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  • 1
    Publication Date: 2018-06-15
    Description: Paid employment is an essential component of adult life and a major determinant of health. However, underemployment, long-term unemployment, poor working conditions and a lack of job security all negatively affect health, may hinder economic growth and further increase inequalities in the population. Occupational exposures are related to a significant proportion of diseases including cancer, cardiorespiratory diseases and musculoskeletal and mental disorders, among others. 1 The demographic shift, with an ageing and increasingly diverse workforce, makes the impact of work on healthy ageing and disease prognosis a key issue. Rapid changes in employment patterns and exposures along with occupational restructuring and the increasing use of new technologies further increase the importance of research in occupational health. 2 Europe currently has some of the most valuable occupational, industrial and population cohorts for aetiological research worldwide. However, relatively limited sample sizes of individual studies and lack of data harmonisation have...
    Keywords: Open access
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 2
    Publication Date: 2018-06-15
    Description: Hypothesis testing is a basic tool of epidemiology: outcomes in individuals are apparently random until we apply some form of averaging, and statistics provides us with the sharpest tools for studying populations without being misled by chance. Hypothesis testing is at the very base of understanding, along with modelling and parameter estimation. An article in this issue by Lenters et al 1 uses simulation to address some questions which should be well understood in the epidemiology community, but sadly are not. Any test is characterised by two parameters. Sensitivity: the probability of a positive conclusion given a specified real effect. In the context of hypothesis testing, this is called power. Specificity: the probability of a negative conclusion given there is no real effect. For hypothesis testing, we call (1–specificity) the type 1 error. The interpretation of a positive or negative test result depends not only on...
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 3
    Publication Date: 2018-06-15
    Description: Background Controversy exists as to the health effects of exposure to asphalt and crumb rubber modified (CRM) asphalt, which contains recycled rubber tyres. Objective To assess exposures and effects on airway symptoms, lung function and inflammation biomarkers in conventional and CRM asphalt road pavers. Methods 116 conventional asphalt workers, 51 CRM asphalt workers and 100 controls were investigated. A repeated-measures analysis included 31 workers paving with both types of asphalt. Exposure to dust, nitrosamines, benzothiazole and polycyclic aromatic hydrocarbon (PAH) was measured in worksites. Self-reported symptoms, spirometry test and blood sampling were conducted prework and postwork. Symptoms were further collected during off-season for asphalt paving. Results Dust, PAHs and nitrosamine exposure was highly varied, without difference between conventional and CRM asphalt workers. Benzothiazole was higher in CRM asphalt workers (p〈0.001). Higher proportions of asphalt workers than controls reported eye symptoms with onset in the current job. Decreased lung function from preworking to postworking was found in CRM asphalt workers and controls. Preworking interleukin-8 was higher in CRM asphalt workers than in the controls, followed by a decrement after 4 days of working. No differences in any studied effects were found between conventional and CRM asphalt paving. Conclusion CRM asphalt workers are exposed to higher benzothiazole. Further studies are needed to identify the source of nitrosamines in conventional asphalt. Mild decrease in lung function in CRM asphalt workers and work-related eye symptoms in both asphalt workers were observed. However, our study did not find strong evidence for severe respiratory symptoms and inflammation response among asphalt workers.
    Keywords: Open access
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 4
    Publication Date: 2018-06-15
    Description: 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.
    Keywords: Open access
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 5
    Publication Date: 2018-06-15
    Description: We thank Barber and colleagues 1 for their interest in our paper. 2 It is excellent that the Surveillance of Work-related Occupational Respiratory Disease (SWORD)  database could be interrogated; in Australia we have no such centralised resource. We were concerned that two-thirds of their cases of silicosis were diagnosed in men of working age; we agree that in the absence of specific information about occupational exposures within the category of ‘stonemason’, it is difficult to be entirely sure that none of these were related to artificial stone processing. The letter highlights the challenge of differentiating silicosis from sarcoidosis in young workers with progressive lung opacities. Compared with chronic and acute silicosis, the histopathological features of accelerated silicosis are yet to be clearly defined. 3 This is partly due to the modest number of reported cases, but also the fact that this is a condition that produces progressive...
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 6
    Publication Date: 2018-06-15
    Description: We read with interest the recent article by Hoy et al highlighting the risk of accelerated silicosis in workers installing kitchen and bathroom worktops. 1 The Australian paper noted that artificial stone had been available in Australia since the early 2000s, and identified seven cases of silicosis diagnosed between 2011 and 2016. We were particularly interested by this, as the same type of artificial stone worktops have also been commercially available in the UK for approximately the same time period, yet there have been no published cases of accelerated silicosis from our country. To investigate further, we interrogated the Surveillance of Work-related Occupational Respiratory Disease (SWORD) national reporting scheme database and reviewed the 161 reported cases of silicosis between 2000 and 2017. 2 Interestingly, two-thirds of these cases were diagnosed in working age individuals. A review of each individual suspected cause confirmed that there have not been...
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    Topics: Medicine
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  • 7
    Publication Date: 2018-06-15
    Description: Objectives We investigated work-unit exit, total and long-term sickness absence following organisational change among public healthcare employees. Methods The study population comprised employees from the Capital Region of Denmark (n=14 388). Data on reorganisation at the work-unit level (merger, demerger, relocation, change of management, employee layoff or budget cut) between July and December 2013 were obtained via surveys distributed to the managers of each work unit. Individual-level data on work-unit exit, total and long-term sickness absence (≥29 days) in 2014 were obtained from company registries. For exposure to any, each type or number of reorganisations (1, 2 or ≥3), the HRs and 95% CIs for subsequent work-unit exit were estimated by Cox regression, and the risk for total and long-term sickness absence were estimated by zero-inflated Poisson regression. Results Reorganisation was associated with subsequent work-unit exit (HR 1.10, 95% CI 1.01 to 1.19) in the year after reorganisation. This association was specifically important for exposure to ≥3 types of changes (HR 1.52, 95% CI 1.30 to 1.79), merger (HR 1.29, 95% CI 1.12 to 1.49), demerger (HR 1.41, 95% CI 1.16 to 1.71) or change of management (HR 1.24, 95% CI 1.11 to 1.38). Among the employees remaining in the work unit, reorganisation was also associated with more events of long-term sickness absence (OR 1.15, 95% CI 1.00 to 1.33), which was particularly important for merger (OR 1.31, 95% CI 1.00 to 1.72) and employee layoff (OR 1.31, 95% CI 1.08 to 1.59). Conclusions Specific types of reorganisation seem to have a dual impact on subsequent work-unit exit and sickness absence in the year after change.
    Keywords: Open access
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 8
    Publication Date: 2018-06-15
    Description: Objectives Poor psychosocial working conditions increase the likelihood of various types of morbidity and may substantially limit quality of life and possibilities to remain in paid work. To date, however, no studies to our knowledge have quantified the extent to which poor psychosocial working conditions reduce healthy or chronic disease-free life expectancy, which was the focus of this study. Methods Data were derived from four cohorts with repeat data: the Finnish Public Sector Study (Finland), GAZEL (France), the Swedish Longitudinal Occupational Survey of Health (Sweden) and Whitehall II (UK). Healthy (in good self-rated health) life expectancy (HLE) and chronic disease-free (free from cardiovascular disease, cancer, respiratory disease and diabetes) life expectancy (CDFLE) was calculated from age 50 to 75 based on 64 394 individuals with data on job strain (high demands in combination with low control) at baseline and health at baseline and follow-up. Results Multistate life table models showed that job strain was consistently related to shorter HLE (overall 1.7 years difference). The difference in HLE was more pronounced among men (2.0 years compared with 1.5 years for women) and participants in lower occupational positions (2.5 years among low-grade men compared with 1.7 years among high-grade men). Similar differences in HLE, although smaller, were observed among those in intermediate or high occupational positions. Job strain was additionally associated with shorter CDFLE, although this association was weaker and somewhat inconsistent. Conclusions These findings suggest that individuals with job strain have a shorter health expectancy compared with those without job strain.
    Keywords: Open access
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    Topics: Medicine
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  • 9
    Publication Date: 2018-06-15
    Description: Objectives We aimed to update an asthmagen job exposure matrix (JEM) developed in the late 1990s. Main reasons were: the number of suspected and recognised asthmagens has since tripled; understanding of the aetiological role of irritants in asthma and methodological insights in application of JEMs have emerged in the period. Methods For each agent of the new occupational asthma-specific JEM (OAsJEM), a working group of three experts out of eight evaluated exposure for each International Standard Classification of Occupations, 1988 (ISCO-88) job code into three categories: ‘high’ (high probability of exposure and moderate-to-high intensity), ‘medium’ (low-to-moderate probability or low intensity) and ‘unexposed’. Within a working group, experts evaluated exposures independently from each other. If expert assessments were inconsistent the final decision was taken by consensus. Specificity was favoured over sensitivity, that is, jobs were classified with high exposure only if the probability of exposure was high and the intensity moderate-to-high. In the final review, all experts checked assigned exposures and proposed/improved recommendations for expert re-evaluation after default application of the JEM. Results The OAsJEM covers exposures to 30 sensitisers/irritants, including 12 newly recognised, classified into seven broad groups. Initial agreement between the three experts was mostly fair to moderate ( values 0.2–0.5). Out of 506 ISCO-88 codes, the majority was classified as unexposed (from 82.6% (organic solvents) to 99.8% (persulfates)) and a minority as ‘high-exposed’ (0.2% (persulfates) to 2.6% (organic solvents)). Conclusions The OAsJEM developed to improve occupational exposure assessment may improve evaluations of associations with asthma in epidemiological studies and contribute to assessment of the burden of work-related asthma.
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    Topics: Medicine
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  • 10
    Publication Date: 2018-06-15
    Description: Objectives Chronic otitis media (COM) is caused by an infection of the middle ear, although it may also be associated with environmental pollutants. Recent reports found that cadmium exposure could be toxic to middle ear cell lines, but the role of cadmium in the development of COM in humans has not been examined to date. We hypothesised that environmental cadmium exposure was associated with an increased risk of COM in the general population. Methods We analysed cross-sectional data for 5331 adults of 20 years of age or above, obtained from the Korea National Health and Nutrition Examination Survey 2010–2012. We examined the association between blood cadmium levels and COM diagnosed by an otolaryngologist. Results The highest quartile group of cadmium blood concentration was associated with an OR of 3.33 (95% CI 1.78 to 7.53) for COM, after adjusting for potential confounding factors. Doubling blood cadmium concentration resulted in an OR of 1.58 (95% CI 1.19 to 2.08) for COM. These associations were robust on sensitivity analyses after excluding current smokers and former smokers and after excluding subjects with a potential history of occupational exposure to cadmium. Conclusions The results of our study suggest that environmental cadmium exposure is associated with increased risk of COM, and further studies are warranted to understand the pathogenetic mechanism by which COM is caused by cadmium exposure.
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    Topics: Medicine
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