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  • 11
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    Response to: Artificial stone-associated silicosis in the UK' by Barber et al (2018)
    BMJ Publishing Group
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    Publication Date: 2018-06-15
    Description: We thank Barber and colleagues 1 for their interest in our paper. 2 It is excellent that the Surveillance of Work-related Occupational Respiratory Disease (SWORD)  database could be interrogated; in Australia we have no such centralised resource. We were concerned that two-thirds of their cases of silicosis were diagnosed in men of working age; we agree that in the absence of specific information about occupational exposures within the category of ‘stonemason’, it is difficult to be entirely sure that none of these were related to artificial stone processing. The letter highlights the challenge of differentiating silicosis from sarcoidosis in young workers with progressive lung opacities. Compared with chronic and acute silicosis, the histopathological features of accelerated silicosis are yet to be clearly defined. 3 This is partly due to the modest number of reported cases, but also the fact that this is a condition that produces progressive...
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 12
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    Systematic review of fit note use for workers in the UK (2018)
    BMJ Publishing Group
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    Publication Date: 2018-06-15
    Description: Objectives The fit note, introduced in England, Wales and Scotland in 2010, was designed to change radically the sickness certification process from advising individuals on their inability to work to advising them on what they could do if work could be adapted. Our review aimed to evaluate the following: (1) Is the ‘maybe fit’ for work option being selected for patients? (2) Are work solutions being recommended? (3) Has the fit note increased return to work? (4) Has the fit note reduced the length of sickness absence? We considered the way in which outcomes vary according to patient demographics including type of health problem. Methods Studies were identified by a systematic search. We included all studies of any design conducted in the UK with working age adults, aged 16 or over, from 1 April 2010 to 1 Nov 2017. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Results Thirteen papers representing seven studies met inclusion criteria. In the largest study, ‘maybe fit’ for work was recommended in 6.5% of fit notes delivered by general practitioners (GP; n=361 801) between April 2016 and March 2017. ‘Maybe fit’ recommendations were made in 8.5%–10% of fit notes received by primary care patients in employment, and in 10%–32% of patients seen by GPs trained in the Diploma in Occupational Medicine. ‘Maybe fit’ was recommended more for women, those with higher socioeconomic status, and for physical, as opposed to psychiatric disorders. The majority of fit notes with the ‘maybe fit’ option selected included work solutions. There was inconclusive evidence to suggest that the introduction of the fit note has reduced sickness absence among patients in employment. Conclusions Fit notes represent a major shift in public policy. Our review suggests that they have been incompletely researched and not implemented as intended.
    Keywords: Editor's choice
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 13
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    Urinary excretion of platinum from South African precious metals refinery workers (2018)
    BMJ Publishing Group
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    Publication Date: 2018-05-18
    Description: Background Urinary platinum (Pt) excretion is a reliable biomarker for occupational Pt exposure and has been previously reported for precious metals refinery workers in Europe but not for South Africa, the world’s largest producer of Pt. Objective This study aimed to quantify the urinary Pt excretion of South African precious metals refinery workers. Methods Spot urine samples were collected from 40 workers (directly and indirectly exposed to Pt) at two South African precious metals refineries on three consecutive mornings prior to their shifts. Urine samples were analysed for Pt using inductively coupled plasma-mass spectrometry and were corrected for creatinine content. Results The urinary Pt excretion of workers did not differ significantly between sampling days. Urinary Pt excretions ranged from 〈0.1 to 3.0 µg Pt/g creatinine with a geometric mean of 0.21 µg Pt/g creatinine (95% CI 0.17 to 0.26 µg Pt/g creatinine). The work area (P=0.0006; 2 =0.567) and the number of years workers were employed at the refineries (P=0.003; 2 =0.261) influenced their urinary Pt excretion according to effect size analyses. Directly exposed workers had significantly higher urinary Pt excretion compared with indirectly exposed workers (P=0.007). Conclusion The urinary Pt excretion of South African precious metals refinery workers reported in this study is comparable with that of seven other studies conducted in precious metals refineries and automotive catalyst plants in Europe. The Pt body burden of workers is predominantly determined by their work area, years of employment in the refineries and whether they are directly or indirectly exposed to Pt.
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 14
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    Meta-analyses in environmental and occupational health (2018)
    BMJ Publishing Group
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    Publication Date: 2018-05-18
    Description: Objectives Meta-analyses are considered generally as the highest level of evidence, but concerns have been voiced about their massive, low-quality production. This paper aimed to evaluate the landscape of meta-analyses in the field of occupational and environmental health and medicine. Methods Using relevant search terms, all meta-analyses were searched for, but those published in 2015 were assessed for their origin, whether they included randomised trials and individual-level data and whether they had authors from the industry or consultancy firms. Results PubMed searches (last update February 2017) identified 1251 eligible meta-analyses in this field. There was a rapid increase over time (n=16 published in 1995 vs n=163 published in 2015). Of the 163 eligible meta-analyses published in 2015, 49 were from China, followed at a distance by the USA (n=19). Only 16 considered randomised (intervention) trials and 13 included individual-level data. Only 1 of the 150 meta-analyses had industry authors and none had consultancy firm authors. As an example of conflicting findings, 12 overlapping meta-analyses addressed mobile phones and brain cancer risk and they differed substantially in number of studies included, eligibility criteria and conclusions. Conclusions There has been a major increase in the publication of meta-analyses in occupational and environmental health over time, with the majority of these studies focusing on observational data, while a commendable fraction used individual-level data. Authorship is still limited largely to academic and non-profit authors. With massive production of meta-analyses, redundancy needs to be anticipated and efforts should be made to safeguard quality and protect from bias.
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 15
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    Residential proximity to livestock farms is associated with a lower prevalence of atopy (2018)
    BMJ Publishing Group
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    Publication Date: 2018-05-18
    Description: Objectives Exposure to farm environments during childhood and adult life seems to reduce the risk of atopic sensitisation. Most studies have been conducted among farmers, but people living in rural areas may have similar protective effects for atopy. This study aims to investigate the association between residential proximity to livestock farms and atopy among non-farming adults living in a rural area in the Netherlands. Methods We conducted a cross-sectional study among 2443 adults (20–72 years). Atopy was defined as specific IgE to common allergens and/or total IgE ≥100 IU/mL. Residential proximity to livestock farms was assessed as 1) distance to the nearest pig, poultry, cattle or any farm, 2) number of farms within 500 m and 1000 m, and 3) modelled annual average fine dust emissions from farms within 500 m and 1000 m. Data were analysed with multiple logistic regression and generalised additive models. Results The prevalence of atopy was 29.8%. Subjects living at short distances from farms (〈327 m, first tertile) had a lower odds for atopy compared with subjects living further away (〉527 m, third tertile) (OR 0.79, 95% CI 0.63 to 0.98). Significant associations in the same direction were found with distance to the nearest pig or cattle farm. The associations between atopy and livestock farm exposure were somewhat stronger in subjects who grew up on a farm. Conclusions Living in close proximity to livestock farms seems to protect against atopy. This study provides evidence that protective effects of early-life and adult farm exposures may extend beyond farming populations.
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    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 16
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    Correction: A study of school-going children on neurobehavior and currently used agricultural pesticide exposure in the rural western cape, South Africa (2018)
    BMJ Publishing Group
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    Publication Date: 2018-05-18
    Description: Chetty-Mhlanga S, Basera W, Aqiel Dalvie M, et al . A study of school-going children on neurobehavior and currently used agricultural pesticide exposure in the rural western cape, South Africa. Occup Environ Med 2018;75(Suppl 1):A11.2. doi: 10.1136/oemed-2018-ISEEabstracts.27 The following changes are required to abstract number A11.2 of the ‘ISEE Young 2018, Early Career Researchers Conference on Environmental Epidemiology – Together for a Healthy Environment’ supplement. (1) The first author should be listed as Shala Chetty-Mhlanga; (2) the third author should be listed as Mohamed Aqiel Dalvie; (3) Martin Röösli should be the last author (not Nicole Probst).
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 17
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    Physical work exposure, chronic musculoskeletal pain and risk of insomnia: longitudinal data from the HUNT study, Norway (2018)
    BMJ Publishing Group
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    Publication Date: 2018-05-18
    Description: Objectives To prospectively investigate (i) the association of physical work demands and work-related physical fatigue with risk of insomnia symptoms and (ii) if these associations are influenced by chronic musculoskeletal pain. Methods Prospective study on a working population of 8563 women and 7598 men participating in the Nord-Trøndelag Health Study (Norway) who reported no insomnia at baseline in 1995–1997. Occurrence of insomnia symptoms was assessed at follow-up in 2006–2008. A Poisson regression model was used to calculate adjusted risk ratios (RRs) for insomnia symptoms with 95% CI. Results Compared with workers without work-related physical fatigue, women and men who reported that they were always fatigued had RRs of insomnia of 2.34 (95% CI 1.72 to 3.18) and 2.47 (95% CI 1.59 to 3.83), respectively. Overall, physical work demands was not associated with risk of insomnia, although men who reported heavy physical work had an RR of 0.67 (95% CI 0.47 to 0.97) compared with men with mostly sedentary work. Compared with the reference group of workers without work-related physical fatigue and no chronic pain, analyses of joint effects showed that women with excessive work-related fatigue had an RR of 4.20 (95% CI 2.95 to 5.98) if they reported chronic pain and an RR of 1.67 (95% CI 0.87 to 3.18) if they did not. Corresponding RRs in men were 3.55 (95% CI 2.11 to 5.98) and 2.13 (95% CI 1.07 to 4.25). Conclusion These findings suggest that there is an interplay between work-related physical fatigue and musculoskeletal pain that should receive particular attention in the prevention of insomnia in working populations.
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 18
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    Effectiveness of face masks used to protect Beijing residents against particulate air pollution (2018)
    BMJ Publishing Group
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    Publication Date: 2018-05-18
    Description: Objectives Many residents in Beijing use disposable face masks in an attempt to protect their health from high particulate matter (PM) concentrations. Retail masks may be certified to local or international standards, but their real-life performance may not confer the exposure reduction potential that is marketed. This study aimed to evaluate the effectiveness of a range of face masks that are commercially available in China. Methods Nine masks claiming protection against fine PM (PM 2.5 ) were purchased from consumer outlets in Beijing. The masks’ filtration efficiency was tested by drawing airborne diesel exhaust through a section of the material and measuring the PM 2.5 and black carbon (BC) concentrations upstream and downstream of the filtering medium. Four masks were selected for testing on volunteers. Volunteers were exposed to diesel exhaust inside an experimental chamber while performing sedentary tasks and active tasks. BC concentrations were continuously monitored inside and outside the mask. Results The mean per cent penetration for each mask material ranged from 0.26% to 29%, depending on the flow rate and mask material. In the volunteer tests, the average total inward leakage (TIL) of BC ranged from 3% to 68% in the sedentary tests and from 7% to 66% in the active tests. Only one mask type tested showed an average TIL of less than 10%, under both test conditions. Conclusions Many commercially available face masks may not provide adequate protection, primarily due to poor facial fit. Our results indicate that further attention should be given to mask design and providing evidence-based guidance to consumers.
    Keywords: Open access
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
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  • 19
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    Human service work, gender and antidepressant use: a nationwide register-based 19-year follow-up of 752 683 women and men (2018)
    BMJ Publishing Group
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    Publication Date: 2018-05-18
    Description: Objectives To examine antidepressant use among male and female human service professionals. Methods A random sample of individuals between 25 years and 54 years of age (n=752 683; 49.2% women; mean age 39.5 years). Information about each individual’s filled antidepressant prescriptions from 1995 to 2014 was provided by the Social Insurance Institution. First, antidepressant use in five broad human service categories was compared with that in all other occupations grouped together, separately for men and women. Then, each of the 15 human service professions were compared with all other occupations from the same skill/education level (excluding other human services professions). Cox models were applied and the results are presented as HRs for antidepressant use with 95% CIs. Results The hazard of antidepressant use was higher among men working in human service versus all other occupations with the same skill/occupational level (1.22, 95% CI 1.18 to 1.27), but this was not the case for women (0.99, 95% CI 0.98 to 1.01). The risks differed between professions: male health and social care professionals (including medical doctors, nurses, practical nurses and home care assistants), social workers, childcare workers, teachers and psychologists had a higher risk of antidepressant use than men in non-human service occupations, whereas customer clerks had a lower risk. Conclusions Male human service professionals had a higher risk of antidepressant use than men working in non-human service occupations. Gendered sociocultural norms and values related to specific occupations as well as occupational selection may be the cause of the elevated risk.
    Keywords: Editor's choice, Epidemiology
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    Topics: Medicine
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  • 20
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    Correction: Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial (2018)
    BMJ Publishing Group
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    Publication Date: 2018-05-18
    Description: Barone Gibbs B, Hergenroeder AL, Perdomo SJ , et al . Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial.  Occup Environ Med 2018;75:321–7. There is an error in the clinical trials registration number listed in this article. The correct number is: NCT02624687.
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