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  • 1
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    A worldwide ban on asbestos production and use: some recent progress, but more still to be done (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: The landmark paper by Wagner et al 1 published in this journal in 1960, which linked work with crocidolite asbestos and mesothelioma in South Africa, has been instrumental in the dramatic reduction in asbestos mining and other measures to reduce asbestos exposure, most successfully in developed countries. This contrasts sharply with the lack of progress in newly industrialising countries, in particular large countries such as Brazil, China and India, which continue to produce, import and use large amounts of chrysotile asbestos. There have been several recent developments in the state of the science relating to asbestos-related cancers which have strengthened the call for more intensive action to cease asbestos mining, the manufacturing of asbestos products and to reduce exposure from existing asbestos-containing materials. In the UK, the spectrum of workers at high risk of developing mesothelioma has been changing, with a decline in those involved in mining and...
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 2
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    Chronic workplace stress and insufficient physical activity: a cohort study (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: Objectives To examine whether exposure to workplace stressors predicts changes in physical activity and the risk of insufficient physical activity. Methods Prospective data from the Finnish Public Sector Study. Repeated exposure to low job control, high job demands, low effort, low rewards and compositions of these (job strain and effort–reward imbalance) were assessed at Time 1 (2000–2002) and Time 2 (2004). Insufficient physical activity (〈14 metabolic equivalent task hours per week) was measured at Time 1 and Time 3 (2008). The effect of change in workplace stressors on change in physical activity was examined using fixed-effects (within-subject) logistic regression models ( N =6665). In addition, logistic regression analysis was applied to examine the associations between repeated exposure to workplace stressors and insufficient physical activity ( N =13 976). In these analyses, coworker assessed workplace stressor scores were used in addition to individual level scores. Results The proportion of participants with insufficient physical activity was 24% at baseline and 26% at follow-up. 19% of the participants who were sufficiently active at baseline became insufficiently active at follow-up. In the fixed-effect analysis, an increase in workplace stress was weakly related to an increase in physical inactivity within an individual. In between-subjects analysis, employees with repeated exposure to low job control and low rewards were more likely to be insufficiently active at follow-up than those with no reports of these stressors; fully adjusted ORs ranged from 1.11 (95% CI 1.00 to 1.24) to 1.21 (95% CI 1.05 to 1.39). Conclusions Workplace stress is associated with a slightly increased risk of physical inactivity.
    Keywords: Mental ill-health, stress, Stress
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 3
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    Chronic obstructive pulmonary disease and longitudinal changes in pulmonary function due to occupational exposure to respirable quartz (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: Objectives The present study sought to examine the long-term effects of exposure to respirable quartz on pulmonary function with particular focus on chronic obstructive pulmonary disease (COPD). Methods The study is based on the Wismut cohort of former uranium miners. Spirometric data were ascertained together with quantitative estimates of cumulative exposure to respirable quartz for each of 1421 study subjects born between 1954 and 1956. The case definition for COPD is based on the criteria of the Global Initiative for Chronic Obstructive Lung Disease. Linear mixed regression models were fitted to identify significant determinants of longitudinal changes in lung function parameters. Results An average of five spirometries were available for each miner. It was shown that cumulative exposure to 1 mg/m 3 -year respirable quartz leads, on average, to a relative reduction in forced expiratory volume in 1 s/ orced vital capacity (FEV 1 /FVC) of 2.75% (p〈0.001). A nested case–control approach demonstrated that the risk for COPD stage I increases with increasing cumulative exposure to respirable quartz (OR 1.81 per 1 mg/m 3 -year). Conclusions This paper adds further evidence on the long-term effects of exposure to respirable quartz, which include a decline in pulmonary function parameters and an increase in the incidence of COPD.
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 4
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    Longitudinal decline in lung function in former asbestos exposed workers (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: Background This study was designed to assess the effect of asbestos exposure on longitudinal lung function decline. Methods A group of 502 former asbestos-cement workers with at least two spirometry tests 4 years apart. Repeated evaluations included respiratory symptoms questionnaire, spirometry and chest imaging. Asbestos exposure was ascertained as years of exposure, an index of cumulative exposure and latency time. The mixed effects model was used to evaluate the effect of exposure on the level and rate of change in forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC). Results Mean age at entry was 51 (SD 9.9) years, mean latency time 25.6 (SD 10.0) years, mean follow-up time 9.1 (SD 2.8) years and mean number of spirometry tests 3.5. The FEV 1 level was significantly related to pack-years of smoking at entry and during the follow-up, the index of cumulative asbestos exposure at entry, and the presence of asbestosis at follow-up. The FVC level was significantly related to pack-years of smoking during the follow-up, cumulative asbestos exposure at entry, asbestosis and pleural thickening at follow-up, and body mass index at entry. Asbestos exposure was not associated with increasing rates of FEV 1 and FVC decline. However, FEV 1 regression slopes with age, estimated by terciles of cumulative exposure, showed significant differences. Combined effects of smoking and exposure conferred further acceleration in lung function decline. Conclusions Occupational exposure in asbestos-cement industry was a risk factor for increased lung function decline. The effect seems to be mostly concentrated during the working period. Smoking and exposure had synergic effects.
    Keywords: Respiratory, Asbestos, Other exposures
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    Topics: Medicine
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  • 5
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    Risk factors for new onset and persistence of multi-site musculoskeletal pain in a longitudinal study of workers in Crete (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: Objectives To explore occupational and psychological risk factors for the incidence and persistence of multi-site musculoskeletal pain. Methods We conducted a longitudinal investigation of three occupational groups in Crete, Greece. Baseline information was obtained at interview about pain in the past year at each of six anatomical sites, and about possible risk factors for subsequent symptoms. Twelve months later, subjects were re-interviewed about pain at the same anatomical sites in the past month. Pain at two or more sites was classed as multi-site. Associations with new development and persistence of multi-site pain at follow-up were assessed by logistic regression. Results Analysis was based on 518 subjects (87% of those originally selected for study). At follow-up, multi-site pain persisted in 217 (62%) of those who had experienced it in the year before baseline, and was newly developed in 27 (17%) of those who had not. Persistence of multi-site pain was significantly related to physical loading at work, somatising tendency and beliefs about work as a cause of musculoskeletal pain, with OR (95% CI) for the highest relative to the lowest exposure categories of 2.3 (1.0 to 5.6), 2.6 (1.5 to 4.6) and 1.9 (1.1 to 3.3) respectively. Development of new multi-site pain was most strongly associated with working for ≥40 h per week (OR 5.0, 95% CI 1.1 to 24.0). Conclusions Our findings confirm the importance of both physical loading at work and somatising tendency as risk factors for multi-site pain, and suggest that persistence of pain is also influenced by adverse beliefs about work causation.
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    Topics: Medicine
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  • 6
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    Perception of slipperiness and prospective risk of slipping at work (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: Objectives Falls are a leading cause of injury at work, and slipping is the predominant cause of falling. Prior research has suggested a modest correlation between objective measures (such as coefficient of friction, COF) and subjective measures of slipperiness (such as worker perceptions) in the workplace. However, the degree of association between subjective measures and the actual risk of slipping at the workplace is unknown. This study examined the association between perception of slipperiness and the risk of slipping. Methods 475 workers from 36 limited-service restaurants participated in a 12-week prospective cohort study. At baseline, demographic information was collected, participants rated floor slipperiness in eight areas of the restaurant, and work environment factors, such as COF, were measured. Restaurant-level and area-level mean perceptions of slipperiness were calculated. Participants then reported their slip experience at work on a weekly basis for the next 12 weeks. The associations between perception of slipperiness and the rate of slipping were assessed. Results Adjusting for age, gender, body mass index, education, primary language, mean COF, use of slip-resistant shoes, and restaurant chain, each 1-point increase in mean restaurant-level perception of slipperiness (4-point scale) was associated with a 2.71 times increase in the rate of slipping (95% CI 1.25 to 5.87). Results were similar for area-level perception within the restaurant (rate ratios (RR) 2.92, 95% CI 2.41 to 3.54). Conclusions Perceptions of slipperiness and the subsequent rate of slipping were strongly associated. These findings suggest that safety professionals, risk managers and employers could use aggregated worker perceptions of slipperiness to identify slipping hazards and, potentially, to assess intervention effectiveness.
    Keywords: Open access
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 7
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    Cross-shift and longitudinal changes in FEV1 among wood dust exposed workers (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: Objectives Acute lung function (LF) changes might predict an accelerated decline in LF. In this study, we investigated the association between cross-shift and longitudinal changes in forced expiratory volume in 1 s (FEV 1 ) among woodworkers in a 6-year follow-up study. Methods 817 woodworkers and 136 controls participated with cross-shift changes of FEV 1 at baseline and FEV 1 and forced vital capacity at follow-up. Height and weight were measured and questionnaire information on respiratory symptoms, employment and smoking habits was collected. Wood dust exposure was assessed from 3572 personal dust measurements at baseline and follow-up. Cumulative wood dust exposure was assessed by a study-specific job exposure matrix and exposure time. Results The median (range) of inhalable dust at baseline and cumulative wood dust exposure was 1.0 (0.2–9.8) mg/m 3 and 3.8 (0–7.1) mg year/m 3 , respectively. Mean (SD) for %FEV 1 /workday and FEV 1 /year was 0.2 (6.0)%, and –29.1 (41.8) ml. Linear regression models adjusting for smoking, age, height and weight change showed no association between cross-shift and annual change in FEV 1 among woodworkers or controls. Including different exposure estimates, atopy or cross-shift change dichotomised or as quartiles did not change the results. Conclusions This study among workers exposed to low levels of wood dust does not support an association between acute LF changes and accelerated LF decline.
    Keywords: Open access
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    Topics: Medicine
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  • 8
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    Risk of leukaemia mortality from exposure to ionising radiation in US nuclear workers: a pooled case-control study (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: Objective To follow-up on earlier studies of the leukaemogenicity of occupational ionising radiation exposure. Methods We conducted a nested case-control analysis of leukaemia mortality in a pooled cohort of US nuclear workers followed through 2005. Each case was matched to four controls on attained age. Exposures were estimated from available records. General relative risk models were used to estimate the excess relative risk (ERR) of leukaemia, excluding chronic lymphocytic (CLL), acute myeloid leukaemia, chronic myeloid leukaemia and CLL while controlling for potential confounders. Preferred exposure lags and time-windows of risks were calculated using joint maximum likelihood. Dose-response was also examined using linear, linear-quadratic, categorical and restricted cubic spline models. Results There were 369 leukaemia deaths in 105 245 US nuclear workers. The adjusted ERR for non-CLL leukaemia was 0.09 (95% CI –0.17 to 0.65) per 100 mGy. Elevated non-CLL risks were observed from exposures occurring 6–14 years prior to attained age of cases (ERR per 100 mGy=1.9; 95% CI 〈0 to 8.0). Lagged models indicated non-linearity of risk at very low (〈10 mGy) and high (〉100 mGy) doses, which contributed to the imprecision of results in linear models. Similar risk attenuation was not evident in time-windows-based models. Conclusions Risk estimates were in reasonable agreement with previous estimates, with the temporality of non-CLL leukaemia risk as a dominant factor in dose-response analyses. Future research should focus on methods that improve evaluations of the dose-response, particularly in the low-dose range.
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    Topics: Medicine
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  • 9
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    Work injury risk by time of day in two population-based data sources (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: Objective To estimate the rate of work injury over the 24 h clock in Ontario workers over 5 years (2004–2008). Methods A cross-sectional, observational study of work-related injury and illness was conducted for a population of occupationally active adults using two independent data sources (lost-time compensation claims and emergency department encounter records). Hours worked annually by the Ontario labour force by time of day, age, gender and occupation were estimated from population-based surveys. Results There was an approximately 40% higher incidence of emergency department visits for work-related conditions than of lost-time workers’ compensation claims (707 933 emergency department records and 457 141 lost-time claims). For men and women and across all age groups, there was an elevated risk of work-related injury or illness in the evening, night and early morning periods in both administrative data sources. This elevated risk was consistently observed across manual, mixed and non-manual occupational groups. The fraction of lost-time compensation claims that can be attributed to elevated risk of work injury in evening or night work schedules is 12.5% for women and 5.8% for men. Conclusions Despite the high prevalence of employment in non-daytime work schedules in developed economies, the work injury hazards associated with evening and night schedules remain relatively invisible. This study has demonstrated the feasibility of using administrative data sources to enhance capacity to conduct surveillance of work injury risk by time of day. More sophisticated aetiological research is needed to understand the specific mechanisms of hazards associated with non-regular work hours.
    Keywords: Open access
    Print ISSN: 1351-0711
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    Topics: Medicine
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  • 10
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    Psychological and culturally-influenced risk factors for the incidence and persistence of low back pain and associated disability in Spanish workers: findings from the CUPID study (2012)
    BMJ Publishing Group
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    Publication Date: 2012-12-18
    Description: Objective To assess the importance of psychological and culturally-influenced factors as predictors of low back pain (LBP) incidence and persistence in Spanish workers. Methods As part of the international Cultural and Psychosocial Influences in Disability (CUPID) study, 1105 Spanish nurses and office workers answered questions at baseline about LBP in the past month and past year, associated disability, occupational lifting, smoking habits, health beliefs, mental health, and distress from common somatic symptoms. At 12-month follow-up, they were asked about LBP and associated disability in the past month. Associations with LBP incidence and persistence were assessed by log binomial regression, and characterised by prevalence rate ratios (PRRs) with associated 95% CIs. Results 971 participants (87.9%) completed follow-up. Among 579 with no LBP at baseline, 22.8% reported LBP at follow-up. After adjustment for sex, age and occupation, new LBP was predicted by poor mental health (PRR 1.5, 95% CI 1.0 to 2.2), somatising tendency (PRR 1.8, 95% CI 1.2 to 2.7) and presence of LBP for 〉1 month in the year before baseline (PRR 4.7, 95% CI 3.1 to 6.9). Among 392 subjects who had LBP at baseline, 59.4% reported persistence at follow-up, which was associated with presence of symptoms for 〉1 month in the 12 months before baseline (PRR 1.4, 95% CI 1.2 to 1.7) and more weakly with somatising tendency, and with adverse beliefs about LBP work-relatedness and prognosis. Conclusions In Spain, as in northern European countries, psychological and culturally-influenced factors have an important role in LBP development and persistence.
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    Topics: Medicine
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