Occupational and Environmental Medicine

Sérazin, Céline; Ha, Catherine; Bodin, Julie; Imbernon, Ellen; Roquelaure, Yves

doi: 10.1136/oemed-2012-100685pmid: 23000823

Objectives To study the employment and occupational outcomes of workers who were diagnosed with upper limb musculoskeletal disorders (UL-MSDs) or had complained of upper limb musculoskeletal pain a few years before compared with workers who had no upper limb pain. Methods In 2002–2005, an epidemiological surveillance system was set up. Occupational physicians examined 3710 randomly selected workers. It focused on six UL-MSDs: rotator cuff syndrome, lateral epicondylitis, flexor-extensor peritendinitis of the hands and fingers, de Quervain's disease, carpal tunnel syndrome and ulnar tunnel syndrome. Three groups were constituted: a ‘UL-MSD’ group (workers with a clinically diagnosed UL-MSD at baseline, 13% of the cohort); a ‘PAIN’ group (workers with pain in the previous 7 days at baseline and without any clinically diagnosed form, 38%); and a ‘HEALTHY’ group (workers with no disorder or upper limb pain in the previous 7 days, 49%). They completed a questionnaire between 2007 and 2009. Results A total of 2332 responded. Fewer subjects were still in work in the ‘UL-MSD’ group (79.3%) than in the ‘PAIN’ (85.9%) and ‘HEALTHY’ (90.4%) groups, the difference remaining significant after adjusting for gender, age, occupational category, type of company and comorbidities. Of the subjects still in work, 24% had changed their work station in the same company in the ‘PAIN’ group compared with 19% in the ‘HEALTHY’ group and 21% in the ‘UL-MSD’ group. Conclusions This study showed the impact of musculoskeletal pain on employment outcome and the difficulty of keeping workers with musculoskeletal problems at work.

Cherry, Nicola; Harris, Jessica; McDonald, Corbett; Turner, Susan; Newman Taylor, Tony; Cullinan, Paul

doi: 10.1136/oemed-2012-100782pmid: 23104732

Objectives To examine mortality from lung cancer, chronic obstructive pulmonary disease (COPD) and chronic non-malignant renal disease (cNMRD) in pottery workers exposed to silica. Methods A cohort of Stoke-on-Trent pottery workers (N=5115), previously followed to 1992, was traced for vital status and cause of death to December 2008. Standardised mortality ratio (SMR) analyses, comparing deaths to England and Wales and Stoke-on-Trent, examined underlying cause in 1985–1992 and 1993–2008 and mentioned cause for 1993–2008. Survival analysis considered exposure duration and concentration of respirable silica for lung cancer, COPD and cNMRD, using Cox regression. Results Excess risks of lung cancer, COPD and cNMRD were seen against both England and Wales and Stoke-on-Trent for 1985–2008. SMRs for lung cancer and COPD were lower in 1993–2008 and non-significant for lung cancer against Stoke-on-Trent in that period (SMR 1.07 95% CI 0.92 to 1.25). Exposure concentration, estimated for 1943 subjects, was related to lung cancer in smokers for early but not later deaths with mean silica concentration >200 µg/m3 among deaths to June 1992 (HR 2.80 95% CI 1.21 to 6.50). For COPD an increasing trend with duration and (non-significantly) with mean concentration was seen for early but not later deaths in smokers. No relation was observed between estimated exposures and cNMRD. Conclusions Excess rates of death from COPD and lung cancer were more marked in the period of the first follow-up (1985–1992) than in the second, with any relation to estimated exposure being limited to the earlier period. Conclusions about COPD and exposure were limited by an early selective destruction of files.

Reinhardt, Jan D; Wahrendorf, Morten; Siegrist, Johannes

doi: 10.1136/oemed-2012-100924pmid: 23243100

Objectives Prevention of disability in the ageing workforce is essential for sustaining economic growth in Europe. In order to provide information on entry points for preventive measures, it is important to better understand sociodemographic, socioeconomic and work-related determinants of disability in older employees. We aimed to test the hypothesis that low socioeconomic position and exposure to a stressful psychosocial work environment at baseline contribute to later disability. We further assumed that the association of socioeconomic position with disability is partly mediated by exposure to adverse working conditions. Methods We studied longitudinal data from the first two waves of the Survey on Health, Ageing and Retirement in Europe comprising 11 European countries. Sociodemographic, socioeconomic and work-related factors (low control, effort-reward imbalance) and baseline disability of 2665 male and 2209 female employees aged between 50 and 64 years were used to predict disability 2 years later. Following the International Classification of Functioning (ICF), disability was subdivided into the components ‘impairment’ and ‘restriction in activities and participation’. Two multilevel Poisson regressions were fitted to the data. Results After adjusting for baseline disability and relevant confounding variables, low socioeconomic position and chronic stress at work exerted significant effects on disability scores 2 years later. We found some support for the hypothesis that the association of socioeconomic position with disability is partly mediated by work stress. Conclusions Investing in reduction of work stress and reducing social inequalities in health functioning are relevant entry points of policies that aim at maintaining work ability in early old age.

Wynant, Willy; Siemiatycki, Jack; Parent, Marie-Élise; Rousseau, Marie-Claude

doi: 10.1136/oemed-2012-100931pmid: 23322922

Objectives We investigated the association between workplace lead exposure and lung cancer risk, separately for organic lead and for inorganic lead, from either engine emissions or from other sources. Methods Two population-based case-control studies were carried out in Montreal (1979–1986 and 1996–2002) to investigate occupational factors in relation to lung cancer among 1593 men with histologically confirmed incident lung cancer, and 1426 controls from the general population. Interviews elicited information on sociodemographic characteristics, lifetime smoking and occupational history. Chemists translated each job into potential chemical exposures. Cumulative indices of exposure were derived and classified into non-substantial and substantial exposure. ORs adjusted for several potential confounders including smoking, and 95% CIs were estimated by logistic regression. Results Lifetime prevalences of exposure in Study I were 3% for organic lead, 40% for inorganic lead from engine emissions and 17% for inorganic lead from other sources; corresponding prevalences in Study II were 4%, 19% and 16%, respectively. No associations were observed when comparing ever to never exposed subjects in pooled analyses (organic lead, OR=1.39, 95% CI 0.77 to 2.52; inorganic lead from engine emissions: OR=0.89, 95% CI 0.72 to 1.09; inorganic lead from other sources: OR=0.99, 95% CI 0.76 to 1.29). Nor were these exposures associated with lung cancer in subjects with substantial cumulative exposure. Conclusions In this large study, using a blinded expert-based assessment of lifetime occupational exposure and adjustment for several potential confounders, we observed no increased risk of lung cancer with exposure to lead compounds.

Morassaei, Sara; Breslin, F Curtis; Shen, Min; Smith, Peter M

doi: 10.1136/oemed-2012-100743pmid: 23123355

Objective We sought to examine the association between job tenure and lost-time claim rates over a 10-year period in Ontario, Canada. Methods Data were obtained from workers’ compensation records and labour force survey data from 1999 to 2008. Claim rates were calculated for gender, age, industry, occupation, year and job tenure group. A multivariate analysis and examination of effect modification were performed. Differences in injury event and source of injury were also examined by job tenure. Results Lost-time claim rates were significantly higher for workers with shorter job tenure, regardless of other factors. Claim rates for new workers differed by gender, age and industry, but remained relatively constant at an elevated rate over the observed time period. Conclusions This study is the first to examine lost-time claim rates by job tenure over a time period during which overall claim rates generally declined. Claim rates did not show a convergence by job tenure. Findings highlight that new workers are still at elevated risk, and suggest the need for improved training, reducing exposures among new workers, promoting permanent employment, and monitoring work injury trends and risk factors.

Heinrich, Joachim; Thiering, Elisabeth; Rzehak, Peter; Krämer, Ursula; Hochadel, Matthias; Rauchfuss, Knut M; Gehring, Ulrike; Wichmann, H-Erich

doi: 10.1136/oemed-2012-100876pmid: 23220504

We assessed whether long-term exposure to air pollution is associated with all-cause and cause-specific mortality during a period of declining particulate matter concentrations. Approximately 4800 women aged 55 years from North Rhine-Westphalia, Germany, were followed for up to 18 years. Exposure to air pollution was assessed in two ways: (1) using the distance between the residential address and the nearest major road, as calculated from Geographic Information System data and (2) calculating 1-year average particulate matter concentrations below 10 µm (PM10) and nitrogen dioxide (NO2) levels using data from the nearest air-monitoring station data to the subjects’ residences. Ninety-two per cent of all subjects lived in the same community during the entire follow-up period. Associations between mortality and exposure were assessed using Cox's proportional hazards models, including confounder adjustment. Sixteen per cent of women passed away during the follow-up period. An increase of 7 μg/m3 PM10 (IQR) was associated with an increased HR for all-cause (HR 1.15, 95% CI (1.04 to 1.27)), cardiopulmonary (HR 1.39, 95% CI (1.17 to 1.64)), and lung cancer mortality (HR 1.84, 95% CI (1.23 to 2.74)). An increase of 16 μg/m3 (IQR) NO2 exposure was associated with all-cause (HR 1.18, 95% CI (1.07 to 1.30)) and cardiopulmonary mortality (HR 1.55, 95% CI (1.30 to 1.84)). The association between cardiopulmonary mortality and PM10 was reduced for the extended follow-up period, during which PM10 concentrations (but not NO2 concentrations) were lower. Living close to a major road was associated with an increased relative risk for all-cause, cardiopulmonary and respiratory mortality. These associations were temporally stable. Long-term exposure to ambient PM10 and NO2 was associated with increased mortality rates.

Lin, Weiwei; Gehring, Ulrike; Oldenwening, Marieke; de Jongste, Johan C; Kerkhof, Marjan; Postma, Dirkje; Smit, Henriette A; Wijga, Alet H; Brunekreef, Bert

doi: 10.1136/oemed-2012-101025pmid: 23243103

Objectives Evidence for a relationship between gas cooking and childhood respiratory health is inconsistent and few longitudinal studies have been reported. Our aim was to examine the association between gas cooking and the development of respiratory and allergic outcomes longitudinally in a prospective birth cohort study. Methods The Prevention and Incidence of Asthma and Mite Allergy birth cohort study followed children from birth (1996/1997) until age 8. Annual questionnaires were used to document respiratory and allergic symptoms. Allergic sensitisation and bronchial hyper-responsiveness (BHR) were measured at age 8 in subpopulations. A total of 3590 children were included in the present analysis. We used generalised estimating equations and discrete-time hazard models to study the overall and age-specific associations between exposure to gas cooking and the risk of developing respiratory illnesses. Sensitivity analyses of intermittent, always, current and early exposure to gas cooking were conducted. Results Ever gas cooking exposure was associated with nasal symptoms (sneezing, runny/blocked nose without a cold) during the first 8 years of life (OR=1.32, 95% CI 1.09 to 1.59), but not with lower respiratory tract infections, eczema, allergic sensitisation and BHR. Associations with nasal symptoms were similar among children with intermittent, always, current and early exposure. Among girls only, prevalent asthma was associated with ever gas cooking (OR=1.97, 95% CI 1.05 to 3.72). Conclusions Overall, our findings provide little evidence for an adverse effect of exposure to gas cooking on the development of asthma and allergies.

Agostini, Michela; Ferro, Gilles; Burstyn, Igor; de Vocht, Frank; Portengen, Lützen; Olsson, Ann; Boffetta, Paolo; Kromhout, Hans; ,

doi: 10.1136/oemed-2012-100839pmid: 23322919

Wheeler, David C; Burstyn, Igor; Vermeulen, Roel; Yu, Kai; Shortreed, Susan M; Pronk, Anjoeka; Stewart, Patricia A; Colt, Joanne S; Baris, Dalsu; Karagas, Margaret R; Schwenn, Molly; Johnson, Alison; Silverman, Debra T; Friesen, Melissa C

Balato, Nicola; Megna, Matteo; Napolitano, Maddalena; Patruno, Cataldo

doi: 10.1136/oemed-2012-101215pmid: 23243101