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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...
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 3
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    Long-term consequences of alcohol misuse in Scottish military veterans (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Objective Serving military personnel are more likely to drink heavily than civilians. The aim of our study was to examine whether veterans have an increased risk of alcoholic liver disease and alcohol-related death compared with non-veterans. Design Retrospective cohort study of 57 000 veterans resident in Scotland and 173 000 age, sex and area of residence-matched civilians, using Cox proportional hazard models to compare the risk of alcoholic liver disease and alcohol-related death overall, by sex, birth cohort, length of service and year of recruitment, adjusting for socioeconomic status. Results Over mean 29 years follow-up, 677 (1.20%) veterans developed alcoholic liver disease compared with 2175 (1.26%) non-veterans (adjusted HR=0.91, 95% CIs 0.84 to 0.99, p=0.035). Only the 1945–1949 veterans’ birth cohort was at higher risk, unadjusted HR=1.25, 95% CIs 1.07 to 1.47, p=0.004, although their difference in risk became non-significant after adjusting for socioeconomic status, p=0.052. The pattern was similar for alcohol-related death. Veterans were less likely than non-veterans to have comorbid hepatitis C. Older age at recruitment at a time of high operational activity in the early 1970s was associated with increased risk, but longer service was not. Conclusions Overall, veterans in Scotland had a significantly reduced risk of alcoholic liver disease or alcohol-related death compared with non-veterans, although the risk was higher in those born before 1950. Reasons for the changing pattern are likely to be complex and may reflect operational exposure, social attitudes to alcohol and the impact of recent military health promotion.
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 4
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    Long-term exposure to outdoor air pollution and the incidence of chronic obstructive pulmonary disease in a national English cohort (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Objectives The role of outdoor air pollution in the incidence of chronic obstructive pulmonary disease (COPD) remains unclear. We investigated this question using a large, nationally representative cohort based on primary care records linked to hospital admissions. Methods A cohort of 812 063 patients aged 40–89 years registered with 205 English general practices in 2002 without a COPD diagnosis was followed from 2003 to 2007. First COPD diagnoses recorded either by a general practitioner (GP) or on admission to hospital were identified. Annual average concentrations in 2002 for particulate matter with an aerodynamic diameter 〈10 µm (PM 10 ) and 〈2.5 µm (PM 2.5 ), nitrogen dioxide (NO 2 ), ozone and sulfur dioxide (SO 2 ) at 1 km 2 resolution were estimated from emission-based dispersion models. Hazard ratios (HRs) per interquartile range change were estimated from Cox models adjusting for age, sex, smoking, body mass index and area-level deprivation. Results 16 034 participants (1.92%) received a COPD diagnosis from their GP and 2910 participants (0.35%) were admitted to hospital for COPD. After adjustment, HRs for GP recorded COPD and PM 10 , PM 2.5 and NO 2 were close to unity, positive for SO 2 (HR=1.07 (95% CI 1.03 to 1.11) per 2.2 µg/m 3 ) and negative for ozone (HR=0.94 (0.89 to 1.00) per 3 µg/m 3 ). For admissions HRs for PM 2.5 and NO 2 remained positive (HRs=1.05 (0.98 to 1.13) and 1.06 (0.98 to 1.15) per 1.9 µg/m 3 and 10.7 µg/m 3 , respectively). Conclusions This large population-based cohort study found limited, inconclusive evidence for associations between air pollution and COPD incidence. Further work, utilising improved estimates of air pollution over time and enhanced socioeconomic indicators, is required to clarify the association between air pollution and COPD incidence.
    Keywords: Open access, Air pollution, air quality, Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 5
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    Exposure of hairdressers to ortho- and meta-toluidine in hair dyes (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Background Carcinogenic aromatic amines derived from hair dyes have recently received new attention. One of these is ortho (o)-toluidine, which is classified as carcinogenic to humans. Objectives To clarify exposure of hairdressers to potentially carcinogenic aromatic amines, including o-toluidine. Methods We measured eight potentially carcinogenic aromatic amines in the blood of 295 hairdressers, 32 users of hair dyes and 60 controls. The study was restricted to female non-smokers. Lifestyle data were collected for all participants using self-administered questionnaires. Blood samples were taken for analysis of ortho-, meta (m)- and para (p)-toluidine; 2-, 3- and 4-ethylaniline, 2,3- and 3,4-dimethylaniline as haemoglobin adducts. The samples were analysed with gas chromatography–tandem mass spectrometry. Results Generally, adduct concentrations were in the range of 0–200 pg/g haemoglobin. A comparison of the adduct concentrations found in hairdressers, consumers and controls showed no statistically significant differences. However, for hairdressers, o- and m-toluidine concentrations increased significantly with the weekly number of hair waving (p=0.020) and permanent hair dyeing treatments (p=0.026), respectively. o-Toluidine and m-Toluidine concentrations also tended (p=0.076 and 0.080, respectively) to increase with the frequency of light-colour permanent hair dye treatments. Conclusions Hairdressers who use light-colour permanent hair dyes, other permanent hair dyes and hair waving treatments seem to be exposed to o- and m-toluidine as indicated by associations with the number of treatments performed. Analyses of hair waving and hair dye products should be performed to identify the possible sources of exposure to o- and m-toluidine.
    Keywords: Open access, Press releases
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 6
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    Shift work and diabetes mellitus: a meta-analysis of observational studies (2014)
    BMJ Publishing Group
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    Publication Date: 2014-12-17
    Description: Background Observational studies suggest that shift work may be associated with diabetes mellitus (DM). However, the results are inconsistent. No systematic reviews have applied quantitative techniques to compute summary risk estimates. Objectives To conduct a meta-analysis of observational studies assessing the association between shift work and the risk of DM. Methods Relevant studies were identified by a search of PubMed, Embase, Web of Science and ProQuest Dissertation and Theses databases to April 2014. We also reviewed reference lists from retrieved articles. We included observational studies that reported OR with 95% CIs for the association between shift work and the risk of DM. Two authors independently extracted data and assessed the study quality. Results Twelve studies with 28 independent reports involving 226 652 participants and 14 595 patients with DM were included. A pooled adjusted OR for the association between ever exposure to shift work and DM risk was 1.09 (95% CI 1.05 to 1.12; p=0.014; I 2 =40.9%). Subgroup analyses suggested a stronger association between shift work and DM for men (OR=1.37, 95% CI 1.20 to 1.56) than for women (OR=1.09, 95% CI 1.04 to 1.14) (p for interaction=0.01). All shift work schedules with the exception of mixed shifts and evening shifts were associated with a statistically higher risk of DM than normal daytime schedules, and the difference among those shift work schedules was significant (p for interaction=0.04). Conclusions Shift work is associated with an increased risk of DM. The increase was significantly higher among men and the rotating shift group, which warrants further studies.
    Keywords: Editor's choice, Press releases
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 7
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    Author's response: 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 thank Dr Hardell for his comment 1 on our article concerning analyses regarding head position of mobile phone use. 2 In our analysis on ipsilateral use, we included cases who used their mobile phone on the same side as the tumour or on both sides of the head, cases who were not regular users (the reference category) and all their matched controls. In our analysis on contralateral use, we used cases who used their mobile phone on the opposite side as the tumour, cases who were not regular users (the reference category), and all their matched controls. The reference category was thus made by the same participants in the two separate analyses. These two separate analyses are thus not really ‘stratified’ analyses since the two subsamples are not disjoint. We chose this strategy because it seemed to us more natural and appropriate to keep matched sets...
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    Topics: Medicine
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  • 8
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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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  • 9
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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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    Topics: Medicine
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  • 10
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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
    Print ISSN: 1351-0711
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    Topics: Medicine
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