A silent epidemic Albin, Maria; Gustavsson, Per
Scandinavian journal of work, environment & health,
01/2020, Letnik:
46, Številka:
1
Journal Article
Recenzirano
Odprti dostop
In an editorial in an earlier issue of this journal, Johanson & Tinnerberg (1) expressed serious and well-founded concern over the large number of future occupational cancer cases that will result if ...exposures for a number of substances are not reduced below the so-called "binding occupational exposure limit values" (BOELV) issued by the EU (2). While the EU's Scientific Committee on Occupational Exposure Limits (SCOEL) recommended an OEL <0.05 (5) in order to protect workers reasonably well against negative health effects, the EU decided on a BOELV of 0.1 mg/m3 for RCS (2). The report estimates the future number of lung cancer cases attributable to occupational exposure to RCS in the EU up to 2069. The US OSHA estimated that exposing 1000 workers for 45 years at 0.1 mg/m3 would result in 33 extra lung cancer deaths as life-time risk, corresponding to an individual risk of 3.3% (6), exceeding the maximum tolerable risk nearly 10-fold. Since the EU Directive concerns cancer, the report did not consider other health effects, which is necessary for a general risk assessment.
Aims:
There are substantial differences in remaining life expectancy at higher ages between occupational groups. These differences may be the effect of work-related exposures, lifestyle factors of ...workers in specific occupations, socioeconomic position or a combination of this. The scope of this paper is the extent to which occupational differences in remaining life expectancy persist after retirement, which would suggest that occupational exposures alone are not likely to explain all the difference.
Methods:
All individuals born between 1925 and 1939 who reported occupational information in the Census 1985 and were residents in Sweden to the end of 2020 or who died were included and followed for death until 2020. The Nordic Classification of Occupations was used to create nine occupational groups. Partial life expectancy and age-specific death rates were applied to examine mortality differentials.
Results:
This study showed substantial differences in partial life expectancy across the occupational cohorts with the biggest difference being about 2 years. The mortality differences persisted with increasing age, both when measured as absolute numbers as well as relative numbers.
Conclusions:
The lack of convergence in mortality at high ages suggests that factors associated with lifestyle may play a larger role than occupational factors for the mortality differences between occupational groups at high ages. However, it cannot be ruled out that long-lasting effects of earlier occupational exposures also contribute. Regardless of the exact mechanism, we conclude that there is room for further reduction in mortality at high ages and, thus, for further improvement in life expectancy.
Many women of childbearing age are occupationally active, which leads to a large number of pregnancies potentially exposed to occupational exposures. Occupational noise has been identified as a risk ...factor for hearing impairment in adults. However, very few studies have assessed the effect of occupational noise on the fetus.
The aim of this study was to investigate whether occupational exposure to noise during pregnancy is associated with hearing dysfunction in children.
This population based cohort study included 1,422,333 single births in Sweden 1986-2008. Data on mothers' occupation, smoking habits, age, ethnicity, body mass index, leave of absence, and socioeconomic factors were obtained from interviews performed by prenatal care unit staff at approximately 10 weeks of gestation and from national registers. Occupational noise exposure was classified by a job-exposure-matrix as < 75, 75-84, or ≥ 85 dBLAeq,8h. Diagnosed cases of hearing dysfunction (ICD-10 codes H90.3-7, 91.0, 91.2-3, 91.8, 93.1-2) were identified from a register of specialized medical care. Cox proportional hazards models were used to estimate associations.
In the full sample, containing a mixture of part-time and full-time workers during pregnancy, the adjusted HR for hearing dysfunction associated with maternal occupational noise exposure ≥ 85 vs. < 75 dBLAeq,8h was 1.27 (95% CI: 0.99, 1.64; 60 exposed cases). When restricted to children whose mothers worked full-time and had < 20 days leave of absence during pregnancy, the corresponding HR was 1.82 (95% CI: 1.08, 3.08; 14 exposed cases).
This study showed an association between occupational noise exposure during pregnancy and hearing dysfunction in children. In view of mechanistic evidence and earlier indicative epidemiological and experimental findings, the results support that pregnant women should not be exposed to high levels of noise at work.
Selander J, Albin M, Rosenhall U, Rylander L, Lewné M, Gustavsson P. 2016. Maternal occupational exposure to noise during pregnancy and hearing dysfunction in children: a nationwide prospective cohort study in Sweden. Environ Health Perspect 124:855-860; http://dx.doi.org/10.1289/ehp.1509874.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract
Background
Previous studies of preterm birth (PTB) concerning night work have been inconclusive and partly limited by imprecise data on working schedules. This study investigated the risk of ...PTB in relation to detailed, registry-based data on working hours.
Methods
In a register-based prospective cohort study, we identified 4970 singleton births with information on PTB from the Swedish Medical Birth Register of health care employees in Stockholm. Day-by-day information on working hours 2008–16 was obtained from a computerized employee register. Odds ratios (ORs) of PTB according to work hour characteristics were analysed by logistic regression adjusted for mother’s age, stature, body mass index (BMI), parity, smoking habits, education, profession and country of birth.
Results
There was an increased risk of PTB among those who frequently worked night shifts (>25 times) OR, 1.62; 95% confidence interval (CI), 1.03–2.53 and who ever worked ≥3 consecutive night shifts (OR, 1.43; 95% CI, 1.03–1.99) during the first trimester. Frequently (> 8 times) working 3 or more consecutive nights, and frequently (>18 times) having quick returns from night shifts (<28 h) during the first trimester showed 3–4 fold increased risk of PTB. Moreover, working frequent (>20 times) long shifts (≥10 h) (OR 1.63; 95% CI, 1.07–2.49) during the first trimester and working any Week >40 h (OR 2.05; 95% CI, 1.31–3.22) during the third trimester were associated with PTB.
Conclusions
In this cohort of Swedish health care employees with registry-based data on working hours, night work, especially working frequent consecutive nights, and quick returns from night shifts during the first trimester were associated with increased risk of PTB among pregnant women.
Chimney sweeps have higher incidence and mortality of cardiovascular disease (CVD), likely related to their exposure to polycyclic aromatic hydrocarbons (PAH). In order to identify underlying ...mechanisms of PAH-related CVD, we here investigated whether PAH exposure was associated with levels of putative CVD-related proteins in serum among currently working chimney sweeps. We enrolled 116 chimney sweeps and 125 unexposed controls, all nonsmoking male workers from Sweden. We measured monohydroxylated PAH metabolites in urine by liquid chromatography coupled to tandem mass spectrometry and a panel of 85 proteins in serum using proximity extension assay. Linear regression analysis adjusted for age and body mass index showed that 25 proteins were differentially expressed between chimney sweeps and the controls (p < .05, adjusted for false discovery rate). Of the 25 proteins, follistatin (FS), prointerleukin-16 (IL-16), and heat shock protein beta-1 (HSP 27) showed positive associations with the monohydroxylated metabolites of PAH in a dose-response manner (p < .05). Pathway and gene ontology analyses demonstrated that the differentially expressed proteins were mainly involved in inflammatory response and immunological functions, such as leukocyte migration, cell movement of leukocytes, and adhesion of immune cells. In conclusion, we found a number of putative CVD-related proteins differentially expressed, between PAH-exposed and unexposed individuals, and mainly involved in inflammation and immune function. Our data warrant protective measures to reduce PAH exposure and longitudinal investigations of the protein profile in chimney sweeps and other occupational groups exposed to PAH.
Objectives
To evaluate cancer incidence among Swedish firefighters and analyze risk in relation to work duration as a proxy for cumulative exposure.
Methods
This cohort study is based on the Swedish ...component of the Nordic Occupational Cancer (NOCCA) project. The cohort includes six million people who participated in one or more of the population censuses in 1960, 1970, 1980 and 1990. The census data were linked to the Swedish Cancer Registry for the 1961–2009 period, extending a previous NOCCA follow-up time by 4 years. We identified 8136 male firefighters. SIRs were calculated using cancer incidence rates in the national population as a reference.
Results
We found a statistically significant excess of non-melanoma skin cancer (SIR = 1.48, 95% CI 1.20–1.80) but no positive relationship between risk and work duration. There was a small, yet statistically significant increased risk of prostate cancer among firefighters with service times of 30 years or more. The first follow-up period (1961–1975) showed an increased risk of stomach cancer relative to the reference group, while the last period (1991–2009) showed an increased risk of non-melanoma skin cancer. There was no excess risk for all cancer sites combined (SIR = 1.03, 95% CI 0.97–1.09).
Conclusions
Our results do not support an overall risk of cancer among Swedish firefighters, but a possible risk of non-melanoma skin cancer exists. The previously noted excess of prostate cancer among Swedish firefighters in NOCCA was no longer statistically significant in this extended follow-up but was present among those with the longest service times.
This study aimed to investigate the effects of various aspects of night and shift work regarding incident cerebrovascular disease (CeVD).
The cohort included 26 667 women and 3793 men (nurses and ...nursing assistants) who were employed for at least one year 2008-2016 in Region Stockholm, Sweden. Information about the cohort and working hours were obtained from a computerized employee-register and diagnoses were retrieved from national and regional registers. We used discrete time proportional hazard models to assess the risk of CeVD (2009-2017), in relation to work hour characteristics, adjusting for sex, age, country of birth, education and profession.
We observed an excess risk of CeVD (N=223) among employees who, during the preceding year, worked night shifts >30 times hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.04-1.99 or ≥3 consecutive night shifts >15 times (HR 1.69, 95% CI 1.18-2.42) or with >30 quick returns (<28 hours) from night shifts (HR 1.52, 95% CI 1.10-2.10) compared to those who did not work nights. We also observed an excess risk among employees with a long duration (>5 years) of exposure to night shift work (HR 1.87, 95% CI 1.27-2.77), all supported by a dose-response pattern.
Our results show that the risk of CeVD among nurses and nursing assistants is associated with night shift work. The number of years with night shift work, the frequency of night shifts per year, the frequency of consecutive night shifts, and short recovery after night shifts influenced the risk. Work schedules aiming at minimizing these aspects of night shift work may reduce the risk.
Approximately 11 million people work as welders worldwide and an additional 110 million are exposed to welding fumes at work (1). Several countries have an occupational exposure limit (OEL) for ...welding fumes of 5 mg/m3 (1,2) and similar OEL for respirable dust (2). Given the accumulating evidence on serious health effects from welding fumes <5 mg/m3, adequate worker protection including a more stringent health based OEL is an urgent issue. We therefore welcome that the European Commission has assigned the European Chemical Agency (ECHA) to propose an OEL for welding fumes at the EU level, pursuant to the Carcinogens and Mutagens Directive (CAD). It should be noted that welding fumes - besides having a very complex and variable composition - are process generated and do not fall under the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) regulation. In the following, we present some of the key issues when setting an OEL for welding fumes.
Objectives
The aim of the study was to examine the associations between heavy physical workload among middle-aged and older workers and disability pension due to any diagnosis, as well as ...musculoskeletal, psychiatric, cardiovascular or respiratory diagnoses. The population-based design made it possible to examine dose–response and potential gender differences in the associations.
Methods
About 1.8 million men and women aged 44–63 years and registered as living in Sweden in 2005 were followed regarding disability pension during 2006–2016, until ages 55–65 years. Mean values of physical workload and job control, estimated through gender-specific job-exposure matrices (JEMs), were assigned to individuals through their occupational titles in 2005. Exposure values were ranked separately for women and men and divided into quintiles. Associations were analyzed with Cox proportional-hazards regression.
Results
The analyses showed robust, dose–response associations between physical workload and disability pension with a musculoskeletal diagnosis in both genders: the adjusted hazard ratio and 95% confidence interval for those with the heaviest exposure was 2.58 (2.37–2.81) in women and 3.34 (2.83–3.94) in men. Dose–response associations were also seen in relation to disability pension with a cardiovascular or a respiratory diagnosis, though the hazard ratios were smaller. Physical workload was not associated with disability pension with a psychiatric diagnosis after adjustment for job control.
Conclusion
This study of the entire Swedish population of middle-aged and older workers suggests that higher degrees of physical workload may increase the risk of disability pension overall, and specifically with musculoskeletal, cardiovascular or respiratory diagnosis, in both women and men.
Objective Little is known about the relationship between quick returns (QR) - shift combinations that result in inter-shift rest periods <11 hours) and stress. The current study examined whether ...variations in the frequency of QR, both between and within individuals, were associated with changes in self-rated stress. Methods A questionnaire was sent weekly to newly graduated nurses during the first 12 weeks of work. Stress was measured with four items from the Stress-Energy Questionnaire on a scale from 1 "not at all" to 5 "very much" mean 2.65, standard deviation (SD) 1.08. Shifts worked in the past week were reported and QR were identified by evening-morning shift combinations (mean 0.98, SD 0.90 per week). In total, 350 persons were included in the analysis (3556 observations). Data were analyzed with a multilevel residual dynamic structural equation model (RDSEM) using Bayesian estimation procedures. Results There was no between-person effect of QR on stress averaged across measurement occasions (0.181, 95% CI -0.060-0.415). However, there was a small within-person effect of QR (0.031, 95% CI 0.001-0.062), meaning that more QR during a given week, compared to that person's average, was associated with an increase in their level of stress during that week. Conclusions Nurses were likely to report increased stress during weeks in which they worked more QR. Intervention studies are needed to determine whether the relationship is causal.
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