Search

Objective: Determine whether volunteer firefighters in Florida are at increased odds of developing cancer compared with nonfirefighters. Methods: A casecontrol study design was implemented to assess the odds of developing cancer among male and female volunteer firefighters in Florida. Gender-specific age and calendar year-adjusted odds ratios and 95% confidence intervals were estimated. Results: Male volunteer firefighters were at increased odds for developing prostate (aOR = 1.26; 95%CI;[1.10-1.44]) and male genital cancers combined (1.22;[1.07-1.39]), while reduced odds for endocrine cancer (0.41; [0.17-1.00]), and all leukemias (0.55;[0.35-0.86]), including lymphocytic (0.48;[0.24-0.97]); and chronic lymphocytic (0.40;[0.17-0.97]) leukemias. Female volunteer firefighters were at increased odds of developing of kidney cancer (2.51;[1.29-4.91]). Conclusions: Male volunteer firefighters are at increased odds for prostate and overall male genital cancers, while female volunteers are increased odds of kidney cancer. [ABSTRACT FROM AUTHOR]

Background: Fishers are at risk of back disorders due to their physically demanding work. The aim was to investigate risk factors for back disorders in fishers in Denmark. Methods: All male Danish registered fishers between 1994 and 2017 were included. ICD-10 codes classified back disorders (M40-M54* and DM99.1-4*). A multistate model on a cause-specific cox regression modelwas conducted. Results: Of 13,165 fishers included, 16% had a hospital contactwith an incident back disorder, and 52% at least had 1 recurrent episode. Having worked in another occupation (HR 1.14; 95% CI: 1.02, 1.27) and another musculoskeletal disorder (HR 1.84; 95% CI: 1.69, 2.01) were significant risk factors for the incident back disorder. No risk factors were seen for recurrent episodes. Conclusions: Risk factors for incident and recurrent back disorders were different; thus, episode-specific initiatives are needed to reduce back disorders among fishers. [ABSTRACT FROM AUTHOR]

Background/Objectives: Women of childbearing age not only reside in agricultural communities but also form an integral part of the agricultural labor force. Limited research investigates the impact of prenatal fungicide exposure on infant health, specifically ethylenebisdithiocarbamates and their toxic by-product, ethylenethiourea (ETU), particularly in occupational settings. This paper describes the background, aims, protocol, and baseline sample characteristics for the SEMILLA study, which investigates prenatal ETU exposure, neonatal thyroid function, infant growth, and neurobehavioral development in an agricultural region of Ecuador. Methods: This cohort study follows pregnant women and their infants up to 18 months of age, incorporating urinary biomarkers and survey data on ETU exposure and infant growth and neurodevelopmental measures. Data collection includes detailed questionnaires, scales, and physical examinations on maternal and infant health and development, as well as environmental factors. Descriptive statistics on key characteristics of the study population at baseline are presented. Results: SEMILLA enrolled 409 participants (72% enrollment rate): 111 agricultural workers (mostly floricultural), 149 non-agricultural workers, and 149 non-workers. Baseline characteristics show comparability between work sector groups, with some economic differences. Conclusions: SEMILLA will provide key evidence on prenatal fungicide exposure and infant development and encompass comprehensive multistage data collection procedures in pregnancy and infancy, focusing on structural and social determinants of health as well as individual-level chemical exposures. The community-based approach has proven essential, even amid challenges like the COVID-19 pandemic. The medium-term objective is to inform sustainable interventions promoting maternal and child health, with a long-term goal to reduce community exposures and improve worker health policies, particularly for women and pregnant workers. [ABSTRACT FROM AUTHOR]

The respiratory health effects of Synthetic Amorphous Silica (SAS) have been studied in human epidemiological research. This article presents a historical overview and review of nine occupational worker studies that have been conducted so far on this topic. The combined study population of all of these studies included 1172 employees, and exposure concentrations ranged from < 1 mg/m3 to 100 mg/m3. In two studies with a total of 293 workers, the incidence of silicosis was investigated after long-term exposure to precipitated SAS, and no cases of silicosis were found (Plunkett and Dewitt, 1962; Volk, 1960). In another study, the spirometry results of 40 workers were normal (Vitums et al., 1977). In a study of 28 workers, 4 cases of silicosis were identified, but it is possible that contamination with cristobalite occurred and detailed information about the amorphous silica origin was not provided (Mohrmann and Kahn, 1985). Ferch et al. (1987) found that lung impairment was associated with confounding factors (smoking) but not with exposure to precipitated SAS in a study of 143 workers. Choudat et al. (1990) reported a reduction in forced expiratory flow in a group exposed to precipitated SAS compared to a control group. Still, they found no correlation between the extent of exposure and pulmonary function was found in a study of 131 workers. Wilson et al. (1979) also failed to show a significant association between the degree of exposure to precipitated SAS and annual changes in lung function in a study of 165 workers. In the most recent and most extensive study (Taeger et al., 2016; Yong et al., 2022) in Germany, involving 462 factory workers, no association between inhalable or respirable SAS dust exposure and respiratory health was reported. Based on the available data, there is no evidence-base to support a relationship between SAS and respiratory health in humans. [ABSTRACT FROM AUTHOR]

Objectives: Research shows the highest rates of occupational heat‐related fatalities among farm laborers and among Black and Hispanic workers in North Carolina (NC). The Hispanic population and workforce in NC have grown substantially in the past 20 years. We describe the epidemiology of heat‐related fatal injuries in the general population and among workers in NC. Methods: We reviewed North Carolina death records and records of the North Carolina Office of the Chief Medical Examiner to identify heat‐related deaths (primary International Classification of Diseases, Tenth Revision diagnosis code: X30 or T67.0‐T67.9) that occurred between January 1, 1999, and December 31, 2017. Decedent age, sex, race, and ethnicity were extracted from both the death certificate and the medical examiner's report as well as determinations of whether the death occurred at work. Results: In NC between 1999 and 2017, there were 225 deaths from heat‐related injuries, and 25 occurred at work. The rates of occupational heat‐related deaths were highest among males, workers of Hispanic ethnicity, workers of Black, multiple, or unknown race, and in workers aged 55–64. The highest rate of occupational heat‐related deaths occurred in the agricultural industry. Conclusions: Since the last report (2001), the number of heat‐related fatalities has increased, but fewer were identified as workplace fatalities. Rates of occupational heat‐related deaths are highest among Hispanic workers. NC residents identifying as Black are disproportionately burdened by heat‐related fatalities in general, with a wider apparent disparity in occupational deaths. [ABSTRACT FROM AUTHOR]

Background Psychosocial stressors at work, defined by the job strain and effort–reward imbalance at work (ERI) models, were shown to increase coronary heart disease risk. No previous study has examined the adverse effect of psychosocial stressors at work from both models on atrial fibrillation (AF) incidence. The objective of this study was to examine the separate and combined effect of psychosocial stressors at work from the job strain and ERI models on AF incidence in a prospective cohort study. Methods and Results A total of 5926 white‐collar workers (3021 women and 2905 men) free of cardiovascular disease at baseline were followed for an average of 18 years. Job strain (high psychological demands combined with low decision latitude) and ERI were assessed using validated instruments. AF events were identified in medical databases with universal coverage. Hazard ratios (HRs) with 95% CIs were estimated using Cox regression models, controlling for socioeconomic characteristics and lifestyle‐related and clinical risk factors. A total of 186 AF incident events were identified over 18 years. Workers exposed to job strain (HR, 1.83 [95% CI, 1.14–2.92]) and ERI (HR, 1.44 [95% CI, 1.05–1.98]) had a higher risk of AF in fully adjusted models. Combined exposure to job strain and ERI was associated with a 2‐fold AF risk increase (HR, 1.97 [95% CI, 1.26–3.07]). Conclusions Psychosocial stressors at work from the job strain and ERI models are associated with an increased risk of AF, separately and in combination. Workplace prevention strategies targeting these psychosocial stressors at work may be effective to reduce the burden associated with AF.

Background/Objectives: Women of childbearing age not only reside in agricultural communities but also form an integral part of the agricultural labor force. Limited research investigates the impact of prenatal fungicide exposure on infant health, specifically ethylenebisdithiocarbamates and their toxic by-product, ethylenethiourea (ETU), particularly in occupational settings. This paper describes the background, aims, protocol, and baseline sample characteristics for the SEMILLA study, which investigates prenatal ETU exposure, neonatal thyroid function, infant growth, and neurobehavioral development in an agricultural region of Ecuador. Methods: This cohort study follows pregnant women and their infants up to 18 months of age, incorporating urinary biomarkers and survey data on ETU exposure and infant growth and neurodevelopmental measures. Data collection includes detailed questionnaires, scales, and physical examinations on maternal and infant health and development, as well as environmental factors. Descriptive statistics on key characteristics of the study population at baseline are presented. Results: SEMILLA enrolled 409 participants (72% enrollment rate): 111 agricultural workers (mostly floricultural), 149 non-agricultural workers, and 149 non-workers. Baseline characteristics show comparability between work sector groups, with some economic differences. Conclusions: SEMILLA will provide key evidence on prenatal fungicide exposure and infant development and encompass comprehensive multistage data collection procedures in pregnancy and infancy, focusing on structural and social determinants of health as well as individual-level chemical exposures. The community-based approach has proven essential, even amid challenges like the COVID-19 pandemic. The medium-term objective is to inform sustainable interventions promoting maternal and child health, with a long-term goal to reduce community exposures and improve worker health policies, particularly for women and pregnant workers.

The risk of violence is present in all workplaces. It must be accurately assessed to establish prevention and protection measures tailored to the features of each situation. The risk management process requires compliance in a sequential order: i) risk identification, ii) quantitative risk assessment, and iii) impact assessment. Gathering workers' experiences using lists, focus groups, or participatory ergonomics groups is necessary to identify the phenomenon. For risk assessment, spontaneous reporting of events is often insufficient. It may be complemented with two methods: systematic recording of violent events that occurred in the past year during periodic medical examinations of workers and targeted surveys. The epidemiological analysis of data from individual interviews and surveys provides the phenomenon's prevalence, incidence, and evolution. Moreover, reporting the harm suffered by victims of violence allows constructing impact matrices to allocate resources where they are most needed. [ABSTRACT FROM AUTHOR]

Background: Sinonasal cancers (SNC) are rare cancers with a high proportion attributable to occupational carcinogens. This study aims to describe the sociodemographic, clinical, and occupational characteristics of subjects with SNC in Brazil. Methods: Observational study conducted with secondary data from a network of Hospital Cancer Registries. We selected epithelial/unspecified SNC records with a year of diagnosis from 2007 to 2021. We performed descriptive statistics of SNC cases and calculated crude and age-standardized rates (ASR, standard: world population) by gender and Region of residence. Results: We identified 2,384 cases, 1,553 (65.1%) in men and 831 (34.9%) in women. The mean age at diagnosis was 59 years for both. Most SNC (50.7% in men and 53.2% in women) originated from the maxillary sinus. Most (65.5% in men and 54.5% in women) were squamous cell carcinomas. Information on occupation was missing in the years 2019-2021. Most male SNC patients (44.8%) were employed in group 6 (Agricultural, forestry, and fishing workers), while women had been mainly (34.6%) working in groups 8 (Workers in the production of industrial goods and services, machine operators) and in group 6 (27.6%). Crude SNC incidence rates were 1.0 per million person-years in men and 0.5 in women, while ASR were 1.0 and 0.4, respectively. In both genders, the highest ASR was in Minas Gerais (men: 1.9; women: 0.7). Conclusions: Establishing the profile of Brazilians with sinonasal cancer can stimulate epidemiologic research for monitoring this group of cancers with a high association with occupational exposures. [ABSTRACT FROM AUTHOR]

Abstract Background The prevalence of musculoskeletal disorders (MSDs) among occupational fishers is high, yet knowledge of the risk factors is scarce and inconsistent. The aim of this study was to investigate the risk from various work-related characteristics on incident hospital contact due to a musculoskeletal disorders and other pain disorders among Danish occupational fishers. Methods This register-based study comprised data from the Danish Occupational Cohort with eXposure (DOC*X) for all persons registered as occupational fishers between 1994 and 2017. Time-to-event analysis with Cox regression model was used with age as the time scale. Results Among the 15,739 fishers, 40% (n = 5,669 cases) had an incident hospital contact with an MSD during follow-up. Back disorders were the dominant complaint. Male fishers working less than 5 years or more than 15 years had higher risks of MSD (HR 2.40 (95% CI: 2.06, 2.80), HR: 2.04 (95% CI: 1.76, 2.35), respectively, than those working for over 20 years. Period effects confounded and reduced the risk from occupational seniority. Conclusion Fishers occupational seniority vary in risk of MSDs across working life. Results showed a nonlinear relationship between the highest risk for fishers working less than 5 years and the lowest risk working more than 20 years as occupational fisher. More years in the workforce, a captain education, and primarily working part time significantly reduced the risk of experiencing a first MSDs for men. Healthy worker effect was documented.

Background: Measles infection in the hospital setting is a major issue. Despite the availability of an effective vaccine, measles outbreaks continue to occur in some European countries. We aimed to evaluate the immunological status of medical students attending the Tor Vergata Polyclinic (PTV). Methods: Measles antibodies titers were assessed by venipuncture on a sample of 2717 medical students who underwent annual health surveillance visits from January 2021 to March 2023. Subjects showing serum IgG values above 1.0 S/CO were considered serologically protected. Personal data, country of origin, and main demographic characteristic were also collected. Results: 66.7% (1467 Italian and 346 foreign) of medical students showed protective IgG antibodies levels. Female students were serologically immune more frequently than males (68.6% vs. 63.3%; p < 0.01 at Chi2). The mean antibody titer was 1.72 S/CO, significantly higher in females than males (1.67 vs. 1.75, respectively; p < 0.05), and significantly related to age (p < 0.01). Albanian students, who were the largest foreign population in our study, showed a low serological protection rate (40/90: 44.4%). Conclusions: The proportion of serologically non-immune students is high, raising concerns about the possible risk of hospital transmission. Substantial differences in the rate of immunity have been found between subjects coming from different parts of Europe and the world. Pre-training assessment of all medical students and vaccination of susceptible individuals is highly recommended, particularly for those from low immunization rate countries. [ABSTRACT FROM AUTHOR]

Evidence suggests that agricultural workers are at higher risk of insulin resistance (IR), but few studies have investigated IR in solar greenhouse workers, who are exposed to higher concentrations of agricultural risk factors than traditional agricultural workers. A prevalence study was conducted in a greenhouse vegetable farm in China. In total, 948 participants were enrolled in this study. Among them, 721 participants were allocated to the greenhouse worker group (G group), and 227 participants were assigned to the field worker group (F group). The TyG index, which is an indicator to evaluate prediabetes (IR), was calculated by the formula: TyG index = ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. To evaluate the associations of TyG index alternation with solar greenhouse and field work, multiple linear regression (MLR) and logistic regression models were performed. The TyG index in the G group (8.53 ± 0.56) was higher than that in the F group (8.44 ± 0.59) (p

Background: The prevalence of musculoskeletal disorders (MSDs) among occupational fishers is high, yet knowledge of the risk factors is scarce and inconsistent. The aim of this study was to investigate the risk from various work-related characteristics on incident hospital contact due to a musculoskeletal disorders and other pain disorders among Danish occupational fishers. Methods: This register-based study comprised data from the Danish Occupational Cohort with eXposure (DOC*X) for all persons registered as occupational fishers between 1994 and 2017. Time-to-event analysis with Cox regression model was used with age as the time scale. Results: Among the 15,739 fishers, 40% (n = 5,669 cases) had an incident hospital contact with an MSD during follow-up. Back disorders were the dominant complaint. Male fishers working less than 5 years or more than 15 years had higher risks of MSD (HR 2.40 (95% CI: 2.06, 2.80), HR: 2.04 (95% CI: 1.76, 2.35), respectively, than those working for over 20 years. Period effects confounded and reduced the risk from occupational seniority. Conclusion: Fishers occupational seniority vary in risk of MSDs across working life. Results showed a nonlinear relationship between the highest risk for fishers working less than 5 years and the lowest risk working more than 20 years as occupational fisher. More years in the workforce, a captain education, and primarily working part time significantly reduced the risk of experiencing a first MSDs for men. Healthy worker effect was documented. [ABSTRACT FROM AUTHOR]

Among the reports on needlestick and sharps injuries (NSIs), many are orthopedic-related due to the frequent use of sharp devices such as pins and wires. This study aimed to identify high-risk instruments, the ost common injury sites for each instrument, and the circumstances of NSIs of the hand during orthopedic surgeries in Japan. Incidents of exposure to blood or bodily fluids among physicians during orthopedic surgeries reported to the Japan-EPINet between 2000 and 2015 were included in this study. The four most common devices were identified and the associations among years of experience, equipment users, and injured sites were analyzed. We identified 666 cases of NSIs affecting orthopedic surgeons in the operating room. The instrument most frequently responsible for NSIs was suture needles, which were involved in 265 cases (39.7%). The second most common instrument was pins/wires, which was involved in 111 cases (16.6%). NSIs of the hands of orthopedic surgeons were frequently caused by suture needles used in all surgeries, but relatively often caused by orthopedic devices. Orthopedic surgeons must be aware that they are at risk of NSIs and must take appropriate measures and always be cautious when performing surgery, regardless of their years of experience. [ABSTRACT FROM AUTHOR]

An assessment of occupational disease in New York State was undertaken that partially replicated and expanded earlier work from 1987. Utilizing an expanded conception of occupational disease, the assessment used a variety of data sources and methods to provide estimates of mortality and morbidity of occupational disease; workers exposed to specific workplace hazards; disparities in occupational disease among racial/ethnic groups and gender; costs and distribution of costs of occupational disease; and accessible occupational medical resources. Examples of the pathways work may impact health in some of the major health issues of current import including stress-related health conditions; substance use; and overweight/obesity were included. The report contains recommendations for addressing the problem of occupational disease in New York State and advocates for the convening of a statewide group to develop an occupational disease prevention agenda. [ABSTRACT FROM AUTHOR]

Background: Environmental radon has been examined as a risk factor for neurodegenerative diseases in a small number of previous studies, but the findings have been inconsistent. This study aims to investigate the association between occupational radon exposure and neurodegenerative disease in a cohort of male miners with work experience in multiple ore types in Ontario, Canada. Methods: Radon exposure (1915–1988) was assessed using two job‐exposure matrices (JEM) constructed from using historical records for 34,536 Ontario male miners. Neurodegenerative outcomes were ascertained between 1992 and 2018. Poisson regression models were used to estimate incidence rate ratios (RR) and 95% confidence intervals (CI) between cumulative radon exposure in working level months (WLM) and each neurodegenerative outcome. Results: Levels of cumulative radon exposure showed variability among cohort members with a mean of 7.5 WLM (standard deviation 24.4). Miners in uranium mines or underground jobs had higher levels and more variability in exposure than workers in non‐uranium work or surface jobs. Compared to the reference group (radon < 1 WLM), increased rates of Alzheimer's (RR 1.23, 95% CI 1.05–1.45) and Parkinson's disease (RR 1.43, 95% CI 1.08–1.89) were observed among workers with >1–5 WLM and >5–10 WLM, respectively, but not among higher exposed workers (>10 WLM). Conclusion: This study did not observe a positive monotonic dose–response relationship between cumulative radon exposure and Alzheimer's or Parkinson's disease in Ontario mining workers. There was no association observed with motor neuron disease. [ABSTRACT FROM AUTHOR]

Abstract Background Mortality from chronic kidney disease of unknown etiology (CKDu) is extremely high along the Pacific coast of Central America, particularly among sugarcane workers. The Mesoamerican Nephropathy Occupational Study (MANOS) is a prospective cohort study of CKDu among agricultural and non-agricultural workers in El Salvador and Nicaragua. The objective of this manuscript is to describe the MANOS cohort recruitment, baseline data collection, and CKDu prevalence after two rounds. Methods Workers with no known diabetes, hypertension, or CKD were recruited from sugarcane, corn, plantain, brickmaking, and road construction industries (n = 569). Investigators administered questionnaires, collected biological samples, and observed workers for three consecutive workdays at the worksite. Serum specimens were analyzed for kidney function parameters, and used to calculate estimated glomerular filtration rate (eGFR). At six months, serum was collected again prior to the work shift. CKD at baseline is defined as eGFR ≤ 60 ml/min/1.73m2 at both timepoints. Age-standardized prevalence was calculated by industry, country, and demographic measures. Kidney function parameters were compared by CKD status. Results Prevalence of CKD at baseline was 7.4% (n = 42). Age-standardized prevalence was highest in Salvadoran sugarcane (14.1%), followed by Salvadoran corn (11.6%), and Nicaraguan brickmaking (8.1%). Nicaraguan sugarcane had the lowest prevalence, likely due to kidney function screenings prior to employment. Conclusion Despite efforts to enroll participants without CKD, our identification of prevalent CKD among agricultural and non-agricultural workers in the MANOS cohort indicates notable kidney disease in the region, particularly among sugarcane workers.

OBJECTIVES: Firefighters are exposed to a variety of known and suspected carcinogens through their work. However, the association with cancer risk has limited evidence. We examined cancer incidence among firefighters in the newly established Norwegian Fire Departments Cohort restricted to sites with established associations with carcinogens encountered during firefighting. This included sites within the respiratory, urinary, and lympho-hematopoietic systems, and the skin and all sites combined. METHODS: Male firefighters (N=3881) in the cohort were linked to the Cancer Registry of Norway for incident cancer cases occurring during the period 1960–2018. We calculated standardized incidence ratios (SIR) with rates for the national male population as reference, and stratified SIR analyses by period of first employment, duration of employment, and time since first employment. RESULTS: Elevated risk was seen for all sites combined (SIR 1.15, 95% confidence interval 1.07–1.23). Elevated risk of urinary tract cancer was observed among firefighters who began working before 1950, and with observation ≥40 years since first employment. Risk of mesothelioma and laryngeal cancer were elevated with ≥40 years since first employment and with ≥30 years employment duration. CONCLUSIONS: The observed associations between firefighting and urinary tract cancer, laryngeal cancer, and mesothelioma have been observed in some studies previously, and our results suggest the observed elevated risks are related to carcinogenic occupational exposures. Differences in risk by period of employment potentially reflect changes in exposures from improved quality and use of personal protective equipment.

OBJECTIVES: We provide a brief introduction to the objectives, data, methods and results of the World Health Organization (WHO)/International Labor Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), which estimated the burden attributable to 19 selected occupational risk factors. METHODS: The WHO/ILO Joint Estimates were produced within the global Comparative Risk Assessment framework, which attributes the burden of one specific health outcome (ie, disease/injury) to a specific occupational risk factor. For 39 established occupational risk factor-health outcome pairs, estimates are produced using population attributable fractions (PAF) from recent burden of disease estimates. For two additional pairs, PAF are calculated from new databases of exposure and risk ratios produced in WHO/ILO systematic reviews. Attributable disease burdens were estimated by applying the PAF to total disease burdens. RESULTS: Globally in 2016, it is estimated that 1.88 [95% uncertainty range (UR) 1.84–1.92] million deaths and 89.72 (95% UR 88.61–90.83) million disability-adjusted life years were attributable to the 19 selected occupational risk factors and their health outcomes. A disproportionately large work-related burden of disease is observed in the WHO African Region (for disability-adjusted life years), South-East Asia Region, and Western Pacific Region (for deaths), males and older age groups. CONCLUSIONS: The WHO/ILO Joint Estimates can be used for global monitoring of exposure to occupational risk factors and work-related burden of disease and to identify, plan, cost, implement and evaluate policies, programs and actions to prevent exposure to occupational risk factors and their associated burden.

IntroductionOccupation can contribute to differences in risk and stage at diagnosis of breast cancer. This study aimed at determining whether occupation, along with skill level and the socio-professional category, affect the breast cancer survival (BCS) up to 10 years after diagnosis.Materials and methodsWe used cancer registry records to identify women diagnosed with primary invasive breast cancer in western Switzerland over the period 1990–2014 and matched them with the Swiss National Cohort. The effect of work-related variables on BCS was assessed using non-parametric and parametric net survival methods.ResultsStudy sample included 8,678 women. In the non-parametric analysis, we observed a statistically significant effect of all work-related variables on BCS. Women in elementary occupations, with low skill level, and in paid employment not classified elsewhere, had the lowest BCS, while professionals, those with the highest skill level and belonging to top management and independent profession category had the highest BCS. The parametric analysis confirmed this pattern. Considering elementary occupations as reference, all occupations but Craft and related trades had a hazard ratio (HR) below 1. Among professionals, technicians and associate professionals, and clerks, the protective effect of occupation was statistically significant and remained unchanged after adjustment for age, calendar period, registry, nationality, and histological type. After adjusting for tumor stage, the HRs increased only slightly, though turned non-significant. The same effect was observed in top management and independent professions and supervisors, low level management and skilled laborers, compared to unskilled employees.ConclusionThese results suggest that work-related factors may affect BCS. Yet, this study was conducted using a limited set of covariates and a relatively small study sample. Therefore, further larger studies are needed for more detailed analyses of at risk occupations and working conditions and assessing the potential interaction between work-related variables and tumor stage.

BACKGROUND:There is growing use of a job exposure matrix (JEM) to provide exposure estimates in studies of work-related musculoskeletal disorders; few studies have examined the validity of such estimates, nor did compare associations obtained with a JEM with those obtained using other exposures. OBJECTIVE:This study estimated upper extremity exposures using a JEM derived from a publicly available data set (Occupational Network, O*NET), and compared exposure-disease associations for incident carpal tunnel syndrome (CTS) with those obtained using observed physical exposure measures in a large prospective study. METHODS:2393 workers from several industries were followed for up to 2.8 years (5.5 person-years). Standard Occupational Classification (SOC) codes were assigned to the job at enrolment. SOC codes linked to physical exposures for forceful hand exertion and repetitive activities were extracted from O*NET. We used multivariable Cox proportional hazards regression models to describe exposure-disease associations for incident CTS for individually observed physical exposures and JEM exposures from O*NET. RESULTS:Both exposure methods found associations between incident CTS and exposures of force and repetition, with evidence of dose-response. Observed associations were similar across the two methods, with somewhat wider CIs for HRs calculated using the JEM method. CONCLUSION:Exposures estimated using a JEM provided similar exposure-disease associations for CTS when compared with associations obtained using the 'gold standard' method of individual observation. While JEMs have a number of limitations, in some studies they can provide useful exposure estimates in the absence of individual-level observed exposures.

White collar workers in the trade and retail industry have relatively low sickness absence/disability pension rates, although the rates increased over the study period, especially with mental diagnoses. Several factors were more strongly associated with SA/DP among men, indicating that there are other factors of importance for women. Objective: This study aimed to investigate future sickness absence (SA) and disability pension (DP) among privately employed white-collar employees in the trade and retail industry. Methods: A prospective population-based cohort study of all 192,077 such workers in Sweden in 2012, using linked microdata from nationwide registers, was conducted. Descriptive statistics of annual SA/DP during 2010 to 2016 and logistic regression for SA/DP in 2016 were used. Results: Women had more mean SA/DP net days/person; however, there were no sex differences in the mean number of net days/person with SA/DP. The mean number of net days/person increased, especially with mental diagnoses. Sickness absence in 2012 was the strongest factor associated with SA/DP in 2016 (women: odds ratio, 3.28; 95% confidence interval, 3.09–3.47; men: odds ratio, 4.10; 95% confidence interval, 3.76–4.48). Work-related factors were weakly associated with future SA/DP. Conclusions: The number of SA/DP net days per person increased, especially SA/DP days due to mental diagnoses. [ABSTRACT FROM AUTHOR]

Work schedule control has been linked to self-reported mental health, a measure that may suffer recall, social desirability, and common-method variance biases. The study proposes an alternative outcome measure to reduce survey measurement errors. It tests whether schedule control is associated with objective allostatic load biomarkers of chronic stress in a national working population, and whether the relationship depends on workers' gender and gender role attitudes. A representative sample of 3677 British adults answered a cross-sectional survey on their work schedule control and provided blood samples in a nurse assessment. Allostatic load was constructed from 12 biomarkers across the cardiovascular, metabolic, and immune systems. The associations between work schedule control and allostatic load were tested for men and women with negative binomial models adjusting for covariates. Traditional versus egalitarian gender role attitude was then tested as a moderator. Control over work schedule is associated with lower or heathier allostatic load in women but not in men. The association is stronger among women who hold a more traditional gender role attitude towards the division of household labor. Women, especially those with traditional gender role attitudes, benefit most in allostatic load from work schedule control. Future research could use allostatic load biomarkers as a complementary indicator of quality of working life. Public health policymakers and organizations could use biomarkers to monitor the mental health risks of psychosocial work conditions and implement work-family policies to reduce the employed women's work-family conflict. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Birth cohorts collect valuable and under-utilized information on employment and health of parents before and during pregnancy, at birth, and sometimes after birth. In this discussion paper, we examine how these data could be exploited to study the complex relationships and interactions between parenthood, work, and health among parents themselves. METHODS: Using a web-based database of birth cohorts, we summarize information on maternal employment and health conditions and other potentially related variables in cohorts spread throughout Europe. This provided information on what data are available and could be used in future studies, and what was missing if specific questions are to be addressed, exploiting the opportunity to explore work–health associations across heterogenous geographical and social contexts. RESULTS: We highlight the many potentialities provided by birth cohorts and identify gaps that need to be addressed to adopt a life-course approach and investigate topics specific to the peri-pregnancy period, such as psychosocial aspects. We address the technical difficulties implied by data harmonization and the ethical challenges related to the repurposing of data, and provide scientific, ecological and economic arguments in favor of improving the value of data already available as a result of a serious investment in human and material resources. CONCLUSIONS: There is a hidden treasure in birth cohorts that deserves to be brought out to study the relationships between employment and health among working parents in a time when the boundaries between work and life are being stretched more than ever before.

Purpose of reviewWe offer an in-depth discussion of the time-varying confounding and selection bias mechanisms that give rise to the healthy worker survivor effect (HWSE).Recent findingsIn this update of an earlier review, we distinguish between the mechanisms collectively known as the HWSE and the statistical bias that can result. This discussion highlights the importance of identifying both the target parameter and the target population for any research question in occupational epidemiology. Target parameters can correspond to hypothetical workplace interventions; we explore whether these target parameters' true values reflect the etiologic effect of an exposure on an outcome or the potential impact of enforcing an exposure limit in a more realistic setting. If a cohort includes workers hired before the start of follow-up, HWSE mechanisms can limit the transportability of the estimates to other target populations. We summarize recent publications that applied g-methods to control for the HWSE, focusing on their target parameters, target populations, and hypothetical interventions.

Knowing the public health impact of occupational hazards is important for prioritization of preventive and mitigating measures and in monitoring how well they succeed. Information is needed on attributable morbidity and mortality, both globally and by national/regional jurisdiction. The best method of estimating population burdens will vary according to the nature of the hazard. One important consideration is whether health effects can be ascribed to work with confidence in the individual. Such attribution is straightforward where a disease occurs only as a consequence of occupational exposure (eg, coal workers’ pneumoconiosis, byssinosis). Alternatively, a link to occupation can sometimes be established through clinical investigation. For example, allergic contact dermatitis may confidently be attributed to work where it is associated with demonstrable sensitization to an agent encountered only in the workplace; and the role of work in an acute injury or poisoning may be clear from its circumstances and timing. Even where a disorder is not occupational in origin, it may be made worse by exposures in the workplace to an extent that can be determined in the individual case. For example, exacerbation of pre-existing asthma by occupational inhalation of irritants may be apparent from serial measurements of lung function when an employee is at, and away from, work. In such circumstances, public health burden can be estimated by aggregating data on individual cases, either across the population as a whole, or in a representative subsample. Possible sources of information include routine surveillance schemes such as the Health and Occupation Research (THOR) Network (1), data on claims for industrial injuries compensation (provided they are sufficiently accurate and complete), and ad hoc surveys in representative samples of the population. Where a disease has material fatality (eg, silicosis), counts of deaths may provide a good measure of attributable mortality. More commonly, occupational disorders are not specific to work, and there is no reliable way of determining occupational contribution in the individual case. The hazard may increase the probability and/or the average severity of a disease. For example, asbestos makes development of lung cancer more likely, while coal mine dust causes chronic obstructive pulmonary disease (COPD) through incremental loss of lung function. Either way, the need is to determine how much morbidity or mortality would be eliminated across the population, if the relevant occupational exposure were removed. To this end, epidemiological data comparing health outcomes in people according to their exposure must be combined with information on the prevalence and distribution of exposure in the population for which an estimate is sought. This is the approach underpinning the WHO/ILO analysis that is reported in Pega et al’s paper (2). Estimates of relative risk for paired combinations of occupational risk factor and disease were collated with data on the population prevalence of exposure to calculate population attributable fractions (PAF) (3), which then were multiplied by estimates of the total population impact of the disease (in terms of deaths and disability-adjusted life-years) to derive burdens attributable to occupation (2). The analysis was necessarily restricted to combinations of risk factor and disease for which there was judged to be adequate evidence, but it also has other important limitations, not all of which are acknowledged and discussed. Some of the assumed hazards are questionable. For example, occupational exposure to formaldehyde is estimated to account for some 350–400 deaths per year from leukemia. Although the International Agency for Research on Cancer has classified formaldehyde as a human carcinogen (4), that decision was controversial, and the systematic review and meta-analysis from which the relative risk was derived concluded that “on balance, these data do not provide consistent support for a relationship between formaldehyde exposure and leukemia risk” (5). Similarly, doubts have been cast on the assumed hazard of ischemic heart disease from long working hours, at least among people of higher socioeconomic status (6). A second problem lies in the ambiguous specification of some risk factors. The analysis attributes large numbers of deaths from COPD to occupational exposure to “particulate matter, gases and fumes” (2). It is unclear, however, what exactly is implied by that term. The many and varied particulates, gases and fumes that people encounter through their work differ widely in their toxicity. If the mix of such pollutants differed between the studies that were used to estimate the prevalence of exposure, and those used to estimate relative risk, then major bias is possible. Even where risk factors are specified more precisely (eg, sulfuric acid), there are challenging complexities in the characterization and classification of exposure. Impacts at an individual level, whether on risk of disease or its severity, can vary enormously according to the timing, duration and intensity of exposures. An earlier report suggests that for many occupational carcinogens, exposures were classed to three levels (background/low/high) (7). However, within such broad categories, there may be substantial heterogeneity of risk. In the WHO/ILO analysis, many of the risk estimates for occupational carcinogens come from industrial cohort studies, which have tended to focus on working populations known or expected to have relatively high intensity and duration of exposure (making any risks more readily detectable). In contrast, data on the prevalence of exposure derive from studies that aimed to ascertain the full extent of exposure in the population, even if only at a modest level. Within a broad exposure category, a meta-estimate of risk from published cohort studies may not be applicable to the distribution of exposures within that category in the general population, and such incompatibility could in some cases cause population burden to be seriously overestimated. Another challenge when extrapolating risk estimates from samples to populations is the potential for effect modification. The burden of back and neck pain was assessed in relation to “occupational exposure to ergonomic factors” (2), defined as “proportion of the population who are exposed to ergonomic risk factors for low back pain at work or through their occupation” (3). However, it is unclear how well the calculation allowed for major variation between countries in the individual risk of musculoskeletal pain and disability from specified occupational activities (8, 9). One way round these problems is to estimate population burden more directly, using the same study to provide information both on the distribution of exposure in the population and the effects of that exposure. For example, a national analysis of mortality by occupation has been used to estimate excess deaths from COPD among coal miners in England and Wales (10). While such analyses have other important limitations (for example, mortality as recorded on death certificates is an imperfect marker for disease, and full account cannot be taken of changes in occupation over a lifetime), the risk estimates that they generate are an average for exposure as it occurs in the population as a whole. In this respect, provided the ascertainment of exposure is reasonably sensitive (specificity is less critical), estimates of population burden will be less prone to bias. Given the many sources of uncertainty in the WHO/ILO analysis, only some of which have been highlighted here, it is surprising that such tight 95% uncertainty ranges are reported. For example, the uncertainty in thousands of deaths globally in 2017 from occupational exposure to formaldehyde is reported as 1 to 1, and that for lung cancer from occupational exposure to diesel exhaust as 16 to 20 (3). This is a concern because findings published under the auspices of authoritative international bodies such as WHO and ILO are liable to be accepted by many without question. As occupational health researchers and practitioners, we are naturally disposed to champion the importance of health protection in the workplace, but that enthusiasm should not compromise scientific rigor. Findings that appear to support our case must be scrutinized with the same care as those that call it into question. When estimating population burdens of disease from occupational hazards, we should aim if possible to triangulate between different analytical approaches and sources of data, carefully considering and acknowledging sources of uncertainty. The potential for error will often be greatest for exposures that are relatively prevalent in the working population (eg, long working hours), for which small differences in excess relative risk can translate into substantial differences in estimated burdens of disease at population level. References 1. Carder M, Hussey L, Money A, et al. The Health and Occupation Research Network: an evolving surveillance system. Safety and Health at Work 2017;8:231-6. https://doi.org/10.1016/j.shaw.2016.12.003 2. Pega F, Hamzaoui H, Náfrádi B, Momen NC. Global, regional and national burden of disease attributable to 19 selected occupational risk factors for 183 countries, 2000-2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Scand J Work Environ Health. 2022;48(2):158168. https://doi.org/10.5271/sjweh.4001 3. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1923-4. https://doi.org/10.1016/S0140-6736(18)32225-6 4. International Agency for Research on Cancer. Chemical agents and related occupations. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans; Volume 100F:401-435. Lyon, France 2012. https://publications.iarc.fr/123 (accessed 30.11.21). 5. Collins JJ, Lineker GA. A review and meta-analysis of formaldehyde and leukemia. Reg Toxicol Pharmacol 2004;40:81-89. https://doi.org/10.1016/j.yrtph.2004.04.006 6. Kivimäki M, Virtana M, Nyberg ST, Batty GD. The WHO/ILO report on long working hours and ischaemic heart disease - conclusions are not supported by the evidence. Environment International 2020;144:106048. https://doi.org/10.1016/j.envint.2020.106048 7. Concha-Barrientos M, Nelson D I, Driscoll T, et al. Chapter 21. Selected occupational risk factors. In Ezzati M, Lopez AD, Rogers A, Murray CJL, editors. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization; 2004. 8. Coggon D, Ntani G, Palmer KT, et al. Disabling musculoskeletal pain in working populations: Is it the job, the person or the culture? Pain. 2013;154:856-63. 9. Coggon D, Ntani G, Palmer KT, et al. Drivers of international variation in prevalence of disabling low back pain: Findings from the CUPID Study. Eur J Pain. 2019;23:35-45. https://doi.org/10.1002/ejp.1255 10. Coggon D, Harris EC, Brown T, Rice S, Palmer KT. Work-related mortality in England and Wales1979-2000. Occup Environ Med. 2010;67:816-22. https://doi.org/10.1136/oem.2009.052670

Healthcare workers (HCWs) have an increased risk to be exposed to infectious diseases compared to the general population. For this reason, according to the National Immunization and Prevention Plan, all HCWs should have demonstrable evidence of immunity to measles, mumps, rubella, varicella and Hepatitis B. Earlier studies have already shown that a large percentage of Italian operators lacked immune protection for one or more of those pathogens. The aim of this study was to evaluate the immunization status for vaccine-preventable diseases of HCWs in a large Italian teaching hospital. We retrospectively evaluated clinical records and serological data of HCWs who followed the occupational health surveillance program between January 1 and December 31 2019. We reviewed the clinical records of 1,017 HCWs: 393 males and 624 females with a median age of 35.69 y (range: 19–67). Protective IgG antibody values were documented in the 88.0%, 75.7%, 90.3%, 87.4% and 85.7% of the HCWs screened, respectively, against measles, mumps, rubella, varicella and Hepatitis B. Age was significantly related to serological protection against measles, mumps and varicella but was not significantly related to protective IgG levels for rubella and HBV. Female gender was significantly related to a higher protection rate against Hepatitis B (87.8 vs 82.4%; p

Background: Measles infection in the hospital setting is a major issue. Despite the availability of an effective vaccine, measles outbreaks continue to occur in some European countries. We aimed to evaluate the immunological status of medical students attending the Tor Vergata Polyclinic (PTV). Methods: Measles antibodies titers were assessed by venipuncture on a sample of 2717 medical students who underwent annual health surveillance visits from January 2021 to March 2023. Subjects showing serum IgG values above 1.0 S/CO were considered serologically protected. Personal data, country of origin, and main demographic characteristic were also collected. Results: 66.7% (1467 Italian and 346 foreign) of medical students showed protective IgG antibodies levels. Female students were serologically immune more frequently than males (68.6% vs. 63.3%; p < 0.01 at Chi2). The mean antibody titer was 1.72 S/CO, significantly higher in females than males (1.67 vs. 1.75, respectively; p < 0.05), and significantly related to age (p < 0.01). Albanian students, who were the largest foreign population in our study, showed a low serological protection rate (40/90: 44.4%). Conclusions: The proportion of serologically non-immune students is high, raising concerns about the possible risk of hospital transmission. Substantial differences in the rate of immunity have been found between subjects coming from different parts of Europe and the world. Pre-training assessment of all medical students and vaccination of susceptible individuals is highly recommended, particularly for those from low immunization rate countries.

Background: Mortality from chronic kidney disease of unknown etiology (CKDu) is extremely high along the Pacific coast of Central America, particularly among sugarcane workers. The Mesoamerican Nephropathy Occupational Study (MANOS) is a prospective cohort study of CKDu among agricultural and non-agricultural workers in El Salvador and Nicaragua. The objective of this manuscript is to describe the MANOS cohort recruitment, baseline data collection, and CKDu prevalence after two rounds.Methods: Workers with no known diabetes, hypertension, or CKD were recruited from sugarcane, corn, plantain, brickmaking, and road construction industries (n = 569). Investigators administered questionnaires, collected biological samples, and observed workers for three consecutive workdays at the worksite. Serum specimens were analyzed for kidney function parameters, and used to calculate estimated glomerular filtration rate (eGFR). At six months, serum was collected again prior to the work shift. CKD at baseline is defined as eGFR ≤ 60 ml/min/1.73m2 at both timepoints. Age-standardized prevalence was calculated by industry, country, and demographic measures. Kidney function parameters were compared by CKD status.Results: Prevalence of CKD at baseline was 7.4% (n = 42). Age-standardized prevalence was highest in Salvadoran sugarcane (14.1%), followed by Salvadoran corn (11.6%), and Nicaraguan brickmaking (8.1%). Nicaraguan sugarcane had the lowest prevalence, likely due to kidney function screenings prior to employment.Conclusion: Despite efforts to enroll participants without CKD, our identification of prevalent CKD among agricultural and non-agricultural workers in the MANOS cohort indicates notable kidney disease in the region, particularly among sugarcane workers. [ABSTRACT FROM AUTHOR]

Objective: The BRAIN Study was established to assess the associations between self‐reported concussions and cognitive function among retired rugby players. Methods: Former elite‐level male rugby union players (50+ years) in England were recruited. Exposure to rugby‐related concussion was collected using the BRAIN‐Q tool. The primary outcome measure was the Preclinical Alzheimer Cognitive Composite (PACC). Linear regressions were conducted for the association between concussion and PACC score, adjusting for confounders. Results: A total of 146 participants were recruited. The mean (standard deviation) length of playing career was 15.8 (5.4) years. A total of 79.5% reported rugby‐related concussion(s). No association was found between concussion and PACC (β –0.03 [95% confidence interval (CI): –1.31, 0.26]). However, participants aged 80+ years reporting 3+ concussions had worse cognitive function than those without concussion (β –1.04 [95% CI: –1.62, –0.47]). Conclusions: Overall there was no association between concussion and cognitive function; however, a significant interaction with age revealed an association in older participants. [ABSTRACT FROM AUTHOR]

Creating a Massive Open Online Course (MOOC) was a very satisfying experience and helped us renew our view on medical education. Given the costs in terms of time and money to develop one, we believe that interdisciplinary and international collaboration would improve the number and quality of future MOOCs especially in the field of occupational health and epidemiology. Objective: Massive Open Online Courses (MOOCs) offer a flexible method of providing education to large numbers of people around the world. This study aimed to develop and pilot test a mini MOOC in order to teach knowledge and skills in occupational epidemiology. Methods: Using instructional design principles, an open online course was developed. Results: Four modules have been designed and delivered in a pilot version requiring an 8-hour time commitment. Thirty postgraduate students evaluated different aspects of the MOOC. They appreciated the active learning approach, gave high rates of approval for learning effects and structure but would welcome more feedback and interaction. Conclusions: Although students were satisfied, developing the MOOC entailed a considerable amount of time. A multi-institutional approach and international collaboration would be beneficial to improve the present MOOC and develop new ones. [ABSTRACT FROM AUTHOR]

Objectives Firefighters are exposed to a variety of known and suspected carcinogens through their work. However, the association with cancer risk has limited evidence. We examined cancer incidence among firefighters in the newly established Norwegian Fire Departments Cohort restricted to sites with established associations with carcinogens encountered during firefighting. This included sites within the respiratory, urinary, and lymphohematopoietic systems, and the skin and all sites combined. Methods Male firefighters (N=3881) in the cohort were linked to the Cancer Registry of Norway for incident cancer cases occurring during the period 1960–2018. We calculated standardized incidence ratios (SIR) with rates for the national male population as reference, and stratified SIR analyses by period of first employment, duration of employment, and time since first employment. Results Elevated risk was seen for all sites combined (SIR 1.15, 95% confidence interval 1.07–1.23). Elevated risk of urinary tract cancer was observed among firefighters who began working before 1950, and with observation ≥40 years since first employment. Risk of mesothelioma and laryngeal cancer were elevated with ≥40 years since first employment and with ≥30 years employment duration. Conclusions The observed associations between firefighting and urinary tract cancer, laryngeal cancer, and mesothelioma have been observed in some studies previously, and our results suggest the observed elevated risks are related to carcinogenic occupational exposures. Differences in risk by period of employment potentially reflect changes in exposures from improved quality and use of personal protective equipment. [ABSTRACT FROM AUTHOR]

Varicella is a potentially serious infectious disease caused by Varicella-Zoster Virus (VZV). In Italy childhood varicella vaccine have gradually introduced into national immunization program since 2003 and from 2017 a two-doses schedule has been stated nationally for all newborns and has become compulsory for school attendance. VZV exposures among healthcare workers (HCWs) and patients can be really dangerous and expensive. According to Centers of Disease Control and Italian national immunization plan health care, institutions should verify that all HCWs have clear evidence of immunity to VZV and should ensure that susceptible subjects will receive 2 doses of VZV vaccine. Currently, the vaccination of HCWs is not compulsory in Italy and the risk of varicella infection among these subjects is not well known. We evaluated the clinical records of 840 HCWs (256 male and 584 female) who underwent the annual occupational screening, from 1st January to 31st August 2018. HCWs were divided into three subgroups according to their age: 18–30, 31–40, and over 40 years old. We compared the mean values of IgG-specific antibodies between the age group through analysis of variance (ANOVA). A total of 784 (93.33%) HCWs were protected for VZV IgG antibodies level. There wasn’t a significant difference between male and female while was found between age group (P

Little is known about the heart disease risks associated with occupational, rather than traffic-related, exposure to particulate matter with aerodynamic diameter of 2.5 µm or less (PM2.5). We examined long-term exposure to PM2.5 in cohorts of aluminum smelters and fabrication workers in the United States who were followed for incident ischemic heart disease from 1998 to 2012, and we addressed 2 forms of survivor bias. Left truncation bias was addressed by restricting analyses to the subcohort hired after the start of follow up. Healthy worker survivor bias, which is characterized by time-varying confounding that is affected by prior exposure, was documented only in the smelters and required the use of marginal structural Cox models. When comparing always-exposed participants above the 10th percentile of annual exposure with those below, the hazard ratios were 1.67 (95% confidence interval (CI): 1.11, 2.52) and 3.95 (95% CI: 0.87, 18.00) in the full and restricted subcohorts of smelter workers, respectively. In the fabrication stratum, hazard ratios based on conditional Cox models were 0.98 (95% CI: 0.94, 1.02) and 1.17 (95% CI: 1.00, 1.37) per 1 mg/m(3)-year in the full and restricted subcohorts, respectively. Long-term exposure to occupational PM2.5 was associated with a higher risk of ischemic heart disease among aluminum manufacturing workers, particularly in smelters, after adjustment for survivor bias.

Background: Needlestick and sharp injuries (NSIs) remain one of the main occupational hazards among health care workers (HCWs) that lead to blood-borne pathogen exposure. Purpose: This study examined the risk factors for NSIs among HCWs at a tertiary referral hospital in Bali. Methods: A case-control study was conducted at Sanglah General Hospital, Bali, involving 171 HCWs, divided into 81 cases and 90 control subjects. The sample was selected using a simple random sampling technique. Data were collected using questionnaires and analyzed using multiple logistic regression. Results: The majority of respondents had experienced NSIs once, in the morning shift, and had affected an individual’s hands. The most frequent activity leading to NSIs was giving an injection and most of the situations causing NSIs involved accidental self-action, and recapping needles. Factors associated with the incidence of NSIs were work career or experience of

To investigate cross-sectional associations between heavy occupational lifting and cardiac structure and function. Participants from the 5th round of the Copenhagen City Heart Study, aged < 65 years old, answering a questionnaire regarding occupational physical activity, heavy occupational lifting, use of anti-hypertensive and heart medication, and data on blood pressure, cardiac structure and function, from an echocardiographic examination, were included. Adjusted linear regressions and logistic regressions were applied to estimate the cross-sectional association between heavy occupational lifting and cardiac structure and function across all included participants and in groups stratified by hypertension status, and the risk for having abnormal values of cardiac structure and function. 2511 participants were included. The cross-sectional standardized associations between heavy occupational lifting and measures of cardiac structure and function showed a trends for raised left ventricular mass index (LVMi) (β 0.14, 99% CI − 0.03 to 0.31). The standardized associations stratified by hypertensive status showed significant associations between exposure to heavy occupational lifting and LVMi (β 0.20, 99% CI − 0.002 to 0.40) and a trend of a raised end-diastolic interventricular septal thickness (IVSd) (β 0.15, 99% CI − 0.03 to 0.33) among normotensives. Exposure to heavy occupational lifting increased the odds for an abnormal IVSd (OR 1.42, 99% CI 1.07–1.89). This cross-sectional study shows heavy occupational lifting to associate with indices of abnormal cardiac structure and function among normotensives, indicating an increased risk for cardiovascular disease. [ABSTRACT FROM AUTHOR]

Objectives We provide a brief introduction to the objectives, data, methods and results of the World Health Organization (WHO)/International Labor Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), which estimated the burden attributable to 19 selected occupational risk factors. Methods The WHO/ILO Joint Estimates were produced within the global Comparative Risk Assessment framework, which attributes the burden of one specific health outcome (ie, disease/injury) to a specific occupational risk factor. For 39 established occupational risk factor-health outcome pairs, estimates are produced using population attributable fractions (PAF) from recent burden of disease estimates. For two additional pairs, PAF are calculated from new databases of exposure and risk ratios produced in WHO/ILO systematic reviews. Attributable disease burdens were estimated by applying the PAF to total disease burdens. Results Globally in 2016, it is estimated that 1.88 [95% uncertainty range (UR) 1.84-1.92] million deaths and 89.72 (95% UR 88.61-90.83) million disability-adjusted life years were attributable to the 19 selected occupational risk factors and their health outcomes. A disproportionately large work-related burden of disease is observed in the WHO African Region (for disability-adjusted life years), South-East Asia Region, and Western Pacific Region (for deaths), males and older age groups. Conclusions The WHO/ILO Joint Estimates can be used for global monitoring of exposure to occupational risk factors and work-related burden of disease and to identify, plan, cost, implement and evaluate policies, programs and actions to prevent exposure to occupational risk factors and their associated burden. [ABSTRACT FROM AUTHOR]

An editorial is presented on public health impact of occupational hazards. Topics include exacerbation of pre-existing asthma by occupational inhalation of irritants being apparent from serial measurements of lung function; and asbestos making development of lung cancer while coal mine dust causing chronic obstructive pulmonary disease (COPD) through incremental loss of lung function.

Job-exposure matrices (JEM) are a common method for exposure assessment in occupational epidemiology. The first JEM were described in the early 1980s (1, 2) and have been used in a wide range of settings ever since. A recent review on methods for retrospective exposure assessment in the general population revealed that more than a quarter of the studies on cancer applied a JEM (3). Where JEM originally assigned exposures at a qualitative or semi-quantitative level based on expert ratings, quantitative exposure estimates can also be derived when measurements are used to calibrate these ratings (4-6). A JEM typically consists of job and exposure axes. The major advantage of JEM is that job histories can be translated into specific exposures in a systematic and unbiased way. It is basically a computerized linkage of exposure estimates to job codes, and, as such, JEM represent a highly efficient and reproducible methodology. This way, a standardized exposure assessment within and between studies can be guaranteed, and any misclassification is expected to be non-differential with respect to the health outcome. Once developed, a JEM is relatively easy to apply and less costly than case-by-case expert assessment. These benefits make JEM a particularly useful instrument for exposure assessment in large-scale, general population studies. Such studies (eg, based on register data) permit collection of full occupational histories and enable the study of rare diseases or subtypes. Subjects have typically worked in a wide variety of occupations and industries. Detailed exposure information, which can more easily be collected in industry-based cohorts, is often not available. For register-based cohorts, collected occupational histories are also typically limited to the basic information of job titles and industries. Using JEM, exposures can be assessed for many agents and stressors, based solely on job titles. The DOC*X project is a good example of the use of register data in occupational epidemiology (7). The large number of subjects – the full working population of Denmark for several decades – offers unique opportunities for studying new associations between a variety of exposures and various health outcomes. Individual data from several databases, including health and labour registries, were linked by a personal identifier. For each cohort member, job title and industry have been annually registered and coded (7). Subsequently, the project has been linking a series of JEM to this nationwide cohort to assess several kinds of occupational exposures. A couple of these efforts have been published in this issue of the Scandinavian Journal of Work, Environment and Health to assess the association between physical activities at work and acute myocardial infarction (8) and the risk of work-related hand eczema in relation to wet work (9). It is impossible to go back to all individuals in this cohort to collect detailed information on their occupations: firstly because part of the cohort has died over the years but also due to practical reasons given the large numbers. So, by applying JEM, the Danes make the best use of the information available in their registry data. The ease of using a JEM, by simply assigning exposures based on job titles, also has a flipside. By design, a JEM allocates the same exposure estimates to all workers with the same job title. This aspect represents the main drawback since it is well-recognized that there can be substantial inter-individual variability (10). In other words, a JEM completely dismisses exposure heterogeneity between workers in similar jobs, as has also been acknowledged by the authors of the DOC*X studies (8, 9). Heterogeneity between workers may be larger for some types of exposures than others, particularly when exposures are largely determined by specific tasks. To illustrate, when assessing welding fumes, job title alone does not provide information on different tasks and circumstances that influence the level and frequency of exposure to welding fumes (11). For exposures related to tasks like welding, decreasing or pesticide application – but also exposures such as shift work or certain psychosocial working conditions – exposure assessment based on job title alone may not be sufficient. Thus, researchers need to critically evaluate for each given exposure, if that exposure can be reasonably assessed on the job group level or if further assessment on the workplace, work unit or individual-worker level is needed. A large part of heterogeneity is determined by the workers’ behavior (12). Although this is virtually impossible to take into account in a JEM, some of the exposure heterogeneity may be accounted for by adding more detail, ie, by expanding the number of axes of the JEM. For example, an industry-axis, a time dimension, or region-, sex- and age-specific estimates may help explain part of the exposure heterogeneity. Importantly, this type of information is also typically available in the large studies where the JEM are being applied to. The JEM for wet work used by Lund et al (9) provided sex-specific estimates. A similar effort has been described for mechanical and psychosocial work exposures in Norway (13). In addition to within-job (ie, between-worker) variability, exposures may have large temporal (ie, within-worker) variability. Levels can vary from day-to-day or over the course of the work day, the variability of which is not captured in a JEM. When studying acute health effects, for example, short-term high exposures may be more relevant than the annual average or cumulative levels and a JEM may not provide the appropriate assessment. Many different JEM, in all forms and shapes, have been developed over the last 40 years. Due to the lack of a gold standard, JEM cannot be truly validated. Several studies, however, have described the performance of JEM (14–16). For asbestos, for instance, poor agreement between different JEM has been reported, indicating variable performance (14). Exposure assessment methods can also be evaluated using known associations with health outcomes. Using lung cancer case–control data, comparisons with other methods showed that a JEM for asbestos could outperform self-reported exposure (16) and perform as well as case-by-case expert assessment in a multicenter study (15). Yet, as indicated above, the performance of a JEM will depend on the exposure and effect of interest. Improvement in the use of JEM could be achieved by harmonizing existing JEM. A harmonized JEM, which provides a standardized exposure assessment across regions and time periods, would be highly valuable for pooled analyses. Such large-scale analyses will offer unique opportunities to study exposure–disease associations that have been understudied until now due to lack of statistical power. JEM will be invaluable instruments to such (exploratory) exercises. Derivation of exposure–response relations requires quantification of exposure. Development of more quantitative JEM, as first described for the multinational SYNERGY project on lung cancer (4) and the Shanghai Women’s Health Study (6), may further increase the impact of occupational studies. However, a quantitative JEM will still have the same limitation of assuming homogeneity within jobs and large amounts of (measurement) data are needed to develop a quantitative JEM. Data mining techniques could be explored to make better use. The coding of job titles is another major challenge related to the use of JEM. Manual coding of each individual’s job history in large epidemiological studies is a very time-consuming task. As a result, many of these studies are not used to their full potential for occupational health outcomes. Further improvement could therefore be achieved by systems that automatically translate free text into occupational codes, increasing the efficiency and feasibility of investigating occupational risk factors (using JEM) in large-scale epidemiological studies. Efforts in developing automatic coding in the US have shown agreements with manual coding of around 50% (17, 18). Automated coding systems would not be applicable to most registry data, however, since job information is only available as a code. For pooling these registry data with other data, or for application of another JEM, crosswalks between systems can be the solution. In addition to differences between human coders, crosswalks may also introduce disagreement between codes and actual jobs, possibly leading to further misclassification of exposure. Interestingly, within DOC*X it was shown that errors in job coding had limited effect on the exposure assessment of wood dust, lifting, standing/walking, arm elevation, and noise (19). Previous studies also reported that the effects of disagreements in job coding generally diminish in the exposure assessment stage (12, 20). Specificity is crucial when the prevalence of occupational exposure is low, which is often the case in the general population because possible associations may otherwise be severely underestimated. When exposures are more prevalent, sensitivity becomes more important (12). Since the performance of a JEM is also determined by the between-worker (ie, within job) and between-job variance, the level of detail of the job classification plays an important role. Occupational classification systems have primarily been developed from a social-economic perspective. These systems, either international or national coding schemes, are therefore not necessarily reflecting exposure categories in the best way. Developing new or adjusted coding systems for exposure assessment may help moving the occupational health field forward. Several research initiatives are currently working on such improvements in the use of JEM, including the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET, omeganetcohorts.eu) and the Exposome Project for Health and Occupational Research (EPHOR, www.ephor-project.eu). In conclusion, a JEM can be a very handy tool for exposure assessment in occupational epidemiology, particularly in large-scale studies with limited occupational information. When selecting the most suitable exposure assessment method, however, researchers should always remain critical. Know when a JEM has added value and recognize its limitations. References 1. Hoar SK, Morrison AS, Cole P, Silverman DT. An occupation and exposure linkage system for the study of occupational carcinogenesis. J Occup Med. 1980;22(11):722-6. 2. Pannett B, Coggon D, Acheson ED. A job-exposure matrix for use in population based studies in England and Wales. Br J Ind Med. 1985;42(11):777-83. https://doi.org/10.1136/oem.42.11.777 3. Ge CB, Friesen MC, Kromhout H, Peters S, Rothman N, Lan Q, et al. Use and Reliability of Exposure Assessment Methods in Occupational Case-Control Studies in the General Population: Past, Present, and Future. Ann Work Expo Health. 2018;62(9):1047-63. https://doi.org/10.1093/annweh/wxy080 4. Peters S, Vermeulen R, Portengen L, Olsson A, Kendzia B, Vincent R, et al. Modelling of occupational respirable crystalline silica exposure for quantitative exposure assessment in community-based case-control studies. J Environ Monit. 2011;13(11):3262-8. https://doi.org/10.1039/c1em10628g 5. Peters S, Vermeulen R, Portengen L, Olsson A, Kendzia B, Vincent R, et al. SYN-JEM: A Quantitative Job-Exposure Matrix for Five Lung Carcinogens. Ann Occup Hyg. 2016;60(7):795-811. https://doi.org/10.1093/annhyg/mew034 6. Friesen MC, Coble JB, Lu W, Shu XO, Ji BT, Xue S, et al. Combining a job-exposure matrix with exposure measurements to assess occupational exposure to benzene in a population cohort in shanghai, china. Ann Occup Hyg. 2012;56(1):80-91. https://doi.org/10.1136/oemed-2011-100382.81 7. Flachs EM, Petersen SEB, Kolstad HA, Schlunssen V, Svendsen SW, Hansen J, et al. Cohort Profile: DOC*X: a nationwide Danish occupational cohort with eXposure data - an open research resource. Int J Epidemiol. 2019;48(5):1413-k. https://doi.org/10.1093/ije/dyz110 8. Bonde JPE, Flachs EM, Madsen IE, Petersen SB, Andersen JH, Hansen J, et al. Acute myocardial infarction in relation to physical activities at work: a nationwide follow-up study based on job-exposure matrices. Scand J Work Environ Health. 2019. https://doi.org/10.5271/sjweh.3863 9. Lund T, Petersen SB, Flachs EM, Ebbehoj NE, Bonde JP, Agner T. Risk of work-related hand eczema in relation to wet work exposure. Scand J Work Environ Health. 2020. https://doi.org/10.5271/sjweh.3876 10. Kromhout H, Symanski E, Rappaport SM. A comprehensive evaluation of within- and between-worker components of occupational exposure to chemical agents. Ann Occup Hyg. 1993;37(3):253-70. 11. IARC Working Group. Volume 118: Welding, Indium Tin Oxide, Molybdenum Trioxide.: IARC Monogr Eval Carcinog Risks Hum; 2018. 12. Kromhout H, Vermeulen R. Application of job-exposure matrices in studies of the general population. Some clues to their performance. European Respiratory Review. 2001;11:80-90. 13. Hanvold TN, Sterud T, Kristensen P, Mehlum IS. Mechanical and psychosocial work exposures: the construction and evaluation of a gender-specific job exposure matrix (JEM). Scand J Work Environ Health. 2019;45(3):239-47. https://doi.org/10.5271/sjweh.3774 14. Offermans NS, Vermeulen R, Burdorf A, Peters S, Goldbohm RA, Koeman T, et al. Comparison of expert and job-exposure matrix-based retrospective exposure assessment of occupational carcinogens in The Netherlands Cohort Study. Occup Environ Med. 2012;69(10):745-51. https://doi.org/10.1136/oemed-2011-100556 15. Peters S, Vermeulen R, Cassidy A, Mannetje A, van Tongeren M, Boffetta P, et al. Comparison of exposure assessment methods for occupational carcinogens in a multi-centre lung cancer case-control study. Occup Environ Med. 2011;68(2):148-53. https://doi.org/10.1136/oem.2010.055608 16. Hardt JS, Vermeulen R, Peters S, Kromhout H, McLaughlin JR, Demers PA. A comparison of exposure assessment approaches: lung cancer and occupational asbestos exposure in a population-based case-control study. Occup Environ Med. 2014;71(4):282-8. https://doi.org/10.1136/oemed-2013-101735 17. Russ DE, Ho KY, Colt JS, Armenti KR, Baris D, Chow WH, et al. Computer-based coding of free-text job descriptions to efficiently identify occupations in epidemiological studies. Occup Environ Med. 2016;73(6):417-24. https://doi.org/10.1136/oemed-2015-103152 18. Burstyn I, Slutsky A, Lee DG, Singer AB, An Y, Michael YL. Beyond crosswalks: reliability of exposure assessment following automated coding of free-text job descriptions for occupational epidemiology. Ann Occup Hyg. 2014;58(4):482-92. 19. Petersen SB, Flachs EM, Svendsen SW, Marott JL, Budtz-Jorgensen E, Hansen J, et al. Influence of errors in job codes on job exposure matrix-based exposure assessment in the register-based occupational cohort DOC*X. Scand J Work Environ Health. 2019. https://doi.org/10.5271/sjweh.3857 20. Koeman T, Offermans NS, Christopher-de Vries Y, Slottje P, Van Den Brandt PA, Goldbohm RA, et al. JEMs and incompatible occupational coding systems: effect of manual and automatic recoding of job codes on exposure assignment. Ann Occup Hyg. 2013;57(1):107-14.

OBJECTIVE: The aim of this study was to investigate cross-sectional and prospective associations between heavy occupational lifting and hypertension. METHODS: Data from the third, fourth and fifth examinations of the Copenhagen City Heart Study were included. Multivariable logistic regression models were applied to adjust for sex, age, body mass index (BMI), smoking, education, self-rated cardiorespiratory fitness, vital exhaustion and baseline blood pressure, and were used to estimate (i) the cross-sectional association between heavy occupational lifting and hypertension, defined as using anti-hypertensives or having a systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg, and (ii) the prospective association between heavy occupational lifting and risk of becoming a systolic blood pressure case, defined as an above median change (from baseline to follow-up) and/or a shift from no use of anti-hypertensives at baseline to use of anti-hypertensives at a ten-year follow-up. RESULTS: Both cross-sectional [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.94–1.20] and prospective (OR 1.10, 95% CI 0.92–1.31) analysis indicated no relations. Explorative prospective analyses suggested linear associations between heavy occupational lifting and systolic blood pressure among participants using anti-hypertensives. Exposure to heavy occupational lifting tended to increase the incidence of hypertension (OR 1.30, 95% CI 0.97–1.73) among participants ≥50 years. CONCLUSIONS: No associations were seen among the general population. Positive associations were seen among users of anti-hypertensives and participants ≥50 years, indicating these groups as vulnerable to increases in blood pressure when exposed to occupational lifting.

Introduction. Violence against healthcare workers (HCWs) is a widespread, underreported, and inadequately prevented problem. Only a few companies have efficient systems for assessing the extent of the phenomenon. Methods . In 2005, the health surveillance service of a public health company introduced a system that monitored violence experienced by HCWs by means of three items from the Violent Incident Form (VIF) integrated with departmental in-depth analyses using the participatory ergonomics group technique. Results . In 2005, the annual rate of physical assaults was 8.2%, that of threats was 12.0%, and the harassment rate was 19.6%. Over the past twenty years of observation (2005-2024), the percentage of workers who reported experiencing a physical attack in the previous year at their periodic medical examination has fluctuated between 5.8% and 11.1%, except for the years 2020 and 2021 when, during the COVID-19 pandemic, the rate was 3.9% and 3.2%, respectively. During the same pandemic period, the annual threat rate, which ranged from 9.4% to 20.1%, dropped to 7.7%, while the prevalence of harassment, which was between 13.5 and 19.6, fell to 7.2%. HCWs believe that (i) limiting visitor access, (ii) a better balance of the demand for services, and (iii) a better attitude towards HCWs were the causes of the reduced rate of violence during the pandemic. Conclusions. Recording the violence experienced during health surveillance is an economical, reliable, and sustainable risk assessment method.

Background: Psychosocial stressors at work, defined by the job strain and effort-reward imbalance at work (ERI) models, were shown to increase coronary heart disease risk. No previous study has examined the adverse effect of psychosocial stressors at work from both models on atrial fibrillation (AF) incidence. The objective of this study was to examine the separate and combined effect of psychosocial stressors at work from the job strain and ERI models on AF incidence in a prospective cohort study., Methods and Results: A total of 5926 white-collar workers (3021 women and 2905 men) free of cardiovascular disease at baseline were followed for an average of 18 years. Job strain (high psychological demands combined with low decision latitude) and ERI were assessed using validated instruments. AF events were identified in medical databases with universal coverage. Hazard ratios (HRs) with 95% CIs were estimated using Cox regression models, controlling for socioeconomic characteristics and lifestyle-related and clinical risk factors. A total of 186 AF incident events were identified over 18 years. Workers exposed to job strain (HR, 1.83 [95% CI, 1.14-2.92]) and ERI (HR, 1.44 [95% CI, 1.05-1.98]) had a higher risk of AF in fully adjusted models. Combined exposure to job strain and ERI was associated with a 2-fold AF risk increase (HR, 1.97 [95% CI, 1.26-3.07])., Conclusions: Psychosocial stressors at work from the job strain and ERI models are associated with an increased risk of AF, separately and in combination. Workplace prevention strategies targeting these psychosocial stressors at work may be effective to reduce the burden associated with AF.

Background: As part of the development of the World Health Organization (WHO)/International Labour Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury, WHO and ILO carried out several systematic reviews to determine the prevalence of exposure to selected occupational risk factors. Risk of bias assessment for individual studies is a critical step of a systematic review. No tool existed for assessing the risk of bias in prevalence studies of exposure to occupational risk factors, so WHO and ILO developed and pilot tested the RoB-SPEO tool for this purpose. Here, we investigate the assessor burden, inter-rater agreement, and user experience of this new instrument, based on the abovementioned WHO/ILO systematic reviews. Methods: Twenty-seven individual experts applied RoB-SPEO to assess risk of bias. Four systematic reviews provided a total of 283 individual assessments, carried out for 137 studies. For each study, two or more assessors independently assessed risk of bias across the eight RoB-SPEO domains selecting one of RoB-SPEO’s six ratings (i.e., “low”, “probably low”, “probably high”, “high”, “unclear” or “cannot be determined”). Assessors were asked to report time taken (i.e. indicator of assessor burden) to complete each assessment and describe their user experience. To gauge assessor burden, we calculated the median and inter-quartile range of times taken per individual risk of bias assessment. To assess inter-rater reliability, we calculated a raw measure of inter-rater agreement (Pi) for each RoB-SPEO domain, between Pi = 0.00, indicating no agreement and Pi = 1.00, indicating perfect agreement. As subgroup analyses, Pi was also disaggregated by systematic review, assessor experience with RoB-SPEO (≤10 assessments versus > 10 assessments), and assessment time (tertiles: ≤25 min versus 26–66 min versus ≥ 67 min). To describe user experience, we synthesised the assessors’ comments and recommendations. Results: Assessors reported a median of 40 min to complete one assessment (interquartile range 21–120 min). For all domains, raw inter-rater agreement ranged from 0.54 to 0.82. Agreement varied by systematic review and assessor experience with RoB-SPEO between domains, and increased with increasing assessment time. A small number of users recommended further development of instructions for selected RoB-SPEO domains, especially bias in selection of participants into the study (domain 1) and bias due to differences in numerator and denominator (domain 7). Discussion: Overall, our results indicated good agreement across the eight domains of the RoB-SPEO tool. The median assessment time was comparable to that of other risk of bias tools, indicating comparable assessor burden. However, there was considerable variation in time taken to complete assessments. Additional time spent on assessments may improve inter-rater agreement. Further development of the RoB-SPEO tool could focus on refining instructions for selected RoB-SPEO domains and additional testing to assess agreement for different topic areas and with a wider range of assessors from different research backgrounds.

Objectives Paper dust has previously been linked to adverse health effects. However, a comprehensive dataset of paper dust exposures does not appear to have been published previously. Our study was intended to address this need by describing a large dataset of measurements made in Swedish soft tissue paper mills. Methods We compiled personal and area total dust exposure measurements collected from a range of operations by our research staff at four soft tissue paper mills in Sweden. We also compiled measurements made by the occupational health staff at each mill and the Swedish Work Environment Authority. We analyzed these measurements to describe patterns and trends in exposures and used mixed-effects regression models to identify measurement characteristics that predicted exposure levels. Results We compiled 1578 measurements from 1971 to 2009, of which 1026 (65%) were personal samples. Statistically significant differences were found between measurements made by research, mill, and Swedish Work Environment Authority staff, as well as between personal and area measurements. The measurement data suggest that, beginning in the 1980s, exposures declined at three of the four mills, but that overexposures were still common at the end of the period. Papermaking and converting operations had the highest observed dust exposures. One mill had significantly lower exposures than the others. Type of measurement (personal versus area) and source of measurement (research staff, company, or regulatory agency) were not significant predictors of measured total dust exposure after controlling for mill, operation, and time. Conclusions Our analysis of measured paper dust exposures may be useful for historical and contemporary exposure assessment in our own and other epidemiological studies. We have identified specific characteristics (i.e. papermaking operations and mill) and time trends that are important data features to consider, and documented continuing overexposure situations. Our results highlight the ongoing need for application of exposure controls to reduce paper dust exposures in the soft tissue paper industry. [ABSTRACT FROM AUTHOR]

Objective: This study examines the association between 8-h time weighted N, N-dimethylacetamide (DMAc) air exposure and potential hepatocellular injury in a retrospective study among fibre-production workers in four European factories. Methods and Results: Twenty-nine (1.5%) of 1844 alanine aminotransferase (ALT) observations had liver values two times above normal; 0.2% three times above normal and 0.05% five times above normal. Two (0.1%) observations were indicative of hepatocellular injury. Logistic regression analyses showed an odds ratio for elevated ALT of 0.88 per 1 ppm (P trend = 0.39). Linear random effects regression analyses showed a decrease of one international unit (IU/L) ALT per 1 ppm increase of DMAc exposure (P  = 0.002). Conclusions: This study found no association between DMAc exposure and hepatoxicity amongst European workers. The prevalence of elevated liver values was lower compared to the general population without occupational exposure. [ABSTRACT FROM AUTHOR]

Objective Birth cohorts collect valuable and under-utilized information on employment and health of parents before and during pregnancy, at birth, and sometimes after birth. In this discussion paper, we examine how these data could be exploited to study the complex relationships and interactions between parenthood, work, and health among parents themselves. Methods Using a web-based database of birth cohorts, we summarize information on maternal employment and health conditions and other potentially related variables in cohorts spread throughout Europe. This provided information on what data are available and could be used in future studies, and what was missing if specific questions are to be addressed, exploiting the opportunity to explore work-health associations across heterogenous geographical and social contexts. Results We highlight the many potentialities provided by birth cohorts and identify gaps that need to be addressed to adopt a life-course approach and investigate topics specific to the peri-pregnancy period, such as psychosocial aspects. We address the technical difficulties implied by data harmonization and the ethical challenges related to the repurposing of data, and provide scientific, ecological and economic arguments in favor of improving the value of data already available as a result of a serious investment in human and material resources. Conclusions There is a hidden treasure in birth cohorts that deserves to be brought out to study the relationships between employment and health among working parents in a time when the boundaries between work and life are being stretched more than ever before. [ABSTRACT FROM AUTHOR]