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  • 1
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    Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009) (2014)
    BMJ Publishing Group
    Details
    Publication Date: 2014-05-11
    Description: Objectives To examine mortality patterns and cancer incidence in a pooled cohort of 29 993 US career firefighters employed since 1950 and followed through 2009. Methods Mortality and cancer incidence were evaluated by life table methods with the US population referent. Standardised mortality (SMR) and incidence (SIR) ratios were determined for 92 causes of death and 41 cancer incidence groupings. Analyses focused on 15 outcomes of a priori interest. Sensitivity analyses were conducted to examine the potential for significant bias. Results Person-years at risk totalled 858 938 and 403 152 for mortality and incidence analyses, respectively. All-cause mortality was at expectation (SMR=0.99, 95% CI 0.97 to 1.01, n=12 028). There was excess cancer mortality (SMR=1.14, 95% CI 1.10 to 1.18, n=3285) and incidence (SIR=1.09, 95% CI 1.06 to 1.12, n=4461) comprised mainly of digestive (SMR=1.26, 95% CI 1.18 to 1.34, n=928; SIR=1.17, 95% CI 1.10 to 1.25, n=930) and respiratory (SMR=1.10, 95% CI 1.04 to 1.17, n=1096; SIR=1.16, 95% CI 1.08 to 1.24, n=813) cancers. Consistent with previous reports, modest elevations were observed in several solid cancers; however, evidence of excess lymphatic or haematopoietic cancers was lacking. This study is the first to report excess malignant mesothelioma (SMR=2.00, 95% CI 1.03 to 3.49, n=12; SIR=2.29, 95% CI 1.60 to 3.19, n=35) among US firefighters. Results appeared robust under differing assumptions and analytic techniques. Conclusions Our results provide evidence of a relation between firefighting and cancer. The new finding of excess malignant mesothelioma is noteworthy, given that asbestos exposure is a known hazard of firefighting.
    Keywords: Editor's choice, Asbestos, Other exposures
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 2
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    Patterns of work injuries: cases admitted to emergency room treatment compared to cases reported to the Danish Working Environment Authority during 2003-2010 (2014)
    BMJ Publishing Group
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    Publication Date: 2014-01-16
    Description: Objective To compare work injuries treated in an emergency department (ED) and injuries reported to the Danish Working Environment Authority (DWEA). Methods Work injuries of the ED, Odense University Hospital, and injuries from the geographical catchment area reported to the DWEA between 2003 and 2010 were included. The injuries included in both datasets were identified by merging the ED file and the DWEA file using the civil registry number and injury date information as key. Results Approximately 50 000 work injuries occurred in the catchment area of the ED. The intersection between the two injury registration systems was 16%. A major discordance concerned the type of injuries, as some injuries were seen frequently in the ED but not reported to the DWEA to any significant extent, for example ‘eye injuries’ and ‘superficial lacerations or wounds’. On the other hand, some injuries are rarely seen in the ED, but often reported to the DWEA, for example ‘low back pain’. Additionally, younger workers visit the ED more often than older workers, and injuries in the high risk sectors have the lowest reporting proportion. Conclusions Neither the ED nor DWEA injury files alone give a complete picture of work injuries. But merged, they represent a significant number of injuries, taking into account differences in data sources, for example concerning uneven distribution of age, sex, type of injury and type of industry. Obviously, not all serious work related ED injuries resulting in lost work time are reported to the DWEA.
    Keywords: Back pain
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 3
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    Do self-reported psychosocial working conditions predict low back pain after adjustment for both physical work load and depressive symptoms? A prospective study among female eldercare workers (2013)
    BMJ Publishing Group
    Details
    Publication Date: 2013-07-11
    Description: Objectives To investigate whether psychosocial working conditions predict the development of low back pain (LBP) in female eldercare workers while adjusting for physical workload and depressive symptoms. Methods We investigated risk for developing LBP for between 1 and 30 days in the past year and developing LBP for more than 30 days in the past year at follow-up in 1537 female eldercare workers with no LBP in the year before baseline. Data were analysed using logistic regression analysis adjusted for sociodemographic variables, health behaviours, physical workload and depressive symptoms at baseline. Follow-up ranged from 18 to 22 months. Results High emotional demands, high and medium role conflicts and low influence predicted risk for reporting LBP for between 1 and 30 days in the past year at follow-up after adjustment for sociodemographics, health behaviours and physical workload. All associations became statistically non-significant when adjusted for depressive symptoms. Low and medium influence at work and high emotional demands predicted risk of reporting LBP for more than 30 days in the past year at follow-up, after adjustment for sociodemographics, health behaviours and physical workload. For employees with low (OR 4.16; 95% CI 1.36 to 12.75) and medium (OR 3.93; 95% CI 1.37 to 11.22) influence, this risk remained statistically significant after adjustment for depressive symptoms. Conclusions Most psychosocial working conditions in this study were no longer associated with risk of LBP after adjustment for depressive symptoms. However, low and medium influence at work predicted risk for LBP for more than 30 days after adjustment for both physical workload and depressive symptoms.
    Keywords: Back pain
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 4
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    Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway (2013)
    BMJ Publishing Group
    Details
    Publication Date: 2013-04-10
    Description: Aims This study examines the impact of work-related psychosocial and mechanical exposure on the development of low back pain (LBP) in the general working population. Methods A randomly drawn cohort from the general population in Norway aged 18–66 years was followed up for 3 years (n=12 550, response rate at baseline=67%). Eligible respondents were in paid work during a reference week in 2006 and 2009, or temporarily absent from such work (n=6745). Five work-related psychosocial factors and seven mechanical exposures were measured. Outcomes of interest were moderate or severe LBP at follow-up adjusted for baseline LBP. Results In total, 12.8% (861 individuals) reported LBP during the last month at follow-up. Work-related psychosocial predictors of LBP were high job demands (OR 1.41, 95% CI 1.16 to 1.72) and low job control (OR 1.26, 95% CI 1.01 to 1.57). Mechanical factors were prolonged standing (OR 1.48, 95% CI 1.20 to 1.83), awkward lifting (OR 1.55, 95% CI 1.28 to 1.88) and squatting/kneeling (OR 1.29, 95% CI 1.04 to 1.61). The estimated population risk attributable to these factors was approximately 42%. The risk for LBP associated with psychosocial exposure was not influenced by adjustment for mechanical risk factors, and vice versa. There was no substantial confounding related to age, gender, education, occupation or psychological distress. Conclusions Highly demanding jobs, prolonged standing and awkward lifting appear as the most consistent and important predictors of LBP.
    Keywords: Back pain
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 5
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    Time trends in the incidence of work-related mental ill-health and musculoskeletal disorders in the UK (2013)
    BMJ Publishing Group
    Details
    Publication Date: 2013-04-10
    Description: Objectives To determine UK trends (from 1996 to 2009) in incidence of work-related mental ill-health and musculoskeletal disorders, for all industry as well as for health and social care employees. Second, to investigate whether there may have been a recent shift from a physical to psychological perspective in how patients present their illness by comparing reporting trends for back pain and ‘other work stress’. Methods Multilevel models were used to investigate changes in incidence of work-related illness, as diagnosed by specialist physicians. The dependent variable comprised case reports to The Health and Occupation Research network. Comparisons were made between medical specialties, industry (health and social care vs all other employees), gender and diagnosis. Results Trends for Occupational Physicians’ (OP) reporting mental ill-health (average annual increase +3.7% (95% CI +2.2% to +5.2%)) differed significantly (p〈0.001) from psychiatrists’ reporting over the same time period (–5.9% (95% CI –7.6% to –4.2%)). For OPs’ reporting, the rate of increase was greater for females and for health and social care employees. A fall in incidence of musculoskeletal disorders for OPs of –5.8% (95% CI –7.3% to –4.3%) and rheumatologists’ reporting –6.6% (95% CI –8.3% to –4.8%) was found, with little variation by gender or industry. Within health and social care, an increase in incidence of ‘other work stress’ was accompanied by a similar decrease in ‘spine/back pain’. Conclusions The evidence presented is consistent with a shift in the presentation of ill-health from a physical to psychological perspective, although changes in hazards, prevention measures and physician awareness should also be considered as explanations.
    Keywords: Back pain
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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