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  • Articles  (42)
  • Other exposures  (23)
  • Editor's choice  (14)
  • Open access, Air pollution, air quality, Other exposures  (3)
  • Metals, Other exposures  (2)
  • 2010-2014  (42)
  • Occupational and Environmental Medicine  (42)
  • 7402
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  • Articles  (42)
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  • 11
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    Exposure to heavy physical occupational activities during working life and bone mineral density at the hip at retirement age (2014)
    BMJ Publishing Group
    Details
    Publication Date: 2014-04-10
    Description: Background People in sedentary occupations are at increased risk of hip fracture. Hip fracture is significantly associated with low bone mineral density (BMD) measured at the hip. Physical activity is important in the development and maintenance of BMD, but the effects of occupational physical activity on bone health are unclear. We investigated the influence of lifetime physical activity on BMD at the hip. Methods This was a cross-sectional epidemiological study of the associations between total hip BMD measured by dual-energy X-ray absorptiometry at retirement age and lifetime exposure to occupational physical workload (standing/walking ≥4 h/day; lifting ≥25 kg; energetic work sufficient to induce sweating and manual work). Results Complete data on occupational exposures were available for 860 adults (488 men and 372 women) who had worked ≥20 years. Their mean age was 65 years, and many reported heavy physical workplace activities over prolonged durations. There were no statistically significant associations between total hip BMD and any of these measures of lifetime occupational physical activity in men or women. Conclusions Lifetime cumulative occupational activity was not associated with hip BMD at retirement age. Our findings suggest that, if sedentary work conveys an increased risk of hip fracture, it is unlikely that the mechanism is through reductions in BMD at the hip and may relate to other physical effects, such as falls risk. Further studies will be needed to test this hypothesis.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 12
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    Risk factors for chronic mucus hypersecretion in individuals with and without COPD: influence of smoking and job exposure on CMH (2014)
    BMJ Publishing Group
    Details
    Publication Date: 2014-04-10
    Description: Background Chronic mucus hypersecretion (CMH) is highly prevalent in smokers and associated with an accelerated lung function decline and chronic obstructive pulmonary disease (COPD). Several risk factors contribute to CMH and to COPD. It is, however, unknown if risk factors for CMH are similar in persons with and without COPD. Methods 1479 persons with and 8529 without COPD, participating in the general population-based LifeLines cohort, completed questionnaires and underwent spirometry. Occupational exposure was assessed using the ALOHA+ job exposure matrix. Analyses were performed using multiple logistic regression models. Results In COPD, a significantly higher risk for CMH was associated with higher pack-years smoking (per 10 pack-years) (OR=1.28; 1.12 to 1.46) and environmental tobacco smoke (ETS) (OR=2.06; 1.33 to 3.19). In non-COPD; male gender (OR=1.91; 1.51 to 2.41), higher Body Mass Index (OR=1.04; 1.01 to 1.06), higher pack-years smoking (OR=1.28; 1.14 to 1.44), current smoking (OR=1.50; 1.04 to 2.18), low and high exposure to mineral dust (OR=1.39; 1.04 to 1.87 and OR=1.60; 1.02 to 2.52), high exposure to gases & fumes (OR=2.19; 1.49 to 3.22). Significant interactions were found between COPD and exposure to gases & fumes (p=0.018) and aromatic solvents (p=0.038). Conclusions A higher risk for CMH was associated with higher pack-years smoking regardless of COPD status. However, a higher risk for CMH was associated with high occupational exposure to gases & fumes in individuals without COPD only.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 13
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    The role of mental health problems and common psychotropic drug treatments in accidental injury at work: a case-control study (2014)
    BMJ Publishing Group
    Details
    Publication Date: 2014-04-10
    Description: Objectives Mental illness and psychotropic drugs have been linked with workplace injury, but few studies have measured exposures and outcomes independently or established their relative timings. To address this shortcoming, we conducted a case–control study nested within a database prospectively recording injury consultations, diagnoses and drug prescriptions. Methods The Clinical Practice Research Datalink logs primary care data for 6% of the British population, coding all consultations (by the Read system) and drug prescriptions. We identified 1348 patients aged 16–64 years from this database who had consulted a family doctor or hospital over a 20-year period for workplace injury (cases, 479 diagnostic codes) and 6652 age, sex and practice-matched controls with no such consultation. Groups were compared in terms of consultations for mental health problems (1328 codes) and prescription of psychotropic drugs prior to the case's injury consultation using conditional logistic regression. Results In total, 1846 (23%) subjects had at least one psychiatric consultation before the index date and 1682 (21%) had been prescribed a psychotropic drug. The OR for prior mental health consultation was 1.44 (p〈0.001) and that for psychotropic drug treatment was 1.57 (p〈0.001). Risks were significantly elevated for several subclasses of mental health diagnosis (eg, psychosis, neurosis) and for each of the drug classes analysed. Assuming causal relationships, about 9–10% of all workplace injuries leading to medical consultation were attributable to mental illness or psychotropic medication. Conclusions Mental health problems and psychotropic treatments may account for an important minority of workplace injuries.
    Keywords: Editor's choice
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 14
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    Association between high temperature and work-related injuries in Adelaide, South Australia, 2001-2010 (2014)
    BMJ Publishing Group
    Details
    Publication Date: 2014-03-06
    Description: Objectives (1) To investigate the association between temperature and work-related injuries and (2) to identify groups of workers at high risk of work-related injuries in hot environments in Adelaide, South Australia. Methods Workers’ compensation claims in Adelaide, South Australia for 2001–2010 were used. The relationship between temperature and daily injury claims was estimated using a generalised estimating equation model. A piecewise linear spline function was used to quantify the effect of temperature on injury claims below and above thresholds. Results Overall, a 1°C increase in maximum temperature between 14.2°C and 37.7°C was associated with a 0.2% increase in daily injury claims. Specifically, the incidence rate ratios (IRRs) for male workers and young workers aged ≤24 were (1.004, 95% CI 1.002 to 1.006) and (1.005, 95% CI 1.002 to 1.008), respectively. Significant associations were also found for labourers (IRR 1.005, 95% CI 1.001 to 1.010), intermediate production and transport workers (IRR 1.003, 95% CI 1.001 to 1.005) and tradespersons (IRR 1.002, 95% CI 1.001 to 1.005). Industries at risk were agriculture, forestry and fishing (IRR 1.007, 95% CI 1.001 to 1.013), construction (IRR 1.006, 95% CI 1.002 to 1.011), and electricity, gas and water (IRR 1.029, 95% CI 1.002 to 1.058). Conclusions There is a significant association between injury claims and temperature in Adelaide, South Australia, for certain industries and groups. Relevant adaptation and prevention measures are required at both policy and practice levels to address occupational exposure to high temperatures.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 15
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    Occupational solvent exposure and risk of meningioma: results from the INTEROCC multicentre case-control study (2014)
    BMJ Publishing Group
    Details
    Publication Date: 2014-03-06
    Description: Objective To examine associations between occupational exposure to selected organic solvents and meningioma. Methodology A multicentre case–control study conducted in seven countries, including 1906 cases and 5565 controls. Occupational exposure to selected classes of organic solvents (aliphatic and alicyclic hydrocarbons, aromatic hydrocarbons, chlorinated hydrocarbons and ‘other’ organic solvents) or seven specific solvents (benzene, toluene, trichloroethylene, perchloroethylene, 1,1,1-trichloroethylene, methylene chloride and gasoline) was assessed using lifetime occupational histories and a modified version of the FINJEM job-exposure matrix (INTEROCC-JEM). Study participants were classified as ‘exposed’ when they had worked in an occupation for at least 1 year, with a 5-year lag, in which the estimated prevalence of exposure was 25% or greater in the INTEROCC-JEM. Associations between meningioma and each of the solvent exposures were estimated using conditional logistic regression, adjusting for potential confounders. Results A total of 6.5% of study participants were ever exposed to ‘any’ solvent, with a somewhat greater proportion of controls (7%) ever exposed compared with cases (5%), but only one case was ever exposed to any chlorinated hydrocarbon (1,1,1-trichloroethane). No association was observed between any of the organic solvents and meningioma, in either men or women, and no dose–response relationships were observed in internal analyses using either exposure duration or cumulative exposure. Discussion We found no evidence that occupational exposure to these organic solvents is associated with meningioma.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 16
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    Influence of poor health on exit from paid employment: a systematic review (2014)
    BMJ Publishing Group
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    Publication Date: 2014-03-06
    Description: The objective was to provide a systematic literature review on associations between poor health and exit from paid employment through disability pension, unemployment and early retirement, and to estimate the magnitude of these associations using meta-analyses. Medline and Embase databases were searched for longitudinal studies on the relationship between health measures and exit from paid employment. Random-effects models were used to estimate the pooled effects. In total, 29 studies were included. Self-perceived poor health was a risk factor for transition into disability pension (relative risk (RR) 3.61; 95% CI 2.44 to 5.35), unemployment (RR 1.44; 95% CI 1.26 to 1.65) and early retirement (RR 1.27; 95% CI 1.17 to 1.38). Workers with mental health problems had an increased likelihood for transition into disability pension (RR 1.80; 95% CI 1.41 to 2.31) or unemployment (RR 1.61; 95% CI 1.29 to 2.01). Chronic disease was a risk factor for transition into disability pension (RR 2.11; 95% CI 1.90 to 2.33) or unemployment (RR 1.31; 95% CI 1.14 to 1.50), but not for early retirement. This meta-analysis showed that poor health, particularly self-perceived health, is a risk factor for exit from paid employment through disability pension, unemployment and, to a lesser extent, early retirement. To increase sustained employability it should be considered to implement workplace interventions that promote good health.
    Keywords: Editor's choice
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 17
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    Rule-based exposure assessment versus case-by-case expert assessment using the same information in a community-based study (2014)
    BMJ Publishing Group
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    Publication Date: 2014-02-07
    Description: Background Retrospective exposure assessment in community-based studies is largely reliant on questionnaire information. Expert assessment is often used to assess lifetime occupational exposures, but these assessments generally lack transparency and are very time-consuming. We explored the agreement between a rule-based assessment approach and case-by-case expert assessment of occupational exposures in a community-based study. Methods We used data from a case–control study of childhood acute lymphoblastic leukaemia in which parental occupational exposures were originally assigned by expert assessment. Key questions were identified from the completed parent questionnaires and, on the basis of these, rules were written to assign exposure levels to diesel exhaust, pesticides and solvents. We estimated exposure prevalence separately for fathers and mothers, and used statistics to assess the agreement between the two exposure assessment methods. Results Exposures were assigned to 5829 jobs among 1079 men and 6189 jobs among 1234 women. For both sexes, agreement was good for the two assessment methods of exposure to diesel exhaust at a job level (=0.70 for men and =0.71 for women) and at a person level (=0.74 and =0.75). The agreement was good to excellent for pesticide exposure among men (=0.74 for jobs and =0.84 at a person level) and women (=0.68 and =0.71 at a job and person level, respectively). Moderate to good agreement was observed for assessment of solvent exposure, which was better for women than men. Conclusions The rule-based assessment approach appeared to be an efficient alternative for assigning occupational exposures in a community-based study for a selection of occupational exposures.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 18
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    Bladder cancer incidence among workers exposed to o-toluidine, aniline and nitrobenzene at a rubber chemical manufacturing plant (2014)
    BMJ Publishing Group
    Details
    Publication Date: 2014-02-07
    Description: Background An earlier investigation found increased bladder cancer incidence among workers at a rubber chemical manufacturing plant that used o -toluidine, aniline and nitrobenzene. The cohort was expanded to include additional workers (n=1875) and updated through 2007 to assess bladder cancer with improved exposure characterisation. Methods Work histories were updated and exposure categories and ranks were developed for o -toluidine, aniline and nitrobenzene combined. Incident cancers were identified by linkage to six state cancer registries. Residency in time-dependent cancer registry catchment areas was determined. SIR and standardised rate ratios for bladder cancer were calculated by exposure category and cumulative rank quartiles for different lag periods. Cox regression was used to model bladder cancer incidence with estimated cumulative rank, adjusting for confounders. Indirect methods were used to control for smoking. Results Excess bladder cancer was observed compared to the New York State population (SIR=2.87, 95% CI 2.02 to 3.96), with higher elevations among workers definitely exposed (moderate/high) (SIR=3.90, 95% CI 2.57 to 5.68), and in the highest cumulative rank quartile (SIR=6.13, 95% CI 2.80 to 11.6, 10-year lag). Bladder cancer rates increased significantly with estimated cumulative rank (10-year lag). Smoking only accounted for an estimated 8% elevation in bladder cancer incidence. Conclusions Bladder cancer incidence remains elevated in this cohort and significantly associated with estimated cumulative exposure. Results are consistent with earlier findings in this and other cohorts. Despite other concurrent chemical exposures, we consider o -toluidine most likely responsible for the bladder cancer incidence elevation and recommend a re-examination of occupational exposure limits.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 19
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    An extensive epidemiological investigation of a kidney cancer cluster in a chemical plant: what have we learned? (2013)
    BMJ Publishing Group
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    Publication Date: 2013-12-07
    Description: Objectives In 2003, a cluster of renal cell carcinoma (RCC) cases was reported among men working at a French chemical plant using a proprietary process to produce vitamin A. The 10 index cases yielded a standardised incidence ratio of 13.1 for 1994–2002. Nine of these 10 cases were diagnosed by a plant-specific abdominal ultrasonography screening programme that targeted exposure to an intermediate chemical, 4-chloro-1,1-dimethoxy-3-methyl-2-butene, commonly named ‘chloracetal C5’, suspected as the cause by some experts. Epidemiological investigations sought to examine the relations between occupational exposures and RCC. Methods A retrospective cohort mortality study and a nested case–control study were conducted. The cohort study included all workers who had been employed at the plant for at least 6 months between 1960 and 2003. The case–control study included an extensive search within the region for other kidney cancer cases among the cohort members. Industrial hygienists assessed occupational exposure. Results From 1968 to 2006, no significant excess mortality was observed for all causes of death or for all cancers. We found excess mortality for kidney cancer only among women. The nested case–control study showed a dose–response relation for cumulative exposure to chloracetal C5: the OR rose from 2.5 in the low-exposure category to 10.5 in the high-exposure group. Adjustment for screening attenuated this relation. Conclusions The results of the case–control study were consistent with the positive results of in vivo genotoxic tests and suggest that chloracetal C5 can have a causal role in RCC.
    Keywords: Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 20
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    Increased risk of breast cancer associated with long-term shift work in Canada (2013)
    BMJ Publishing Group
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    Publication Date: 2013-11-09
    Description: Objectives Long-term night work has been suggested as a risk factor for breast cancer; however, additional studies with more comprehensive methods of exposure assessment to capture the diversity of shift patterns are needed. As well, few previous studies have considered the role of hormone receptor subtype. Methods Relationships between night shift work and breast cancer were examined among 1134 breast cancer cases and 1179 controls, frequency-matched by age in Vancouver, British Columbia, and Kingston, Ontario. Self-reported lifetime occupational histories were assessed for night shift work, and hormone receptor status obtained from tumour pathology records. Results With approximately one-third of cases and controls ever employed in night shift work, associations with duration demonstrated no relationship between either 0–14 or 15–29 years, while an association was apparent for ≥30 years (OR=2.21, 95% CI 1.14 to 4.31). This association with long-term night shift work is robust to alternative definitions of prolonged shift work, with similar results for both health and non-health care workers. Conclusions Long-term night shift work in a diverse mix of occupations is associated with increased breast cancer risk and not limited to nurses, as in most previous studies.
    Keywords: Editor's choice
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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