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  • 1
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    Bernardino Ramazzini (1633-1714): a visionary physician, scientist and communicator (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Three hundred years after his death, it is interesting to speculate how much this doctor from Carpi's talent for clinical innovation and communication still relates to modern occupational medicine. Bernardino Ramazzini insisted that progress in medicine should not focus solely on physiology and clinical questions, but should also cover the health of the population, observing any relations between environmental factors and disease. This approach, while influenced by the Hippocratic doctrine of ‘airs, waters, places’, also refers to the need to test new criteria for observation ‘on the population’, using new tools for processing and interpreting the findings. This surely demonstrates that this scholar from Carpi was very forward-looking indeed! His De Morbis Artificum Diatriba [Diseases of Workers], first published in Modena in 1700, reveals his forward-thinking ideas in its dedication to the Venetian reformers, laying the foundations for the social role of occupational medicine and hygiene, linking workers, business...
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 2
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    Occupational carcinogen exposure in Canada (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: My colleague Professor John Cherrie once said that we know more about the number of birds breeding in British meadows each year (see http://jncc.defra.gov.uk/pdf/BBSreport12_web.pdf ) than the number of workers exposed to carcinogens in the workplace. It is clearly important to monitor bird populations, but I would consider it of at least equal importance to know what hazardous agents workers are exposed to. However, there are few data sources that can provide accurate information on the prevalence of occupational exposures. In the early 1990s, Timo Kauppinen at the Finnish Institute of Occupational Health led a team that aimed to estimate the prevalence of occupational exposure in 55 industries for 15 member states of the European Union (EU). 1 This CAREX system has been extensively used in surveillance and burden of disease studies as well as by the International Agency for Research on Cancer (IARC) within the Monograph...
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 3
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    Comparison of musculoskeletal disorder health claims between construction floor layers and a general working population (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Objectives Compare rates of medical insurance claims for musculoskeletal disorders (MSD) between workers in a construction trade and a general worker population to determine if higher physical exposures in construction lead to higher rates of claims on personal medical insurance. Methods Health insurance claims between 2006 and 2010 from floor layers were frequency matched by age, gender, eligibility time and geographic location to claims from insured workers in general industry obtained from MarketScan. We extracted MSD claims and dates of service from six regions of the body: neck, low back, knee, lower extremity, shoulder and distal arm, and evaluated differences in claim rates. Results Fifty-one per cent of floor layers (n=1475) experienced musculoskeletal claims compared with 39% of MarketScan members (p〈0.001). Claim rates were higher for floor layers across all body regions with nearly double the rate ratios for the knee and neck regions (RR 2.10 and 2.07). The excess risk was greatest for the neck and low back regions; younger workers had disproportionately higher rates in the knee, neck, low back and distal arm. A larger proportion of floor layers (22%) filed MSD claims in more than one body region compared with general workers (10%; p〈0.001). Conclusions Floor layers have markedly higher rates of MSD claims compared with a general worker population, suggesting a shifting of medical costs for work-related MSD to personal health insurance. The occurrence of disorders in multiple body regions and among the youngest workers highlights the need for improved work methods and tools for construction workers.
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 4
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    Biomechanical risk factors for carpal tunnel syndrome: a pooled study of 2474 workers (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Background Between 2001 and 2010, five research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries and collected detailed subject-level exposure information with follow-up of symptoms, electrophysiological measures and job changes. Objective This analysis examined the associations between workplace biomechanical factors and incidence of dominant-hand CTS, adjusting for personal risk factors. Methods 2474 participants, without CTS or possible polyneuropathy at enrolment, were followed up to 6.5 years (5102 person-years). Individual workplace exposure measures of the dominant hand were collected for each task and included force, repetition, duty cycle and posture. Task exposures were combined across the workweek using time-weighted averaging to estimate job-level exposures. CTS case-criteria were based on symptoms and results of electrophysiological testing. HRs were estimated using Cox proportional hazard models. Results After adjustment for covariates, analyst (HR=2.17; 95% CI 1.38 to 3.43) and worker (HR=2.08; 95% CI 1.31 to 3.39) estimated peak hand force, forceful repetition rate (HR=1.84; 95% CI 1.19 to 2.86) and per cent time spent (eg, duty cycle) in forceful hand exertions (HR=2.05; 95% CI 1.34 to 3.15) were associated with increased risk of incident CTS. Associations were not observed between total hand repetition rate, per cent duration of all hand exertions, or wrist posture and incident CTS. Conclusions In this prospective multicentre study of production and service workers, measures of exposure to forceful hand exertion were associated with incident CTS after controlling for important covariates. These findings may influence the design of workplace safety programmes for preventing work-related CTS.
    Keywords: Open access, Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 5
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    CAREX Canada: an enhanced model for assessing occupational carcinogen exposure (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Objectives To estimate the numbers of workers exposed to known and suspected occupational carcinogens in Canada, building on the methods of CARcinogen EXposure (CAREX) projects in the European Union (EU). Methods CAREX Canada consists of estimates of the prevalence and level of exposure to occupational carcinogens. CAREX Canada includes occupational agents evaluated by the International Agency for Research on Cancer as known, probable or possible human carcinogens that were present and feasible to assess in Canadian workplaces. A Canadian Workplace Exposure Database was established to identify the potential for exposure in particular industries and occupations, and to create exposure level estimates among priority agents, where possible. CAREX EU data were reviewed for relevance to the Canadian context and the proportion of workers likely to be exposed by industry and occupation in Canada was assigned using expert assessment and agreement by a minimum of two occupational hygienists. These proportions were used to generate prevalence estimates by linkage with the Census of Population for 2006, and these estimates are available by industry, occupation, sex and province. Results CAREX Canada estimated the number of workers exposed to 44 known, probable and suspected carcinogens. Estimates of levels of exposure were further developed for 18 priority agents. Common exposures included night shift work (1.9 million exposed), solar ultraviolet radiation exposure (1.5 million exposed) and diesel engine exhaust (781 000 exposed). Conclusions A substantial proportion of Canadian workers are exposed to known and suspected carcinogens at work.
    Keywords: Open access, Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 6
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    A new look for OEM in 2015 (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: In this first edition of Occupational and Environmental Medicine for 2015 we have introduced a new front cover. We have decided to retire the ‘word cloud’, which has adorned the front cover since May 2012. This word cloud was based on the frequency of words contained in articles published in OEM prior to that date and after more than two and a half years it was becoming increasingly out of date. Our new front cover retains the blue colour scheme and continues the tradition of OEM being known as the ‘blue journal‘ amongst occupational health journals. The central feature of the new cover is a globe which signifies the wide reach of OEM around the world. For this first edition, we have selected a group of pictures which illustrate a range of hazardous working environments, as well as motor vehicle exhausts, an increasingly recognised contributor to a wide...
    Keywords: Musculoskeletal
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 7
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    Effect of an office ergonomic randomised controlled trial among workers with neck and upper extremity pain (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Background Office computer workers are at increased risk for neck/upper extremity (UE) musculoskeletal pain. Methods A seven-month office ergonomic intervention study evaluated the effect of two engineering controls plus training on neck/UE pain and mechanical exposures in 113 computer workers, including a 3-month follow-up period. Participants were randomised into an intervention group, who received a keyboard/mouse tray (KBT), touch pad (TP) for the non-dominant hand and keyboard shortcuts, and a control group who received keyboard shortcuts. Participants continued to have available a mouse at the dominant hand. Outcomes were pain severity, computer rapid upper limb assessment (RULA), and hand activity level. Prevalence ratios (PRs) evaluated intervention effects using dichotomised pain and exposure scores. Results In the intervention group, the dominnt proximal UE pain PR=0.9, 95% CI 0.7 to 1.2 and the dominant distal UE PR=0.8, 95% CI 0.5 to 1.3, postintervention. The non-dominant proximal UE pain PR=1.0, 95% CI 0.8 to 1.4, while the non-dominant distal UE PR=1.2, 95% CI 0.6 to 2.2, postintervention. Decreases in non-neutral postures were found in two RULA elements (non-dominant UE PR=0.9, 95% CI 0.8 to 0.9 and full non-dominant RULA PR=0.8, 95% CI 0.8 to 0.9) of the intervention group. Hand activity increased on the non-dominant side (PR=1.4, 95% CI 1.2 to 1.6) in this group. Conclusions While the intervention reduced non-neutral postures in the non-dominant UE, it increased hand activity in the distal region of this extremity. To achieve lower hand activity, a KBT and TP used in the non-dominant hand may not be the best devices to use.
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 8
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    Genetic susceptibility to beryllium: a case-referent study of men and women of working age with sarcoidosis or other chronic lung disease (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Objective The study was designed to investigate whether beryllium exposure was related to illness diagnosed as sarcoidosis. Chronic beryllium disease (CBD) and sarcoidosis are clinically and pathologically indistinguishable, with only the presence of beryllium-specific T-lymphocytes identifying CBD. Testing for such cells is not feasible in community studies of sarcoidosis but a second characteristic of CBD, its much greater incidence in those with a glutamic acid residue at position 69 of the HLA-DPB1 gene (Glu69), provides an alternative approach to answering this question. Methods Cases of sarcoidosis aged 18–60 years diagnosed in Alberta, Canada, from 1999 to 2005 were approached through their specialist physician, together with age-matched and sex-matched referents with other chronic lung disease. Referents were grouped into chronic obstructive pulmonary disease (COPD), asthma and other lung disease. Participants completed a telephone questionnaire, including industry-specific questionnaires. DNA was extracted from mailed-in mouthwash samples and genotyped for Glu69. Duration of employment in types of work with independently documented beryllium exposure was calculated. Results DNA was extracted for 655 cases (270 Glu69 positive) and 1382 referents (561 positive). No increase in sarcoidosis was seen with either Glu69 or beryllium exposure (none, 〈10, ≥10 years) as main effects: longer duration in possible beryllium jobs was related to COPD. In Glu69 positive men with exposure ≥10 years, the trend towards increasing rate of COPD was reversed, and a significant interaction of duration of exposure and Glu69 was detected (OR=4.51 95% CI 1.17 to 17.48). Conclusions The gene–environment interaction supports the hypothesis that some cases diagnosed as sarcoidosis result from occupational beryllium exposure.
    Keywords: Respiratory
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    Topics: Medicine
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  • 9
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    Associations between three specific a-cellular measures of the oxidative potential of particulate matter and markers of acute airway and nasal inflammation in healthy volunteers (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Introduction We evaluated associations between three a-cellular measures of the oxidative potential (OP) of particulate matter (PM) and acute health effects. Methods We exposed 31 volunteers for 5 h to ambient air pollution at five locations: an underground train station, two traffic sites, a farm and an urban background site. Each volunteer visited at least three sites. We conducted health measurements before exposure, 2 h after exposure and the next morning. We measured air pollution on site and characterised the OP of PM 2.5 and PM 10 using three a-cellular assays; dithiotreitol (OP DTT ), electron spin resonance (OP ESR ) and ascorbic acid depletion (OP AA ). Results In single-pollutant models, all measures of OP were significantly associated with increases in fractional exhaled nitric oxide and increases in interleukin-6 in nasal lavage 2 h after exposure. These OP associations remained significant after adjustment for co-pollutants when only the four outdoor sites were included, but lost significance when measurements at the underground site were included. Other health end points including lung function and vascular inflammatory and coagulation parameters in blood were not consistently associated with OP. Conclusions We found significant associations between three a-cellular measures of OP of PM and markers of airway and nasal inflammation. However, consistency of these effects in two-pollutant models depended on how measurements at the underground site were considered. Lung function and vascular inflammatory and coagulation parameters in blood were not consistently associated with OP. Our study, therefore, provides limited support for a role of OP in predicting acute health effects of PM in healthy young adults.
    Keywords: Air pollution, air quality, Other exposures
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    Topics: Medicine
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  • 10
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    Re: Mobile phone use and brain tumours in the CERENAT case-control study (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: We have with great interest read the article by Coureau et al 1 on mobile phone use and the risk for glioma and meningioma. However, we are concerned about the results in appendix 2. Side of mobile phone use was defined as ipsilateral for cases if the phone was used on the same side of the brain as the tumour or on both sides. Contralateral use was assigned to cases with tumour on the opposite side as the phone was used. OR for both ipsilateral and contralateral use was lower than the total OR which is not what one would expect. It seems all controls were used in the analysis without assignment of ‘tumour laterality’. In our studies 2–4 and in Interphone 5 the matched control was given the same ‘tumour side’ as the respective case. To illustrate the problem we have...
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    Topics: Medicine
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