意图。结果：F2F学习者的培训后知识得分比远程学习者高2.5% (95% CI: 0.3%, 4.7%)，具有统计学意义（Cohen’s d = 0.23，这被认为是小的）。在线学习者和远程学习者之间的差异在统计学上不显著，仅为0.4%（95%:-1.4%,2.3%）。合作培训提供者认为这些差异在实践中没有意义。在参与、感知效用和自我效能方面，不同模式之间存在统计学上的显著差异。F2F学习者的分数比远程学习者的分数更有利，而远程学习者的分数又比电子学习者的分数更有利。结论：本研究提供的证据表明，F2F、远程学习和电子学习在确保学习者知识成就的能力方面存在很小甚至没有差异。这一发现很可能推广到其他旨在获取新知识的精心设计的短期职业安全与健康培训。需要更多的研究来了解这些模式在职业健康安全基本技能获得和学习转移到工作场所方面是否存在重要差异。
{"title":"Differences in the Effectiveness of Three OHS Training Delivery Methods","authors":"Lynda S. Robson, Cynthia Chen, Cameron A. Mustard, Faraz Vahid Shahidi, Victoria Landsman, Peter M. Smith, Aviroop Biswas","doi":"10.1002/ajim.23719","DOIUrl":"10.1002/ajim.23719","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Methods of delivering occupational safety and health (OSH) training have shifted from in-person to online. Widespread delivery of a standardized OSH training course in three modalities in the province of Ontario, Canada allowed measurement of differences in their effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Learners (<i>N</i> = 899) self-selected into face-to-face (F2F) instructor-led learning, online instructor-led synchronous distance learning, or online self-paced e-learning. Pre- and post-training surveys collected information on knowledge and other measures. Multiple regression analyses compared modalities on knowledge achievement (0%–100% scale; the primary outcome), engagement, perceived utility, perceived applicability, self-efficacy, and intention-to-use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>F2F learners achieved a statistically significant 2.5% (95% CI: 0.3%, 4.7%) higher post-training knowledge score than distance learners (Cohen's <i>d</i> = 0.23, which is considered small). A statistically insignificant difference of 0.4% (95%: −1.4%, 2.3%) was seen between e-learners and distance learners. Collaborating training providers regarded these differences as not meaningful in practice. Statistically significant differences between modalities were seen for engagement, perceived utility, and self-efficacy. Scores of F2F learners were more favorable than scores of distance learners, which were, in turn, more favorable than scores of e-learners.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study provides evidence that there are small to no differences among F2F, distance and e-learning in their ability to ensure knowledge achievement among learners. This finding is likely generalizable to other well-designed short-term OSH training aimed at acquiring new knowledge. More research is needed to understand whether there are important differences across these modalities in basic OHS skill acquisition and transfer of learning to the workplace.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 5","pages":"450-463"},"PeriodicalIF":2.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23719","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher R. Dasaro, Ahmad Sabra, Henry S. Sacks, Benjamin J. Luft, Denise J. Harrison, Iris G. Udasin, Michael A. Crane, Jacqueline M. Moline, Winston Kwa, Andrew C. Todd, Nancy L. Sloan, Susan L. Teitelbaum
Background
People participating in the rescue, recovery, and clean-up effort after the September 11, 2001 attack on the World Trade Center (WTC) were exposed to a complex mix of noxious substances and subsequently experienced elevated gastroesophageal reflux disease (GERD) incidence, the second-most-common WTC-related condition.
Methods
Longitudinal WTC Health Program data, collected between July 2002 and December 2022, were used to describe the sample characteristics, diagnostic procedures, and treatment of consenting cohort members with self-reported GERD who reported incident GERD for a year or longer (n = 19,067). Cross-tabulations and binomial logistic regression, adjusted for confounders including comorbidities, assessed the associations with intermittent and resolved, compared with unresolved, GERD.
Results
12.6% of the study cohort reported intermittent GERD; 5.5% reported GERD resolution. Analyses indicated that most GERD resolution was reported by people of color and those with body mass index <25, and by cohort members who had longer postdiagnosis follow-up and implemented dietary modifications together with proton pump inhibitors or Program-approved antacids. GERD-certified members who underwent endoscopy, used medications without dietary modifications, or used bed head-elevation, and those with Barrett's disease (5.8%) or esophageal cancer (0.1%) may have had more severe GERD and reported little resolution.
Conclusions
The use of GERD services was consistent with clinical guidelines. Members' implementing dietary modifications in conjunction with proton pump inhibitors or Program-approved antacids reported more resolution and may have had less severe GERD. Earlier diagnosis and intervention might increase earlier therapeutic resolution.
{"title":"Gastroesophageal Reflux Disease in the World Trade Center Health Program General Responder Cohort","authors":"Christopher R. Dasaro, Ahmad Sabra, Henry S. Sacks, Benjamin J. Luft, Denise J. Harrison, Iris G. Udasin, Michael A. Crane, Jacqueline M. Moline, Winston Kwa, Andrew C. Todd, Nancy L. Sloan, Susan L. Teitelbaum","doi":"10.1002/ajim.23721","DOIUrl":"10.1002/ajim.23721","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>People participating in the rescue, recovery, and clean-up effort after the September 11, 2001 attack on the World Trade Center (WTC) were exposed to a complex mix of noxious substances and subsequently experienced elevated gastroesophageal reflux disease (GERD) incidence, the second-most-common WTC-related condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Longitudinal WTC Health Program data, collected between July 2002 and December 2022, were used to describe the sample characteristics, diagnostic procedures, and treatment of consenting cohort members with self-reported GERD who reported incident GERD for a year or longer (<i>n</i> = 19,067). Cross-tabulations and binomial logistic regression, adjusted for confounders including comorbidities, assessed the associations with intermittent and resolved, compared with unresolved, GERD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>12.6% of the study cohort reported intermittent GERD; 5.5% reported GERD resolution. Analyses indicated that most GERD resolution was reported by people of color and those with body mass index <25, and by cohort members who had longer postdiagnosis follow-up and implemented dietary modifications together with proton pump inhibitors or Program-approved antacids. GERD-certified members who underwent endoscopy, used medications without dietary modifications, or used bed head-elevation, and those with Barrett's disease (5.8%) or esophageal cancer (0.1%) may have had more severe GERD and reported little resolution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The use of GERD services was consistent with clinical guidelines. Members' implementing dietary modifications in conjunction with proton pump inhibitors or Program-approved antacids reported more resolution and may have had less severe GERD. Earlier diagnosis and intervention might increase earlier therapeutic resolution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 5","pages":"473-483"},"PeriodicalIF":2.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julia S. Sisti, Ananya Dhanya, Howard E. Alper, Nicholas Millet, Ayda Ahmadi, Robert M. Brackbill
Background
Exposure to the terrorist attacks on the World Trade Center (WTC) on September 11, 2001, has been associated with several chronic physical and mental health conditions. We assessed the burden, nearly 20 years after the attacks, of several 9/11-related health conditions and indicators of poor health-related quality of life (HRQOL) among individuals exposed to the WTC disaster.
Methods
Among individuals enrolled in the longitudinal WTC Health Registry in 2020–2021 (N = 26,964), we estimated post-9/11 prevalence of: self-reported diagnosed physical health conditions known to be associated with WTC exposure; probable posttraumatic stress disorder (PTSD) and depression; and poor HRQOL indicators. We also compared lifetime prevalence of selected conditions and poor-HRQOL indicators among WTC-exposed rescue and recovery workers and community members, separately, to New York State general population estimates, using multivariable-adjusted logistic regression.
Results
Prevalence of post-9/11 physical health conditions ranged from 10.5% (chronic obstructive pulmonary disease, COPD) to 26.3% (gastroesophageal reflux disease). Prevalence of probable post-9/11 PTSD and depression were 9.6% and 12.7%, respectively. Lifetime prevalence of physician-diagnosed asthma, COPD, and depression were higher among WTC-exposed individuals compared to the general population. Indicators of poor HRQOL were higher among WTC Registry enrollees relative to the general population, and among enrollees with any physical or probable mental health conditions compared to enrollees without any conditions.
Conclusions
Nearly 20 years after 9/11, WTC-exposed populations experience a high burden of health conditions that affect their wellbeing, highlighting the need for continued monitoring of this population.
{"title":"Exposure to the World Trade Center Disaster, Health, and Health-Related Quality of Life Nearly 20 Years After 9/11","authors":"Julia S. Sisti, Ananya Dhanya, Howard E. Alper, Nicholas Millet, Ayda Ahmadi, Robert M. Brackbill","doi":"10.1002/ajim.23706","DOIUrl":"10.1002/ajim.23706","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Exposure to the terrorist attacks on the World Trade Center (WTC) on September 11, 2001, has been associated with several chronic physical and mental health conditions. We assessed the burden, nearly 20 years after the attacks, of several 9/11-related health conditions and indicators of poor health-related quality of life (HRQOL) among individuals exposed to the WTC disaster.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among individuals enrolled in the longitudinal WTC Health Registry in 2020–2021 (<i>N</i> = 26,964), we estimated post-9/11 prevalence of: self-reported diagnosed physical health conditions known to be associated with WTC exposure; probable posttraumatic stress disorder (PTSD) and depression; and poor HRQOL indicators. We also compared lifetime prevalence of selected conditions and poor-HRQOL indicators among WTC-exposed rescue and recovery workers and community members, separately, to New York State general population estimates, using multivariable-adjusted logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Prevalence of post-9/11 physical health conditions ranged from 10.5% (chronic obstructive pulmonary disease, COPD) to 26.3% (gastroesophageal reflux disease). Prevalence of probable post-9/11 PTSD and depression were 9.6% and 12.7%, respectively. Lifetime prevalence of physician-diagnosed asthma, COPD, and depression were higher among WTC-exposed individuals compared to the general population. Indicators of poor HRQOL were higher among WTC Registry enrollees relative to the general population, and among enrollees with any physical or probable mental health conditions compared to enrollees without any conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nearly 20 years after 9/11, WTC-exposed populations experience a high burden of health conditions that affect their wellbeing, highlighting the need for continued monitoring of this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7873,"journal":{"name":"American journal of industrial medicine","volume":"68 5","pages":"413-427"},"PeriodicalIF":2.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajim.23706","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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